Why pain does not always equal damage

What is pain? 

Pain is a protective mechanism of the nervous system designed to keep the body safe, but it’s also influenced by previous experiences, sleep, stress, emotions, expectations and context, as well as what the body is physically experiencing at any given time. 

This protective system can sometimes become more sensitive following injury, surgery or prolonged pain – a process known as pain sensitisation.

Think of the pain system like a smoke alarm. The smoke alarm’s job is to warn us of a potential fire – but if it’s tuned too sensitively, even trace amounts of smoke from a burning crumb in the toaster can set it off. The alarm is real, but the intensity of the alarm doesn’t tell us anything about the size of the fire.

When the body experiences persistent or chronic pain, or conditions like fibromyalgia, the pain system can become overprotective, and continue to send pain signals even when there’s no longer identifiable tissue damage. The nervous system has learned over time to become more effective at protecting the painful areas, and continues to trigger the signal even with less stimulation.

There’s good news, though. Just like it can learn to become more efficient and protective, the nervous system can also learn to reduce its level of protectiveness again. And you don’t need to automatically remove every movement that causes discomfort; in fact, this could make things worse by reinforcing the body’s existing response.

By prescribing appropriate movement, graded exposure and progressively rebuilding physical capacity, an Exercise Physiologist can support you to retrain your nervous system’s response to pain.

This is what we’ve done with a recent client of ours, Emma*. Emma was experiencing persistent lower back pain. She’d already had surgery to fix the actual structural problem; but it still hurt. She was avoiding movement as much as possible in an effort to protect herself from more damage.

But avoiding movement was actually making her pain worse – she’d lost strength, and her body had adapted to protective movements and patterns that were actually unhelpful.  We worked with Emma to shift her focus from “How can I avoid making it worse?” to “What can my body currently tolerate, and how can we safely build from here?” 

The pain cycle 

Why was avoiding movement making Emma’s pain worse? It’s because of something we call the “pain cycle”. Past pain causes fear of future pain, so we avoid movement in an effort to prevent it. But avoiding movement reduces our strength and capacity for those movements, making them less familiar to our body over time. Because of this, the nervous system can increase its protective effect relating to that movement – leading to more pain in the area.

The physical and mental aspects of pain aren’t separate. But that doesn’t mean you’re just imagining pain. Not finding tissue damage that adequately explains someone’s pain does not make the pain any less real, or easier to overcome.

Working with an Exercise Physiologist, like Emma did, can help you to gradually rebuild strength, function, capacity and confidence around movement in a safe and supported way.

An Exercise Physiologist can advise on appropriate exposure to triggering movements and the right speed of progression to help retrain your body to tolerate the movements that are causing pain.