Pain is one of the most complex topics we deal with in physical therapy and life. Most of the people I work with in my clinic have pain. That’s one of the main reasons they come in to see us. It hurts when they work, or run, or sleep, or all the time. This is true in all of health care. Pain is the number one reason to see a doctor, and it is where the most money is spent in the US in healthcare. More than heart disease, cancer, and diabetes combined.

Remarkably though pain can be poorly understood, both by people in pain, and by people trying to help the people in pain. The science of pain, the nervous system, and the brain and body is ever evolving, and not everyone understands it well.

We as a culture and as health professionals continue to treat the body as a machine, like a car for example. A part is broken. We fix it, or replace it, and the pain goes away. Right? Of course if you have pain, you know this doesn’t always happen. Sometimes we repair things and the pain doesn’t go away, or maybe even gets worse. What’s going on?

In this space I haven’t posted in a bit. I am going to talk about pain and injury and rehab more consistently in the future hopefully. Today we will talk about 5 misconceptions about pain.

Pain equals damage. This is the most important thing to understand. Yes you can have pain with damage, of course. But pain is an output of our nervous system. Our body senses damage or stress of various types, this is called nociception. These signals are sent to the brain and are processed with many other inputs, other senses, memories, experiences, thoughts, and beliefs for example and then decides what the response will be. This can be pain. Or not. Or another response. If you ever have had a bruise or cut that you didn’t know about until you saw it, you had damage without pain. Sometimes we can have pain, or amplification of pain without damage.

Pain means something hasn’t healed properly in your body. This is the same principle as above. We can have an injury that our nervous system responds to with pain. But in most people our healing response is amazing. Tissues respond and heal very well in a few weeks to a few months. If you have ever had cuts you can see this. They close well and in a short period they disappear. If pain continues longer term, changes in your nervous system may be contributing to this. We, of course, must rule out sinister things such as things not healing. But, pain is used by the nervous system like an alarm. Sometimes the system stays very protective and the alarm is very sensitive. This allows it to go off very easily, even if proper healing has happened.

Pain is 100% physical and real or “in your head”. This is a huge misconception. Pain is real. And no pain is 100% anything. It is a biological response from our nervous system and our brain. But the inputs include biological or physical components, along with psychological components and social components. These can be factors like sleep, stress, fear, thoughts, beliefs, and how pain is affecting your work, family and social life. When pain doesn’t make sense we tend to focus primarily on the physical. Something must be terribly wrong in my body to hurt so much. But sometimes, the body is healing well, but these other factors begin to play a bigger role.

If I have pain my body must be fragile. This is understandable. People when they are injured are told to be careful, don’t bend, don’t twist, don’t do too much, take it easy. And sometimes we need to protect an injury. But we probably should be told to be careful or not do things for a little while. Once the body heals it is very strong and resilient, but it may be sensitive. So, if you do too much too quickly it may respond by telling you to slow down a bit. Pain problems can occur when we interpret every pain as not slow down a bit, but as stop don’t ever do it you are injuring yourself. Our system can continue to sensitize as new memories, thoughts, and beliefs are integrated into our nervous system and we get into a negative cycle.

If you have chronic pain, you will never overcome it. I hear this a lot from people with longer term pain. They feel lost and hopeless that they can never get better and live how they want to live. We know now of a concept called neuroplasticity. This means that our nervous system can continue to change. It changed in a way to get someone in a chronic pain state, it has the potential to change in other ways and help your situation. Sometimes pain will not fully resolve and sometimes it may. But, using neuroplasticity can help your system become less sensitive and allow changes to how you live.

Pain and our bodies is always a complex topic. And every person with pain is unique with different challenges. Hopefully, learning about pain can help you move forward.

If you have further questions about pain, we would love to hear from you. Go ahead and post them here.