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Myth Busting 7: The myth about pain

· 3 min read

Part of the "Myth Busting" series

There's a huge myth about pain that is really widespread. Almost everyone believes it, including many healthcare professionals. And this misunderstanding of pain is something we've touched on in each of the previous "Myth Busting" blogs, but not approached directly.

So here's the myth, in its raw form:

PAIN = DAMAGE

On many levels this makes sense to us, doesn't it? You have an injury, nerves carry pain signal to your brain and you feel pain. But if we stop and think about this for a minute, this doesn't work for a lot of scenarios. For example, how about migraines? The head pain accompanying a migraine can be really severe, but there's no initial injury or lasting damage. If you took 100 people who had no back pain and put them in an MRI scanner, 50-60% of them would have a disc bulge and/or osteoarthritis. And in cases of phantom limb pain, a person will feel pain and other sensations from a limb that is no longer there, due to amputation. There are also cases of people born without limbs experiencing sensations from limbs they've never had.

So if you can have migraine pain without tissue damage, disc or joint tissue damage but no pain, and pain without even a body part, then it can't be as simple as PAIN = DAMAGE.

So what is pain, if not a sign of tissue damage?

It would actually be much more accurate to describe pain as PAIN = THREAT. Pain is not actually something that exists in our bodies. It is an experience created by our brains and projected onto our bodies. (For more on that, see my TedX talk). Because of this, it's possible to feel pain before tissue damage occurs, or in situations where tissue damage might occur. Where your brain can predict potential danger or damage, it will use pain as a protective mechanism.

But, importantly, this threat detection system is not just concerned with physical tissue damage. When creating the experience of pain, your brain takes into account:

  • Your previous experience - have you been in this situation or environment before? Was it dangerous then?
  • Your levels of stress hormones - if you're ready to fight/flight/freeze, then you're probably at a higher risk of tissue damage, your brain might think
  • Your beliefs about your body - if you feel weak and vulnerable and prone to damage, then the potential threat in any given situation will be perceived as higher
  • Activity in the nerves in the area of your body that may be under threat - receptors on these are sensitive to pressure, temperature and certain chemicals

We've mentioned in a previous post the Biopsychosocial model of pain. This teaches that pain has 3 components which contribute to it.

  • "Bio" refers to the activity in the nerves and other things occurring in the body, like the levels of stress hormones.
  • "Psych" refers to previous experience and your beliefs about your body.
  • "Social" refers to the role of people, perhaps in your family or work. Are they generally supportive or dismissive of your pain?

And so, if you remember nothing else, remember that pain is not an accurate indicator of tissue damage. Remember that many other things go into the creation of an experience of pain. And remember that addressing things like stress at work, believing your body is "broken" and facing difficult memories, can be equally important as doing your exercises and taking your pills.


See other posts in the "Myth Busting" series