Pain Science Basics

Key Points:

• Pain is complex, multifaceted, and entirely subjective
• Treating pain requires us to look at the whole person and respect their lived experience
• Pain is a lot more than just the tissues involved, and may in fact have very little to do with physical structures

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Inputs vs Outputs

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What is pain?

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One dictionary definition is “physical suffering or discomfort caused by illness or injury”.

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But how does pain work?

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We often think of pain as something that your body detects and sends to your brain, which is what causes us to feel it. But this isn’t quite accurate.

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What our body picks up is a dizzying variety of sensations: vibration, temperature, deep pressure, etc. It also picks up what we call “nociceptive” or noxious inputs. You can think of this as anything that feels unpleasant, like being pinched.

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This input gets sent to your brain and then your brain has to interpret it. It’s this interpretation that can turn nociception into pain.

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Once your brain picks up these inputs, looks at your surroundings, compares it to your past experience, and decides that these inputs might be threatening, then it outputs pain to try and convince you not to do that thing because it might be damaging.

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So pain is (among many other things):

1. A response to actual or perceived threat(s)
2. An output from our brain

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What Brain Pain Means

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If pain is not actually a marker of damage in our bodies, but a response to possible threats, what does that mean?

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It means that pain and damage are not the same thing. We can have lots of pain and not much damage (like in [this BJM article] about a roofer who thought he put a nail through his foot) or lots of damage and relatively little pain (like hikers who break a bone and walk home).

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It also means that pain is something that everyone experiences differently. What pain means to us, how we think about it, and how we deal with it will vary based on our upbringing, our personality, and our current circumstances.

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Pain being an output of our brain also means that there are a lot of things we can do to help with pain that might not be directly connected to the place where we feel the pain. Examples include:

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1. Walking as a treatment for low back pain. Walking doesn’t impact the back very directly, but can still be a great intervention for pain, comparable to other forms of exercise.
2. Cognitive behavioral therapy as a treatment for chronic pain. Changing how we think about and relate to our pain can directly impact how much pain we feel!

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All of these factors and more are summed up in what’s called the biopsychosocial model of pain, which is currently one of the most research-supported models of how pain works. Other models include anatomical or mechanical models, which leave out the vital brain connection.

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Further Reading

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Pain is a very complex topic, and there are lots of resources available to help get your head around it. Some of our favorites include:

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1. Explain Pain by Lorimer Moseley
2. The Science of Pain by Paul Ingraham (along with the rest of his site)
3. Why Do I Hurt? By Adriaan Louw

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This article presents the very tip of the iceberg when it comes to understanding pain. But hopefully it helps give you a little perspective, namely by showing that pain and damage are not the same thing, and that pain is multifactorial and ultimately kind of weird.

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If you need help with a pain issue, we’re here to help. Whether it’s an acute, chronic, or episodic problem, we can help you find ways to manage it, help your body heal, and keep you moving. So reach out and let us know how we can help!

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