Explaining Pain

We’ve all been there—that annoying ache in your shoulder or the sharp tug at your lower back that just won’t quit. While pain is often our body’s way of hitting the “alarm” to protect us, sometimes it goes from a helpful warning to a major roadblock in our daily lives. The good news is that understanding your pain is the first step toward feeling better. In this post, we break down how pain works and which strategies can help quiet the alarm so you can move more comfortably.

First things first. A few definitions:

What pain is…

The brain’s “alarm” that is meant to protect us from harm.

What pain isn’t…

A direct measure of tissue damage.

The process of detecting potential or actual tissue damage and sending this signal to the brain is called nociception. Pain is the unpleasant experience your brain creates when it receives those signals.

In other words…

Nociception = the signal

Pain = the perception/experience

For those who like analogies:

The doorbell ringing is nociception. Pain is you deciding to get up and answer it.

Still not convinced that pain doesn’t directly correlate with damage?

Consider these examples…

Signals with NO Pain: Have you ever found a bruise on your arm and had no idea how it got there? Your nerves sent "danger" signals (nociception) when you bumped into that table, but your brain was busy or didn't see the bump as a threat, so it never produced the feeling of pain.

Pain with NO Signals: People with phantom limb pain feel real, intense pain in a limb that is no longer there. In this case, there are no "danger" signals coming from the arm or leg, but the brain still produces the feeling of pain because it thinks the area is under threat.

In short, the signal is just information; the brain decides what it means, and pain is the brain’s response to that information.

The brain is always asking, “How dangerous is this?” and things like context, past experience, and what you expect all matter.

Like snowflakes, pain is incredibly complex and unique. It is a personal experience shaped by a mix of body, mind, and social factors.

Biological: things like your genetics, age, and any existing health conditions (such as inflammation or nerve damage) can determine how sensitive you are to pain.

Psychological: your mindset matters a lot. High stress, anxiety, or focusing too much on pain can actually make it feel stronger.

Social: Your environment and relationships matter. Having a strong support system or specific cultural beliefs can change how you express and cope with discomfort.

Since all these factors interact, two people with the exact same injury can feel very different levels of pain!

A couple more definitions:

Acute pain is the normal, predicted response to a stimulus. For example, if you had hip surgery, there would be a usual pattern of pain and recovery based on patient demographics. 

Chronic pain is pain that persists for 3 months or longer. It can often lead to physical decline, limited function, and emotional distress. 

Sometimes…

As we said before, this alarm system can change from a helpful warning to a big problem. In other words, it can get too sensitive and cause pain even during normal, safe movements.

But remember…

Hurting doesn’t always mean you are being harmed. If serious medical “red flags” are ruled out, feeling pain when you move does not always mean you are actually hurting your body.

It’s important to understand:

What you believe about your pain can make the experience more or less intense. Knowledge is safety. So, even just learning how pain works can help your brain feel safer, which can naturally lower the pain you feel.

This is good news because it means we can retrain this system with the right rehab!

Strategies for managing chronic pain aren’t necessarily about “fixing” a body part. It’s about retraining our brains to feel safe again. When the brain stops seeing movement as a threat, it “turns down the volume” on the pain.

Curious what that might look like?

Well, it depends on the person. But here are a few strategies your physio (and other healthcare providers) might discuss and practice with you:

Graded Exposure

This is a common way to retrain the brain. You find a movement you’re scared of (like bending over) and do it in small, safe amounts. By doing the movement again and again without getting hurt, you show your brain it’s safe, and it slowly lowers the alarm.

Graded Motor Imagery

Sometimes a movement hurts so much it’s hard to even try. In this case, you can “exercise” the brain without moving your body. This might mean imagining yourself doing the painful movement easily and comfortably. This is called mental rehearsal, and it uses many of the same brain pathways as actually doing the movement. Think of Olympic athletes who visualize their race before it happens.

Sensory Retraining

If an area is so sensitive that even clothes or a light touch hurts, you can “calm down” the nerves. This might mean touching the sensitive spot with different textures (silk, wool, a soft brush) for a few minutes several times a day. This helps the brain learn the difference between “normal touch” and “danger” and gradually reduces its response to all sensations.

Pacing

Many people push themselves until they "crash" and then rest for days. This keeps the brain on high alert. You can learn to move in smaller, more consistent amounts that create a “steady state” to calm the nervous system and prevent big pain spikes that trigger the brain’s alarm.

Down-Regulation Techniques

A simple example of this is slow, deep (diaphragmatic) breathing. Breathing this way stimulates the vagus nerve, which reduces stress hormones like cortisol and adrenaline, potentially decreasing the overall pain response. It also stimulates the release of endorphins, our body’s natural pain relievers. Deep breathing also helps relax muscles, which can help decrease tension-related pain. Over time and with regular practice, controlled breathing has been shown to alter brain pathways and actually raise the pain tolerance threshold!

Information overwhelm? That’s fair. We know it’s a lot. But you deserve to understand your symptoms. So, if you’re experiencing pain, we encourage you to come in and see us to learn more. As physios, we love educating and empowering patients. We’d be thrilled to support you through an individualized therapy program!

Call us at 250.339.6221 or book online HERE.

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References:

Asmundson,G. Gomez-Perez,L. Richter, A. Carleton, RN. The psychology of pain: models and targets for comprehensive assessment. Chapter 4 in Hubert van Griensven’s Pain: A text book for health care professionals. Elsevier, 2014.

Moseley GL. Reconceptualising pain according to modern pain science. Physical Therapy Reviews. 2007;12(3):169–78.

Wager TD. Expectations and anxiety as mediators of placebo effects in pain. Pain 2005;115:225–6

Fields HL. Pain modulation: expectation, opioid analgesia and virtual pain. Biol Basis Mind Body Interact 2000:245–53

Moseley L, Butler,  DS. Fifteen years of explaining pain: the past, present and future. The Journal of Pain. 2015; 16(9): 807-813.

Louw A, Nijs J, Puentedura EJ. A clinical perspective on a pain neuroscience education approach to manual therapy. J Man Manip There. 2017; 25(3): 160-168.

Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, Fu R, Brodt ED, Wasson N, Winter C, Ferguson AJ. Noninvasive nonpharmacological treatment for chronic pain: a systematic review.