An observation I had early in my career was that when a patient told me “I have a high pain tolerance,” what it meant was…
You do not have a high pain tolerance.
If you did, then you would not actually know since you never found it.
The people with the highest pain tolerances are usually the people that admit they are “weenies” and hate pain.
Over time as I grew as a clinician, this statement stopped “bothering me” and I just came to accept it. Also I’m not the gatekeeper of pain, my opinion of your pain is irrelevant. So, if you tell someone something hurts…
It DOES NOT matter if they believe you and it should not change the treatment.
I also learned how to really interpret what patients mean versus what they say.
It is all semantics, and please don’t take this as me saying your pain is not real, because pain is very real.
What I’m really talking about is the biology and psychology of pain. If we are going to address how to manage it, we have to establish some guidelines first.
I’ll break it down and then teach you how to overcome it.
Pain Tolerance vs Pain Sensitivity
There’s overlap that varies between people but think of tolerance as a mental thing and sensitivity as a physical thing.
Tolerance is the max level of pain you can deal with.
This is the psychology part and related to motivation/incentive.
If you broke your leg but I offered you $1 million dollars to walk 10 miles, would you do it? Or you had to run from a tiger?
Motivation can be positive or negative influence.
Sensitivity is the minimum level pain needs to be for you to FEEL pain. It would be the difference between getting punch by a toddler or Mike Tyson. They are both punches, but the one from the toddler isn’t hard enough to register as painful.
You feel SOMETHING, it just doesn’t register as pain.
This is the biology part - people with diabetes can’t feel their feet so they have to constantly inspect them to insure some minor cut/scrape doesn’t turn into gangrene.
So in simple terms when someone says “I have a high pain tolerance” what they really mean is
“I’m properly incentivized to deal with this pain for some period of time.
Obviously we’ve reached a ceiling or I would not be talking to you.
3 ways to improve each
#1 Turn down the pain alarm
When you just run around with high levels of pain all day, this changes your brains “set point.”
Over time, things that should not cause pain cause pain, or simple things hurt more than they should.
Basically it’s like a bruise. When a bruise is present, it hurts to the touch. When you leave the bruise alone and it heals, you can touch it again.
Pain during activity is fine, just try to keep it under a 5/10. Everyone is different, but practically that means your pain should not be getting worse during the activity or before you need to do the activity again.
#2 Improve your strength (sensitivity)
Strength training makes you less sensitive to pain. Remember the analogy of getting punched by a toddler vs Tyson? The toddler doesn’t hurt you because you are bigger/stronger.
Progressive overload is applying more and more force to you body, repeatedly, over time.
#3 Improve your endurance (tolerance)
When you really think about endurance sports, all it is is teaching your body to tolerate pain. You go off on a run or bike, and feel your muscles working. Your easy Zone 2 stuff is tolerable pain.
When you do more high intensity stuff, you’re exposing yourself to pain closer to your threshold for a period of time, and repeating that multiple times (intervals).
As you get in better shape you can tolerate 1) more pain for 2) longer periods of time.
Summary
The key here is to 1) get stronger and more aerobically fit 2) without overdoing it. This sums up the actual “mental” benefits of exercise. Like I eluded to, you can’t separate the mental and physical, they work together.
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