When we are sick and battling an illness, we often experience painful achy sensations as we cough. But why is this the case? It makes intuitive sense that we might experience some pain in our throats or lungs while coughing, but why do we feel pain in other areas as well? Why does this pain sometimes make us feel sad or even depressed?
To answer these questions, we’ll need to take a closer look at the pain pathway in the body, the process of coughing, and how coughs may produce different types of pain depending on what’s causing them to occur.
Pain science is an enormously complex topic deserving of its own detailed article. However, in order to answer the primary question posed in this article, we’ll need to lay a basic foundation with regards to pain science.
For our purposes, we don’t need to dive too deeply into the complicated world of neuroscience. We will merely scratch the surface to help us better understand pain.
In context of a common injury: let’s say an elderly woman fell and broke her leg. When she first fell and fractured the bone, the nerve cells in her leg (which are also present in nearly every tissue in the body) would have sent a signal to other nerve cells in her spinal cord. These spinal cord cells would then have had to determine how severe the injury was, and whether or not it was worth sending the information up to her brain. Obviously, with a broken leg, the brain needs to be informed. So, her brain received this input and then sent out its own signal to the rest of the body, indicating that she was in pain from the injury. Now her body can respond appropriately by sending out pain relieving substances, healing white blood cells, etc.
Again, this is a very watered down version of the science, but it serves to give a basic overview of the pain pathway.
Basic neuroscience aside, perhaps an even more important component of our understanding of pain is the biopsychosocial model. In essence, the theory posits that pain contributes to, and is caused by various biological, psychological, and sociological stimuli.
To illustrate this, let’s return to our example from the previous section and apply the principles of the biopsychosocial model. Why would this woman’s leg hurt weeks or months after the injury apart from the pain pathway outlined in the previous section?
Table of Contents
Biological Considerations
The woman’s leg hurts, in part, because there is a physical or biological cause: she broke the bone. This is the most well understood part of pain science. When a tissue is disrupted, the nerves associated with it will detect pain and the brain will respond by interpreting this stimulus as pain so that it can be addressed by her body’s healing processes.
As time goes by, if all of the healing processes follow the expected course, her tissues will recover and she will slowly but surely get past this painful experience.
Psychological Considerations
The woman’s leg also may partially hurt due to some psychological factors. She may be feeling depressed at the fact that she broke her leg. Research has shown that even these psychological symptoms alone can result in pain. She could feel sad about the injury; being reminded of her age and the increased frailty that often affects us in our later years.
Sociological Considerations
Perhaps the most confusing premise of the biopsychosocial model is that of the sociological components of pain. For the case of our woman with the broken leg, she may feel removed from her role in society due to her broken leg, which can cause “social” pain. She may no longer want to participate in activities she used to like to do because she now has a fear of being treated differently or otherwise removed from her friend and family groups. This can result in further “social” pain which can, at first glance, be indistinguishable from a biological source of pain.
Sociological considerations are often discounted, but they can play a major role in our ability to fully recover from a painful condition or injury.
So when it comes to a more obvious physical injury like breaking a leg, it’s fairly easy to apply some pain science principles. However, when it comes to pain caused by something slightly more nuanced such as a cough, we find things can get a bit more complicated.
Let’s start with how the cough reflex works.
Again, let’s keep this really basic. If you want a more in depth description, here you go.
For all intents and purposes, a cough reflex or involuntary cough occurs as follows:
- The sensory cells associated with a cough are stimulated.
- From there, the brain interprets the signal.
- Lastly, the brain sends out a signal to the appropriate tissues, causing the cough to occur.
Along the way, various cells and tissues are involved which all contribute to the act of coughing.
As was detailed in a previous section, nearly all of the tissues in our body have sensory and pain receptors attached to them. The structures associated with a cough are no different in this regard (granted, some of them might be less sensitive to certain magnitudes and types of pain than others) and include our:
- Lungs;
- Throat;
- Muscles along the pathway;
- And many others.
As each of these areas are irritated by a cough (especially very forceful and frequent coughs), tissues may start to become damaged and inflamed, sending pain signals along the associated nervous system pathways.
If we apply the three-part biopsychosocial principle to coughs, we can break it down as follows:
Biological Considerations
All of the tissues are being stressed and, in a sense, injured when someone is forcefully and frequently coughing. The “injury” of the cough is similar to a broken leg in this respect. If these tissues heal, and the cough goes away in a normal time frame, the pain should recede as well.
Psychological Considerations
If the cough is really intense and has been affecting you for quite awhile, you might start to become worried that it will never go away. This could create a feeling of anxiety which may contribute to your body-wide pain and psychological symptoms every time you cough.
Sociological Considerations
If you’re coughing and sick (especially if you have COVID-19), you are forced to withdraw from interaction with your family and friends. Especially for very social people, this can cause increased “social” pain associated with the cough due to your lack of interaction. This type of pain may be long lasting and is sometimes difficult to treat.
This is especially true now that coughing has become so stigmatized through our experience with COVID-19.
We’ve touched on some of the general science surrounding pain and coughing, but what about some specifics?
Let’s look at painful coughs with respect to the painful regions involved:
Abdominal pain while coughing can be due to a variety of factors including:
- Appendicitis;
- Kidney stones;
- Pancreatitis;
- Other internal organ-related issues.
The pressure caused by coughing can create discomfort in these already affected organs, which then leads to increased pain in the abdominal region. These conditions should be examined by a doctor and treated in order to address the painful cough symptoms the patient is experiencing.
Additionally, many of these internal organs can cause referred pain, which is pain experienced in a region other than the injured or diseased area itself.
Headaches caused by coughing are categorized into either:
- Primary cough headaches or;
- Secondary cough headaches.
Primary cough headaches, while irritating, are usually not serious and can be managed in a variety of ways including with medication.
Secondary cough headaches, on the other hand, can be extremely serious and may be indicative of brain pathology. Headaches due to coughs should always be examined by a medical provider to rule out serious issues.
Coughing is hard work! It’s perfectly normal for muscles all over your body to be sore after a coughing fit or an illness that has caused you to cough for an extended period of time. Rest and recovery are the best remedies for sore bodies due to coughing.
So, now that we know a little bit about why we have pain when we cough, the big question is, “What can we do with this information?”
The most important steps we can take are:
- Staying healthy and avoiding getting sick, if possible.
- Treating and diagnosing coughs and other diseases quickly, before they become problematic.
For the first point, there are many ways to improve our health that are fairly intuitive such as eating well, exercising, and getting enough sleep.
As per the second point: obviously, to treat and diagnose coughs, we should maintain a good relationship with our healthcare providers. Getting regular checkups and being evaluated when we have symptoms (even if we are just coughing, and we don’t think we are sick) are some of the best ways to get ahead of an illness.
However another angle to consider for treating and diagnosing existing coughs, is leveraging technology for this purpose. Exciting new technology advancements such as the Hyfe app are revolutionary developments in the field of cough diagnostics.
It’s likely that the widespread use of technology and apps such as Hyfe will help us better prepare for any future diseases that plague our world. We need to be ready for what’s to come, and we need to work with technology in order to do so.
To answer the original question: “Why does it hurt when we cough?”, we now see that pain is a multi-faceted and extremely complex mechanism. Pain due to coughing could be caused by a variety of physical, psychological, or even sociological issues. Therefore, any painful cough or condition should be treated with great attention to detail. Always consult with your doctor if you are experiencing pain due to coughing.
Looking to the future, it is vital that we tap into the best available technology to improve our diagnostic and treatment capabilities with regards to coughs. The use of technology that analyzes and provides recommendations pertaining to coughs is one of the best ways we can move toward a healthier society overall.
Bennett Richardson is a physical therapist and writer out of Pittsburgh, PA. You can find more of his writings on his blog, and you can learn more about his PT practice on his website.
