A Primer on Pain

We all experience pain, but what is it?

Written by John Ferrari

We all experience pain. Many different types of pain, in fact— from the sharp, quick pain of a cut or a burn to the throbbing pain of a sore muscle to the shooting pain of sciatica. But what exactly is pain? How do our body and brain work together to feel and process pain … and what can we do to stop it?

“Pain is a lot of different things,” explains Torrance Memorial Physician Network interventional pain medicine physician Sina Samie, MD. “It starts as something physical—tissue damage, for example—and a signal is transmitted through nerves to the spinal cord and the brain.”

“Pain doesn’t happen exactly where it occurred. It is interpreted centrally,” agrees Kartik Ananth, MD, a Torrance Memorial psychiatrist and pain management specialist and interventionist. “A signal goes from the site to the brain, and your brain has to process it.”

Broadly speaking, Dr. Samie says, there are two types of pain. Nociceptive pain is a response to tissue damage, while neuropathic pain occurs when the nerves aren’t functioning correctly. “After surgery, for example, nerves may grow back abnormally and fire without a stimulus. A lot of times there might not be a physiological cause for neuropathic pain—you just treat it and find out what controls it.”

“Pain is much more complex than just a physical response,” he adds. “There’s both the physical feeling and the emotional response to that physical feeling. People rate pain differ-

ently. Some people may describe pain as just annoying, while for others it may be terribly painful. Pain perception changes over time too. Chronic pain makes people more sensitive to it. Functional MRI scans show different parts of the brain light up in people with chronic pain. The brain focuses on the pain. It reorganizes the way it perceives things and focuses more on that kind of stimulus.”

The effects of chronic pain can extend beyond the pain itself, Dr. Ananth says. “When you have chronic pain, it’s very easy to become depressed or anxious.” That depression or anxiety, in turn, can lead to worse pain.

“If you can go about your business, you can focus on other things and to some extent forget about the pain,” but when chronic pain is affecting your emotions or ability to live your life, it’s time to speak with your primary care physician or a pain intervention specialist. Chronic pain can be addressed with procedural interventions, such as surgery, but also with medications that treat both pain and emotional symptoms. The bottom line, Dr. Samie, says, is “untreated pain can result in even more pain.”

The options for treating pain are as varied as the types of pain itself—from medication to lifestyle changes. “Everyone deals with their pain differently. For example, a lot of people don’t want to take pills and just want to use yoga, acupuncture and stretching. Other people prefer physical therapy, and others want medication. A big percentage of people I see are not even on prescription medications. They want to work to reduce pain.”

While medication used to be the primary solution for severe or chronic pain, “our thinking on opioids has changed drastically—it’s not as great a long-term treatment as we thought,” says Dr. Ananth. “In some cases, opioids can make the pain worse. They do have a place in treatment—cancer patients, for example—but for the vast majority of patients, if we can start them on lower amounts of opioids, that will be better for them.”

“Very high doses can cause opioid-induced hyperalgesia,” Dr. Samie adds. “That’s where the entire body is sensitive to pain.”

If you have concerns about the addictive potential of opioids, your primary care physician, pain intervention specialist and the Thelma McMillen Recovery Center can discuss and provide treatment options.

“Patients need to know there are many other options too,” Dr. Ananth says. These include spinal cord stimulation and peripheral nerve stimulation, both of which work by identifying the nerves sending the pain signal to the brain and stimulating just those nerves—“hijacking” them to send a different, nonpainful signal.

Dr. Samie and Dr. Ananth agree on the takeaway for pain: Talk with your physician when it affects your quality of life or function. “We can

do a lot to diagnose the problem and reduce the pain,” says Dr. Samie. “A lot of decisions are made by the patient. We give them various options and explain the pros and cons. In the end it’s all about improving quality of life.”

If you or a loved one are concerned about reliance on opioid medications, speak with your primary care physician or specialist, or reach out to Torrance Memorial’s Thelma McMillen Recovery Center at 310-784-4879.