Book Review: "Why Do I hurt?" by Adriaan Louw

​I normally ask my patients, "Has anyone ever asked you why you hurt?" or " Do you know why your pain increases with stress, activity, or weather?" Pain is a normal response in the body and is a very important for helping us survive. However, persistent pain and nociceptive pain (pain that occurs during light touch or activates that should not be painful) is not a normal process. Persistent and nociceptive pain is due to the sensitivity of the nervous system and how the brain processes different pain signals. 
 
The body is constantly sending signals, for example, right now your feet are telling your brain that you are wearing socks and shoes. There is a threshold for the signals that determines what is important to get to the brain or not. This is why we can go our whole day without thinking about the fact that we are wearing socks and shoes. This is not important information for our body to process all day long. 
 
Some of our nerves act as the internal alarm system and will signal the body if there is a threat or injury. If you imagine you were to step on a nail, without looking at your foot or seeing the nail, you would know that you stepped on a nail. You would automatically jump off of that foot, sit down, and inspect the foot. There is a natural threshold of input that, if hit, will trigger a response from the body (see the first picture attached), this case it was when your foot stepped on the nail.
 
In the case of an accident, surgery, emotional stress, or chronic pain the body develops this alert system which wakes up your body in response to danger. Some people's nerves remain elevated and don't calm down very easily. This response impedes on movement and function and is actually very normal. What your body could previously tolerate, is now more difficult because your nerves have become more sensitivity in alerting the alarm system (see the second picture).
 
I also like to think about a car alarm. The car alarm's purpose is supposed to alert the driver if there has been an accident, a break-in, or a bump. If the alarm system is too good at recognizing potential threat, the car alarm will go off when a leaf blows by the car. This is very similar to how our body can act, what was previously easy for us to do becomes painful or difficult. Physical therapy can help turn down your alarm system and help your body perform those tasks that were once easy to complete without triggering your alarm system. 

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This book review was written by Jordan Weyker PT, DPT. 

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