Pain: Intensity versus Unpleasantness

Last summer I went for a swim in the sea with my daughter. As I waded in ever so slowly clad in my wetsuit, my daughter was happily splashing around in her bikini. I asked her how on earth she could ignore the extreme unpleasantness of the cold water, to which she replied it was simple! All she had to do was convince herself she was getting into a really hot bath. She had turned the unpleasant cold feeling into a pleasant one. 

If we could measure pain, we would need two meters; an intensity meter and an unpleasant meter. We’ve all experienced intense pain which wasn’t all that unpleasant, such as when we’ve knocked our leg against a table corner, and it hurt like anything, but two days later wondered how we ever got that bruise. We’ve also experienced very unpleasant pain that wasn’t that intense, like my cold sea experience. Whether its deeply unpleasant or not, we can only feel pain if we pay attention to it, and once we have, we decide whether this pain is alerting us to something terribly serious or not, and whether we should do something about it. 

Pain is a funny thing. It doesn’t necessarily match up to the severity of an injury where tissue damage is concerned. Only the other day I met a patient just six weeks after sustaining multiple fractures from a bike crash, who was in no pain at all, and yet I was nursing a painful splinter in my finger. 

When we first injure ourselves, our pain motivates us to look after our injured tissues and, although it’s unpleasant, we comfort ourselves in the knowledge that from past experiences we will get better. 

But sometimes the pain doesn’t get better in the time frame we expect it to, and then we start to worry. As we pay more attention to it, its intensity seems to increase. And so does it’s unpleasantness. Then bad thoughts come into our head. What if this doesn’t get better? Didn’t Uncle Arthur have a back injury which led to a lifetime of disability and pain? What if that happens to me?  

Once we’ve convinced ourselves this pain is an indication that its only downhill from here, we head for the doctor for reassurance. He sends us for a scan just to make sure it’s nothing serious, but the radiology report indicates things have changed in our spines. We’re not sure what this means, but the doctor surmises we have the spine of an 80-year-old and that we will have pain from now on. Now the pain is extremely unpleasant, as it is scary and a reminder that we can no longer do the things we’ve loved doing. We are going the way of Uncle Arthur after all! The pain now motivates us to avoid it at all costs by resting and being extra careful how we move. We feel our spine must be so delicate and fragile, it could break like a wineglass with the slightest knock. 

If you recognise yourself in this story, how can you turn this around, and not only make your pain less intense and less unpleasant, but get back to do doing all those things you love? 

Firstly, you need to educate yourself on the topic of chronic pain. Look up the Brainman Pain Video on Youtube for a taster, and attend a talk on Pain Education at our Physiotas Shearwater Clinic. Don’t take a doctor’s words as the absolute truth. Learn what your scan report really means by looking at the pictures with your physiotherapist. Often changes in the spine are in keeping with age, just like skin ages with time. It may look different, but it is still robust and able to function adequately. 

Address all the worries you may have linked to your pain and ask yourself whether these worries have any foundation. Pain can often become more intense and unpleasant when there are other stressful issues in your life, and addressing these issues may have a positive effect on your pain. For some, practicing mindfulness can help you cope better with everyday stressors, and this can be done by simply downloading an app on your phone. 

Re-introduce activity by starting with short walks each day. Book in for physiotherapy sessions where you can work with the therapist in the gym, and establish an enjoyable home exercise program which can help you reach your goals. 

In summary, if you can change the feelings of unpleasantness that you’ve connected with your pain, you will, in time, change its intensity. And next time you paddle in our cold sea, think of it as a deliciously hot bath… 

 About the Author:

Dinah Spratt is a Physiotherapist at Physiotas in the North West.

Dinah has a special interest in the management of spinal and chronic pain conditions. She has worked in an advanced scope role for an orthopaedic spinal surgeon diagnosing and managing spinal patients conservatively and pre and post operatively. Dinah has a Masters of Science in Medicine on Pain Management (MScMed(PnMgt)) from the Sydney University, and is an APA Pain Physiotherapist.

Dinah gives regular talks entitled ‘Chronic pain from a biopsychosocial perspective’ for patients, and is involved in presenting talks to GPs on this subject. She is based in the Physiotas Shearwater clinic.