Pain Tolerance vs. Pain Threshold

Is pushing through the pain actually helpful?

“I have a really high pain tolerance!”  I hear this all of the time with my patients and for many it can be a badge of honor.  Being able to take care of multiple children, a new puppy, the house, the carpools, the homework, and the doctors appointments all while experiencing 8/10 pain is absolutely impressive! But here is the thing, is this really helpful?  In actuality, no, not really.  Here’s why. 

What’s the difference between pain tolerance and pain threshold? 

Pain tolerance and pain threshold are 2 different things.  Pain tolerance is what you, as an individual, experience.  

For example: 3 people cut their fingers in the exact same way. 

1. Person 1 rates the pain as 4/10

2. Person 2 rates the pain as 6/10 

3. Person 3 rates the pain at 10/10

In this example, technically all 3 people have the same injury, but their experience is quite different.  

Pain threshold is the point at which a stimulus becomes painful, or more clearly, how much of a stimulus you need to make your brain say that something is now painful.  

Think about it like this: Imagine someone is holding your hand.  You can sense the pressure but it is not painful.  They begin to squeeze a little harder and you note the increase in pressure but it is still not painful.  Now they squeeze as hard as they can, it feels like they are going to crush your hand, now you’re experiencing 8/10 pain.  

The point that you shifted from experiencing pressure to experiencing pain is your pain threshold.  

What’s the impact of chronic pain?

If you’re someone experiencing chronic pain or chronic urinary urgency, this can be a big deal! In people with chronic symptoms, they have been shown in research to have a lower pain threshold.  This says nothing about your pain tolerance.  You may be experiencing 8/10 pain with daily activities.  You may report pain at 3/10 that many people would report at 7/10.  All of this is very likely; however, your threshold for when your brain starts responding to a stimulus as a painful one versus a non painful one is likely happening sooner than someone who is not experiencing chronic symptoms.  

Let’s refer back to your hand shaking example and insert someone with chronic symptoms.  Someone holds your hand and you note the pressure. They begin to squeeze and you note that it now causes 3/10 pain.  They squeeze as hard as they can and now you feel 6/10 pain.  Your pain tolerance may be at 6/10, lower than our original example, but you began to experience pain sooner due to a lower threshold.  

Sympathetic Nervous System (SNS) vs Parasympathetic Nervous System (PNS)

So why is this happening? Without getting too technical, this happens because of the nervous system, more specifically the Sympathetic (fight or flight, SNS) and Parasympathetic (rest and digest, PNS) Nervous Systems.  Think about these as volume controls.  If our SNS is turned up too loudly then it cannot hear our PNS talking.  The louder the volume is, the more the nervous system has to shout to send a message.  If your SNS is screaming pain or urgency at you all day and your PNS is trying to quietly tell you that your bladder is filling up then your brain is not going to hear the PNS’s nice request. It’s going to respond as if it needs to respond to pain.  This is how we can go from “I kind of have to go to the bathroom” to “I have severe bladder pain even though I just went to the bathroom.”

Ways to Lower Your Stress Levels

What are some things you can do? The first thing to do is stop trying to fight through the pain so much.  Constantly fighting through the pain over time actually decreases our threshold, making quiet requests get perceived as screaming.  How can you do this? There are a lot of options but mainly it’s about downtraining the nervous system.  You have to give it breaks. This means taking time for yourself to intentionally calm your nervous system.  This can be in a lot of different forms and is specific to each individual based on what brings them mental peace. 

Options include:

1. Yoga

2. Meditation/Processing your emotions

3. Taking a nap

4. Sitting on a bench in the park

5. Going for a run

6. Reading a book

7. Going to a fitness class

8. Any other thing that can bring peace and calmness to the mind 

All that matters is that it is time that you are taking to intentionally lower your stress levels.  You may also need to delegate some of your responsibilities which can often feel overwhelming and nearly impossible. Doing so is likely essential in lowering stress levels so that you can increase your threshold and no longer deal with symptoms all day.  

Examples of this may be:

1. Educating your partner and/or older children in the house to take on some of the household responsibilities. 

2. Taking time to schedule your day and including your self care time in that so that it has its own dedicated spot. 

3. Writing down a list of all of the things you would like to accomplish for the day/week and picking the top 3 things that need to happen each day for you to feel successful. 

   1. If you get more done, great, but if not you’re not going to beat yourself up about it.  

4. Hire someone to help with the more menial tasks around the house or to run the kids to their activities.

5. Set up a carpool.

6. Order your groceries online and save yourself the trip into the store with the kids.

7. Any other way to offload the lengthy list of “to-do’s” to someone who can help absorb the load.

There are a lot of options out there for downtraining your nervous system and the great thing is that you get to pick what works best for you and when you do it.  If you feel like you are already working on this and you’re not making the progress with your symptoms that you would like, it may be time to see a pelvic floor PT to help you find techniques that work best for you!