UNDERSTANDING BACK TROUBLE: WHERE DOES IT HURT?
The body’s central nervous system consists of the brain and the spinal cord, which is the brain’s extension down the spinal canal. The nerve roots which pass in pairs out of the spinal cord at the level of each vertebra, and at the sacrum, proliferate into an abundant network of nerves, some as long as one metre, reaching to distant parts of the body. They carry information about injury along the spinal cord to the brain, which acts as a control centre, where the information is interpreted in the form of a sensation of pain. The sensory nerves which bring it are able to convey information about the type of injury; thus, the pain of a blow is different from that of a pinprick.
Pain is not sensed in the injured tissues themselves: the experience of pain is registered in the brain. For pain to be felt, there must be, or have been, a nerve supply. Some structures of the body have little, or none: for instance, the nucleus of an intervertebral disc. If it is damaged, no pain will be felt unless part of the disc presses on one of the nerve roots, the dural tube or on a ligament. Therefore the absence of pain does not necessarily mean that there has been no injury.
There can be an interval, sometimes days, between injury and sensation of pain. If you are concentrating hard on something else, you can often override the pain message. Sportsmen, in particular, often fail to realise that they have been hurt, until the game they are playing is over. A severe pain can mask a lesser pain, rather like a strong radio signal suppressing a weaker one. Thus it may not be until the more severe pain has responded to treatment that a secondary pain reveals the presence of a lesser injury
Pain is both a mental and a physical event, and the extent to which it is found endurable depends largely on individual temperament. Some people give way rapidly, and take to their bed, while others grimly remain at their posts, regardless of suffering. There is an intelligent compromise between these extremes: an awareness that pain is, in general, a warning of injury or risk of injury through misuse or malfunction, which should not be neglected.
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