Pain – All in Your Head?

Last week we explored the PAIN = DAMAGE myth and saw that:

If the brain feels there is credible evidence of a threat, it will create the experience of pain to protect you. Like that fire alarm sensing smoke or heat, it will sound the alarm. This in essence means that pain is not something that exists IN the body, it is created by your brain and projected ONTO your body.

Now, I just want to pause here and deal with a thought that many of you are having right now. You might be thinking “Are you saying that for some people their pain is in their head?” No. I’m saying that for all of us, 100% of the time, pain is in our heads.

But don’t mis-understand me. What I mean by that is that 100% of the time pain is an output of the brain. What I’m not saying is that, if your pain isn’t driven by tissue damage, then it’s not “real” pain.

If we return to our fire alarm analogy, that fire alarm could be sounding because of a house fire or because of burned toast, but the sound it makes in both those situations is the same. Regardless of what is driving pain, the experience of it is just as real.

And for this reason we must move away from the PAIN = DAMAGE myth. Because if we believe that pain is always an accurate indicator of injury or damage in the body, not only is it untrue, it can actually be very harmful. 

I mentioned last week that this myth could be considered a leading cause of long-standing low back pain. One of the reasons for this is because the language we use when talking about low back pain is often quite scary. When we talk about a slipped disc, a twisted pelvis, a weak core or a spine that’s “out” these can be scary-sounding things, even though they are not life-threatening things at all. What often results from this kind of language is that people become frightened of their own bodies. Thinking back to what we learned last week about pain, we know that stress hormones and your beliefs about your health and your body play a big role in the creation of the pain experience. And so, we see how a vicious cycle could begin. People are frightened, feel more pain, and because they feel more pain they become more frightened.

So an obvious thing that I would ask is that if you’re a healthcare professional, especially if you’re in the manual therapies, stop scaring your patients. We don’t have good evidence that weak cores or twisted pelvises exist in the way that we describe them, much less that they cause pain. But we do have good evidence that the language we use can make patients feel fragile and broken. And this absolutely does contribute to their experience of pain.