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The Body

7 Things You Should Know About Pain

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Understanding the dimensions of pain and the neuroscience behind it is an empowering recovery tool.

As unpleasant as it is, pain is actually quite normal. We all (with very rare exceptions) experience pain, defined as a localized or generalized bodily sensation (or complex of sensations) causing mild to severe physical discomfort. According to the U.S. Centers for Disease Control and Prevention, 20.4 percent of adults experience chronic pain—classified as pain felt on most days or every day for longer than three months.

Pain is also tricky. We each experience it differently and for various reasons.

Thanks to advancements in neuroscience, our understanding of pain and how it’s processed has dramatically changed. For starters, scientists now know that pain is a complex and subjective experience unique to the individual—not a reliable indicator of damage. How a person perceives and experiences pain is dependent on many factors, and understanding how it works has been proven to help with recovery.

Research studies show that pain neuroscience education (PNE)—aimed at helping patients understand and reframe their experience of discomfort—effectively reduces pain and improves function. So, it’s about time we all knew some basic understandings about the sensation.

While there’s so much more to learn, particularly about chronic pain, here are seven fundamental things everyone should know.

1. Pain is essential.

Designed to protect you, pain is your brain’s way of sounding the alarm when it suspects that your body is under threat. Its purpose is to get you to do something, like pull your palm away from a hot burner or to get up when you’ve been sitting for too long. In that sense, pain is a good thing. It’s a survival mechanism designed to keep you safe.

2. All pain is created in the brain.

Even when there is an acute injury, pain doesn’t come from the damaged tissue itself—pain is always processed in the brain and nervous system. In other words, your brain determines whether or not you feel pain.

You can think of pain as an output from the brain that’s determined by the various input it receives, including information from little sensors in the tissue called nociceptors. Nociceptors send potential danger signals from the body to the brain, but aren’t the only input taken into consideration. A number of things are unconsciously factored into the brain’s decision to create (or inhibit) pain.

3. Pain is multidimensional.

Your beliefs expectations, emotions, past experiences, coping strategies, attitude, and lifestyle all influence your level of pain. No longer blindly equating pain to physical damage, scientists (and an increasing number of health professionals) have adopted a bio-psycho-social approach to pain.

In other words, there is a physical, emotional, cognitive, and social component to the distressing experience of pain. All areas of your life—your job, relationships, habits, memories, internal dialogue, and especially stress—influence how much pain you experience. Which means you have a lot of personal agency when it comes to managing your own pain.

4. Pain is unique to the individual.

Given its multidimensional nature, you can see how pain is highly individualized. No two people experience pain the same way regardless of injury. How your central nervous system and brain interpret and respond to the many signals they receive is entirely unique to you and your individual circumstances.

5. Pain isn’t synonymous with damage. And sometimes it’s just weird.

Counterintuitive as it seems, pain (for all of the reasons above) does not necessarily mean there’s damage. And, there can be damage without the experience of pain.

For example, someone with a healthy spine can experience chronic lower back pain. Meanwhile, studies show that individuals with degenerative spinal conditions may or may not experience pain.

Remember, tissue damage is just one of the inputs. The brain can perceive there’s a threat and create pain when there isn’t any real danger or damage. The brain can also determine that sounding the alarm isn’t necessary even in the presence of an injury. Pain’s just weird like that. The brain may even inhibit the pain response completely if it deems it better for survival.

6. Persistent pain alters the brain’s pain response.

Acute pain tends to be helpful when you’ve been injured, protecting the body part long enough for it to heal. Complications arise, however, when pain hangs around longer than necessary.

Pain is considered chronic after three months. Persistent chronic pain alters the brain and pain response, increasing the sensitivity of the alarm system.

Through a neural process called long term-potentiation (neurons that fire together, wire together), we essentially train our brains to become better at creating pain. The nervous system becomes hypersensitive, taking less stimulus (be it physical, cognitive, emotional, or environmental) to trigger the pain response. Sometimes even just thinking about pain can create pain.

7. All pain is real.

While produced by your brain, pain is not “all in your head.” It is a very real and unpleasant experience. Even in the absence of damage, whatever pain you’re experiencing is real. And it’s important to know that.

Pain, particularly chronic pain, is an incredibly personal, complex, unpleasant, and distressing experience. However, that also means there are many ways to approach your recovery. The more you understand the neuroscience behind pain, the more empowered you’ll become to start helping yourself and the sooner you’ll be on the road to recovery.

Take action: “Help Your Nervous System Manage Pain.”