The Sources of Pain

The Source Makes a Difference

Why do we even have pain signals?

You'd think the whole world would be better if we just didn't have pain at all. But it's simply not that easy. Pain is actually really important. The whole purpose of pain is to alert your brain to possible tissue damage, so you move your hand off a hot stove. People who have spinal cord injuries sometimes get a cut where they can't feel it. The cut then becomes infected, and the person doesn't know until they're really sick with high fevers and possibly sepsis. It's important for our bodies to be able to feel pain to keep us safe.

Where do pain signals come from?

Pain signals related to tissue damage start with activation of something called nociceptors. These are sensory neurons all around your body that fire when there's possible tissue damage. They are easier to activate when there's inflammation and immune system activation hanging around. These two things are what help your body heal wounds and prevent infections. It makes sense that when your body is trying to fight an infection, you might want to know about it. 

 When your body is sending pain signals related to possible damage, the signals can come in different kinds of flavors:organ pain and non-organ pain. 

Pain coming from internal organs

Organ pain comes from internal organs such as your stomach, gallbladder, uterus, ovaries, intestines, and bladder.  

Pain signals from your organs mostly come from the organ being stretched (such as your stomach when you eat too much), lack of blood flow (such as your foot “going to sleep” when you sit on it), and inflammation (caused by illness or injury).

Acute pain* from an organ can be caused by appendicitis, a hot gallbladder or a heart attack. It may be accompanied by symptoms such a tightness or squeezing fullness, being pale, sweaty, or feeling a sense of impending doom. Heart attack symptoms also may include pain in the left arm, shoulder, neck, and jawline. Acute pelvic organ pain is most often felt with bladder infections or period cramps. 

Chronic pain** from an organ tends to be more like a dull ache, discomfort or nausea that won’t go away. The pain can fluctuate. When it is bad, you can have nausea and sweating. When the pain lessens, you’ll experience a more general discomfort. Perhaps you’ll feel a constant need to urinate or empty your bowels. These sensations are common.

Pain coming from other places.

Pain from skin, muscle, bones, joints, and ligaments is considered non-organ pain. These are usually a little easier for your brain to figure out. The neurons in these locations will fire with almost any unpleasant sensation; stretch, heat, cutting, inflammation etc...

In your pelvis, though, the pain signals get mixed up with the organs, making it especially hard for your brain to figure things out.

The pelvis is a tight area, with lots of stuff in it, including your bladder, uterus, tubes, ovaries, bowel, muscles, nerves, and fascial tissue. The body has to transmit information from all these things to the brain for processing. Because it's such a tight area, there's only a few spots in the spinal cord that are available to transmit ALL of this information. Once the information gets to the spine, the pain signals all get thrown in together. What your brain reads is "there's pain somewhere in my pelvis". Every body feels that different. Some people feel it as bladder pain or bowel pain, some feel it as ovary pain.

What is pelvic and intimate pain, and what can be done about it?

Pain specialists define pelvic pain as anything that hurts between your belly button and mid thighs, front and back. (See What’s in the Pelvis?). Intimate pain is anything that hurts in your genital region, including pain with sexual intercourse.

You may have been told at one time that your pain is “all in your head,” or you’re “blowing things out of proportion.” But rest assured, chronic pelvic and sexual pain are medical problems.

Seeking help from a pelvic pain specialist is the best approach to help diagnosis and manage pelvic pain. S/he can teach you how to get your brain and body to stop making your pain worse than it needs to be.

* Acute pain is defined as a one-time or brief event

**Chronic pain is defined as lasting from a few weeks to more than six months

References:

1. Aredo J, Heyrana K, Karp B, Shah J, Stratton P. Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. Seminars in Reproductive Medicine. 2017;35(1):88-97.
2. Huang L, Kutch JJ, Ellingson BM, Martucci KT, Harris RE, Clauw DJ, Mackey S, Mayer EA, Schaeffer AJ, Apkarian AV, Farmer MA, MAPP. Brain white matter changes associated with urological chronic pelvic pain syndrome: multisite neuroimaging from a MAPP case-control study. Pain. 2016;157:2782-2791.