Pain

We all talk about it. The word is thrown around in so many different contexts. In sport it is often seen as an obstacle to overcome. So what is pain? This isn't the easiest question to answer. The exact definition of pain has been discussed and argued by so many people from so many different view points, that there probably won't ever be an exact definition.

The International Association for the Study of Pain after much deliberation came to a general consensus:

Pain. An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Note: The inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment. Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life. Biologists recognize that those stimuli which cause pain are liable to damage tissue. Accordingly, pain is that experience we associate with actual or potential tissue damage. It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience. Experiences which resemble pain but are not unpleasant, e.g., pricking, should not be called pain. Unpleasant abnormal experiences (dysesthesias) may also be pain but are not necessarily so because, subjectively, they may not have the usual sensory qualities of pain. Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report. If they regard their experience as pain and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain. This definition avoids tying pain to the stimulus. Activity induced in the nociceptor and nociceptive pathways by a noxious stimulus is not pain, which is always a psychological state, even though we may well appreciate that pain most often has a proximate physical cause.

Having read the above it appears that this is far from simple. In 1968 Margo McCaffery defined pain as "whatever the experiencing person says it is, existing whenever he says it does." Much simpler, but maybe not very useful. This brings me to point of my post. In trying to further my understanding of pain, I hope to find ways of either building a better tolerance, overcoming or using pain to further my performance. After all, pain does feature a lot during racing.

THE EXPERIENCE OF PAIN

Pain has generally been categorised into two common classes:

1. Somatogenic: is pain with a physical cause such as a fractured leg or heart attack
2. Psychogenic: is pain where there is no known physical cause.

Both types of pain are real and can be just as intense or distressing as each other. In fact pain is usually experienced as a combination of the two types. Not being purely one or the other.

There are three systems that interact to produce pain in a person:

1. The Sensory/Discriminative system processes information about the intensity, spatial and temporal aspects of pain. These sensations are mediated along afferent nerve fibers, the spinal cord, brain stem and higher brain centres. The result is a quick withdrawal from the painful stimulus.
2. The Motivational/Affective system is the person's conditioned or learned approach and avoidance behaviours. They are mediated through the interaction of the reticular formation, limbic system and brain stem.
3. The Cognitive/Evaluative system overseas the person's learned behaviours regarding the experience of pain. The person's interpretation of appropriate pain behaviours is learned in several ways including: cultural preferences, upbringing and experience. These may block, modulate or enhance the perception of pain.
   

There are a number of different theories about how a person's body identifies pain. These include:

1. Specificity Theory: pain is caused by stimulation of nerve endings in the skin that is transmitted through fibres to the spinal cord and ascend to the brain. This causes a direct relationship between the stimulus and the perception of pain.
2. Intensity Theory: pain results from excessive stimulation of sensory receptors with summation of impulses.
3. Pattern Theory: pain perception is the result of stimulus intensity and summation of the impulses.
4. Gate Control Theory: specialised cells within the spinal cord (substantia gelatinosa) act as a gate, opening and closing the afferent pathways of transmission of painful stimuli to the brain.

Don't ask me to explain these theories. I have far from a good understanding of them, and I don't think learning too much about them will serve my purpose. So what is useful from all the jargon filled models and theories described above?

There are four key points that I believe are important:

1. The most important aspect of pain is that it serves a purpose. That purpose is to protect the body from damage. Pain often correlates highly with activities or events that have the possibility of causing damage to tissues.


2. Pain often causes a stress response. This involves increases in heart rate, blood pressure, respiratory rate, temperature, release of endorphins and other changes that all work towards increasing the ability of the body to perform. While originally intended to improve a persons ability to remove itself from danger, there is potential to use this to enhance sports performance.


3. We have the ability to condition our response to pain. This suggests that training can have an effect on how we respond.


4. We have the ability to evaluate pain and alter our perception of the pain experienced.

How can we use these four points?

It is the last point I find to be the most important. Having the ability to evaluate pain is priceless. This ability means we can use pain as information. While pain is primarily a warning against actual or potential injury, if we combine this with what we have learnt over time, through training, racing and other experiences we can evaluate how high or low the risk of injury actually is. We can take an inventory on the pain we are experiencing. This inventory can include it's: location, description (sharp, burning, tearing, heavy etc.), onset (when and what caused it), what relieves or aggravates the pain and any other associated feelings (nausea, dizziness etc.). Having taken this inventory, and using past experience we can make an educated assessment of what this pain is. For example, a deep burning session in your thighs and calves, that is gradually increasing over time or with an increase in running pace is likely to as a result of anaerobic energy metabolism. This is not too likely to cause injury. However, a sharp or tearing pain that suddenly appears in your achilles tendon following a short sprint is likely to be an actual injury.

Once we have evaluated the pain we then have the ability to choose our response. For pain that involves a high risk of or actual injury, then the response is usually straight forward. For pain that has a lower risk of injury weighed against other goals, sustaining your action (ie. racing) may be the preferred option. This is easier said than done. Pain has a powerful response on the body and people have different levels of pain tolerance. This is where the ability to condition our response to pain is so important. Through training we can change this response. Familiarity can be helpful. We can condition ourselves not only to suffer through or not slow down due to pain, but even turn our response around to enhance performance.

Through exposure and concentrated effort over time we can use pain levels as a guide to how hard or fast we are travelling. If it's not hurting, then you probably aren't going hard enough. There is pain caused by the acidosis of anaerobic metabolism. It can play a role in identifying where you are in relation to the so-called anaerobic threshold. Certain levels of discomfort are expected during racing. If you haven't reached these, then chances are you can speed up.
By using conditioning and practice it is possible to develop a certain mindset to use pain to your advantage. Tap into the heightened response it provides. That sympathetic drive (fight or flight response) is very useful when an intense effort is required. A range of hormones are released including adrenaline, noradrenaline, glucagon, growth hormone and many others. These and others increase the body's ability to respond to increasing demands. Blood pressure and heart rate are regulated faster, blood supply is shunted to the working muscles. Endorphins are released which may actually help you feel good about the pain.

Pain is important. Maybe not the friend you want, but it is the friend you need. Embrace it, and use it to your advantage.