Chronic Pain

What is nociception?

Do I have pain receptors? Why do I hurt? Why is my body producing so much pain? These are all complex questions that have some answers rooted in the word nociception. Nociception’s relationship to pain production is not always straightforward, so let’s unpack some of its complexities.

“Nociception is the process by which information about actual tissue damage, or the potential for such damage, is relayed to the brain.”(1) Sufficiently intense stimulation (such as stretching, cutting, or pinching), intense warming of the skin, or exposure to noxious chemicals can activate nociceptors (very small receptors throughout our bodies). Under most circumstances transmission of nociceptive information results in pain perception (ouch!!!). Many physicians and patients are unaware that nociception is dissociable from the experience of pain. This dissociation means the process of nociception can occur in the absence of awareness of pain, and pain can occur in the absence of noxious stimuli (something painful like a sprain, strain, bruise, etc.)

This phenomenon is observable in instances of massive trauma (such as a motor vehicle accident), when victims exhibit a stoic painless state despite severe injury, and when individuals with functional pain syndromes report considerable pain despite having no noticeable tissue damage.

Why does this matter?

How we feel and what is happening around us will influence the nociception. For example, an ankle sprain will typically feel worse if it occurs in a negative context. (1,2) Past negative experiences with healthcare practitioners, negative or positive emotions, fears (fear of pain is worse than the pain itself), social life (which includes support or lack of support from friends and family) can all influence how nociceptive information is processed in our bodies. (2, 3, 4, 5)

What should we do?

Navigating healthcare is tough. We recommend seeking out high-quality explanations for pain and injury which normalize pathological terms, thus, improving the quality of care given and avoiding producing unneeded nociception. For example, degenerative findings on MRI are very normal and no worse for you than wrinkles on your skin. Clinicians’ words matter and can provide reassurance, which increases our confidence in the pain or injury or nociception which decreases our confidence and can lead to undue suffering.

To summarize, if you are feeling confused about your pain and injury, please consider seeking a qualified health care professional to provide you with high-quality, clear explanations. Here at Hulst Jepsen Physical Therapy, we pride ourselves on staying current and helping you navigate the confusion that surrounds pain and injuries. (5, 6, 7, 8, 9) Call any of our clinics today to schedule an appointment.

1. Garland EL. Pain processing in the human nervous system: a selective review of nociceptive and biobehavioral pathways. Prim Care. 2012;39(3):561–571. doi:10.1016/j.pop.2012.06.013.

2. Ossipov MH, Morimura K, Porreca F. Descending pain modulation and chronification of pain. Curr Opin Support Palliat Care. 2014;8(2):143–151.3

3. Thacker, Mick. (2015). Louis Gifford – revolutionary:the Mature Organism Model,an embodied cognitive perspective of pain. In Touch. 152. 4-9.

4. Crombez, Geert & Vlaeyen, Johannes & Heuts, Peter & Lysens, Roeland. (1999). Fear of pain is more disabling than pain itself. Evidence on the Role of Pain-related Fear in Chronic Back Pain Disability Pain. 80. 329-340.

5. Moseley, G. (2004), Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. European Journal of Pain, 8: 39-45.

6. Rajasekaran S, Dilip Chand Raja S, Pushpa BT, Ananda KB, Ajoy Prasad S, Rishi MK. The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials. Eur Spine J. 2021 Mar 21. doi: 10.1007/s00586-021-06809-0. Epub ahead of print. PMID: 33748882.

7. Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S. The enduring impact of what clinicians say to people with low back pain. Ann Fam Med. 2013;11(6):527-534. doi:10.1370/afm.1518

8. P Goddu A, O’Conor KJ, Lanzkron S, Saheed MO, Saha S, Peek ME, Haywood C Jr, Beach MC. Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record. J Gen Intern Med. 2018 May;33(5):685-691. doi: 10.1007/s11606-017-4289-2. Epub 2018 Jan 26. Erratum in: J Gen Intern Med. 2019 Jan;34(1):164. PMID: 29374357; PMCID: PMC5910343.

9. Karran EL, Medalian Y, Hillier SL, Moseley GL. 2017. The impact of choosing words carefully: an online investigation into imaging reporting strategies and best practice care for low back pain. PeerJ 5:e4151