Pain Doesn’t Always Mean Damage: What Is Your Pain Actually Telling You?
How much something hurts doesn't necessarily tell us how much damage there is.
That can sound strange. If something hurts, surely that means something is injured?
Sometimes, yes.
If you sprain your ankle, cut your finger or burn your hand, pain is doing an important job. Something has happened to the tissues and your nervous system is responding to it.
But pain is more complicated than a simple damage detector.
And understanding that can completely change how we think about pain that sticks around.
So what actually is pain?
Pain is an experience created by your nervous system in response to information about actual or potential threat.
The International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage (Raja et al., 2020).
There are two important words in there:
Actual or potential.
Your nervous system doesn't need to wait until damage has occurred before protecting you.
Think about touching something extremely hot. You pull your hand away very quickly. Your nervous system is designed to detect potential danger and respond.
That's useful.
Pain is part of that protective system.
Does pain mean something is damaged?
It can.
If you've just fractured a bone, sprained an ankle or injured a muscle, tissue damage may be an important part of why you're experiencing pain.
But pain and damage don't have a simple one-to-one relationship.
A lot of pain doesn't automatically mean a lot of damage.
And very little pain doesn't necessarily mean nothing is wrong.
Pain is influenced by information coming from the body and by the way the nervous system processes that information (Raja et al., 2020).
That's why I don't assess pain by asking only:
“Which structure is damaged?”
I also want to know what happened, how long it has been there, what makes it better or worse, how it's affecting your movement and activity, and whether there are any signs that need further investigation.
Why can something still hurt after an injury has healed?
This is where pain science becomes particularly interesting.
Pain can sometimes persist beyond the expected healing time of an injury.
That doesn't mean the pain isn't real.
And it doesn't mean someone is imagining it.
Our nervous system is adaptable. The way it processes potentially threatening information can change over time. In some persistent pain presentations, the pain system can become more responsive or protective even when ongoing tissue damage doesn't adequately explain the symptoms. This altered processing is one of the mechanisms considered in some forms of chronic pain.
A useful way to think about it is a smoke alarm.
A smoke alarm is supposed to alert you when there's a fire.
But imagine if it became so sensitive that it started going off when you made toast.
The alarm is real. The fire isn't.
That's not a perfect representation of how pain works, but it helps explain why the intensity of an alarm doesn't always tell us the size of the threat.
Pain can work in a similar way.
Does that mean pain is “all in your head”?
No.
Pain is always real.
Describing the nervous system's role in pain does not mean pain is psychological, imaginary or something you should simply ignore.
The current definition of pain specifically recognises that pain is a personal experience influenced to varying degrees by biological, psychological and social factors (Raja et al., 2020).
Sleep, stress, previous experiences, beliefs about an injury, general health, physical activity and many other factors can influence someone's pain experience.
That doesn't make the pain less legitimate.
It just means the human pain system is more sophisticated than a warning light that switches on whenever a tissue is damaged.
Why does this matter for recovery?
Because what we believe about pain can influence what we do when something hurts.
If every painful movement is interpreted as:
“I'm damaging myself.”
...it makes complete sense to avoid that movement.
Sometimes avoiding a movement temporarily is appropriate.
But if the tissue is safe to load and pain is persisting, gradually returning to movement can be an important part of recovery.
This is one reason pain science education is increasingly used alongside approaches such as exercise and rehabilitation for persistent musculoskeletal pain.
Recent systematic reviews suggest pain neuroscience education may help some people with chronic musculoskeletal pain, particularly when incorporated into a broader treatment approach rather than used by itself. However, the research is heterogeneous and the quality of the existing evidence varies, so education shouldn't be presented as a stand-alone solution to persistent pain (Cuenca-Martínez et al., 2023; Siddall et al., 2023).
Understanding pain doesn't magically make it disappear.
But it can give us a better framework for deciding what to do next.
Should I ignore pain then?
Definitely not.
“Pain doesn't always equal damage” is not the same as “pain doesn't matter.”
Pain is information.
If something suddenly becomes painful, changes significantly, follows a substantial injury or is accompanied by other concerning symptoms, it deserves appropriate assessment.
The aim of pain science isn't to convince someone that nothing is wrong.
It's to work out what the pain might be telling us.
Sometimes the answer is that a tissue has been injured and needs time and appropriate rehabilitation.
Sometimes the tissues are safe, but the area has become sensitive.
Sometimes several factors are contributing at once.
And sometimes the presentation tells us that further investigation is appropriate.
So what should I take away from this?
If there is one thing I'd like people to understand about pain, it's this:
Pain is a protective experience, not a damage meter.
It deserves to be listened to, but it also needs to be interpreted in context.
If something hurts, the question doesn't always have to be:
“What have I damaged?”
Sometimes a more useful question is:
“Why might my system be protecting me here, and what information do we have that tells us what is safe to do next?”
That's where a good assessment becomes important.
Pain that doesn't seem to make sense?
If your pain has persisted longer than expected, seems disproportionate to what happened, keeps returning or is making you afraid to move, it may be worth looking at the bigger picture.
You’re welcome to book an osteopathy appointment with me in Burleigh Waters.
References
Cuenca-Martínez, F., Suso-Martí, L., Calatayud, J., Ferrer-Sargues, F. J., Muñoz-Alarcos, V., Alba-Quesada, P., & Biviá-Roig, G. (2023). Pain neuroscience education in patients with chronic musculoskeletal pain: An umbrella review. European Journal of Pain.
Raja, S. N., Carr, D. B., Cohen, M., et al. (2020). The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain, 161(9), 1976–1982. DOI: 10.1097/j.pain.0000000000001939.
Siddall, B., et al. (2023). A call for improving research on pain neuroscience education and chronic pain: An overview of systematic reviews. Journal of Orthopaedic & Sports Physical Therapy, 53(6). DOI: 10.2519/jospt.2023.11833.
