While research has given us tremendous insight into pain over the past half century, that knowledge hasn’t infiltrated the minds of the public. This is unfortunate, because if we understand more about how pain works then we will actually hurt less.
We now know with 100% certainty that pain is an output of the brain. Said another way, “No brain, no pain”. Information coming into the brain from threatened or injured tissues the body, termed nociception, is very important when it comes to pain but it doesn’t guarantee that you will have pain. This is because the brain weighs all of the information it receives and makes the final decision based on perceived threat.
Because pain is a function of the brain, you can have an injury without pain, and you can have pain without injury. Have you ever been working in the shop or garden and a couple hours later and noticed a cut on your hand that you didn’t realize happened? Your skin was damaged enough to trigger nociception, however the brain didn’t produce pain. Your brain actually shut down the signal coming into the central nervous system, and did so using the most powerful pain relieving chemicals on the planet. You won’t find these chemicals at your local drug store and they aren’t available by prescription, they are produced by your brain. On the contrary, when watching someone sprain their ankle or wiping out on a skateboard, many of us “feel” pain. There is no actual tissue damage here, no nociceptive input, but the pain is real. Your brain produces actual pain despite no information coming from your ankle.
Therefore, nociception doesn’t equal pain, and pain doesn’t equal nociception. Most of the time, nociception leads to pain, however it isn’t a guarantee you will have pain and it isn’t required for pain.
In fact, according to the International Association for the Study of Pain (IASP), the definition of pain is “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”
Many people reading this will think “So you’re saying pain is all in my head?” The answer is yes and no. Yes, because your brain is in your head, and you cannot have pain without a brain. No, because all pain is real, whether it comes from nociception or not.
What I am saying here may be contrary to what you think about pain, however there is good news. Since pain is ultimately produced in the brain, it is a biological event and has the potential to change. Since the brain has a huge effect on your pain, what you believe about your pain can powerfully influence your pain. Knowledge about how pain actually works, therefore, may be the most underestimated, cheap, and underused treatment of all.
Treatment directed at a painful body part (e.g. lower back, hip, elbow, etc.), even with interventions directed toward the body (e.g. the McKenzie Method), should include accurate pain education. In pain states that aren’t dominated by nociception, for example chronic pain states, education about pain, with the goal to change the perception of threat, has been shown to be a very powerful intervention to regain function and get back to life. In fact, there is Gold Level evidence for pain education combined with movement in the treatment of persistent pain.
Accurate pain language and education is a critical component of our assessment and treatment. Learning about pain is part of therapy. When you understand why you hurt, you hurt less.