9 Things You Should Know About Pain

1. Pain is output from the brain.

While we used to believe that pain originated within the tissues of our body, we now understand that
pain does not exist until the brain determines it does. The brain uses a virtual "road map" to direct an
output of pain to tissues that it suspects may be in danger. This process acts as a means of
communication between the brain and the tissues of the body, to serve as a defense against
possible injury or disease.

2. The degree of injury does not always equal the

degree of pain.
Research has demonstrated that we all experience pain in individual ways. While some of us
experience major injuries with little pain, others experience minor injuries with a lot of pain (think of a
paper cut).
3. Despite what diagnostic imaging (MRIs, x-rays,
CT scans) shows us, the finding(s) may not be the
cause of your pain.
A study performed on individuals 60 years or older who had no symptoms of low back pain found
that 36% had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or
bulging disc, upon diagnostic imaging.

4. Psychological factors, such as depression and

anxiety, can make your pain worse.
Pain can be influenced by many different factors, such as psychological conditions. A recent study in
the Journal of Pain showed that psychological variables that existed prior to a total knee
replacement were related to a patient's experience of long-term pain following the operation.

5. Your social environment may influence your

perception of pain.
Many patients state their pain increases when they are at work or in a stressful situation. Pain
messages can be generated when an individual is in an environment or situation that the brain
interprets as unsafe. It is a fundamental form of self-protection.

6. Understanding pain through education may

reduce your need for care.
A large study conducted with military personnel demonstrated that those who were given a 45-
minute educational session about pain sought care for low back pain less than their counterparts.

7. Our brains can be tricked into developing pain

in prosthetic limbs.
Studies have shown that our brains can be tricked into developing a "referred" sensation in a limb
that has been amputated, causing a feeling of pain that seems to come from the prosthetic limb – or
from the "phantom" limb. The sensation is generated by the association of the brain's perception of
what the body is from birth (whole and complete) and what it currently is (postamputation).

8. The ability to determine left from right may be

altered when you experience pain.
Networks within the brain that assist you in determining left from right can be affected when you
experience severe pain. If you have been experiencing pain, and have noticed your sense of
direction is a bit off, it may be because a "roadmap" within the brain that details a path to each part
of the body may be a bit "smudged." (This is a term we use to describe a part of the brain's virtual
roadmap that isn’t clear. Imagine spilling ink onto part of a roadmap and then trying to use that map
to get to your destination.)

9. There is no way of knowing whether you have a

high tolerance for pain or not. Science has yet to
determine whether we all experience pain in the
same way.
While some people claim to have a "high tolerance" for pain, there is no accurate way to measure or
compare pain tolerance among individuals. While some tools exist to measure how much force you
can resist before experiencing pain, it can’t be determined what your pain "feels like."

Read more about Pain and Chronic Pain Syndromes.

The American Physical Therapy Association's #ChoosePT campaign raises awareness about the
risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn
more at our #ChoosePT page.

Author: Joseph Brence, PT, DPT

Bibliography
Allegri M, Montella S, Salici F, et al. Mechanisms of low back pain: a guide for diagnosis and therapy
[revised]. F1000Res.2016;5:F1000 Faculty Rev-1530. doi: 10.12688/f1000research.8105.2.

George SZ, Childs JD, Teyhen DS, et al. Brief psychosocial education, not core stabilization,
reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military
(POLM) cluster randomized trial. BMC Med. 2011;9:128.

Carroll I, Wang J, Wang M, et al. Psychological impairment influences pain duration following
surgical injury. J Pain. 2008;9 (Suppl 2):21.

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