Myth 1: Pain = tissue damage

Pain is absolutely real, and we will never downplay someone’s experience with pain. Pain = pain… but we want to discuss a common misconception: that pain = damage.  

This is an important concept to understand because the first step in appropriately treating pain is understanding it. Studies suggest that pain neuroscience education, in conjunction with other pain management approaches, (like physical therapy) will help improve outcomes.

Research shows us that there is not necessarily a correlation between pain and tissue damage. This means that you can experience pain without actual tissue damage and you can have tissue damage without experiencing any pain. 

 Pain is a protective mechanism, your body’s way of sending you a warning. We have come to learn that pain is extremely complex and is actually an output from the central nervous system. This means that your brain interprets sensory information and responds to it based off of biological, psychological, and social factors including emotions and past memories. In other words, pain is the response to how your brain perceives a threat. It is not an accurate assessment of tissue damage, but rather a signal from the brain urging some form of action.

Something most of us can relate to is the phenomenon of stepping on a Lego. We’ve all done it. It feels like 10/10, awful, excruciating pain…but at the end of the day has any significant injury occurred? Usually not. Your brain has sent a signal and the common response is to assess the situation and pick up the legos.

Another, less common example involves you spraining your ankle while running away from a lion. More likely than not, you won’t feel the pain until the emergency is over and you are safely away from the lion. Does this mean that you did not sprain your ankle? No..it means that your brain perceives the threat of the lion as more dangerous than the injury to your ankle.

In chronic or persistent pain conditions, we discover that the pain experienced is not necessarily reflective of the state of the tissues, but of the overactive pain system itself. Generally, in these cases the pain system becomes overly sensitive and hyper-responsive to non-threatening stimuli. The threshold for pain is lowered, meaning less stimulus is required to feel pain.

What is the key to handling pain? Once we can understand the true threat vs. perceived threat we can put into action a plan to reduce and normalize the pain system response.

References:

• Crofford LJ, Casey KL. Central modulation of pain perception. Rheum Dis Clin N A. 1999;25:1–13

• Crofford LJ. Chronic pain: Where the body meets the brain. Trans Am Clin Climatol Assoc. 2015; 126: 167-183

• Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331(2):69–73

• W de Heer et al. The association of depression and anxiety with pain: a study from NESDA. PLoS One. 2014 Oct 15;9(10):e106907.  doi: 10.1371/journal.pone.0106907

• Geneen LJ, Martin DJ, Adams N, et al. Effects of education to facilitate knowledge about chronic pain for adults: a systematic review with meta-analysis. Syst Rev. 2015;4:132. Published 2015 Oct 1. doi:10.1186/s13643-015-0120-5