Understanding Pain: 3 Things You Should Know
Written by Meg Perri, BHES
What Is Pain?
Pain is one of the most common reasons people seek healthcare, yet it is often misunderstood. Many people assume that pain always means damage has occurred in the body. Modern pain science tells us that this is not always the case.
The International Association for the Study of Pain (IASP) defines pain as:
"An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."
This definition is important because it recognizes that pain can occur with or without tissue damage. Pain is real regardless of whether an injury is present.
Think of pain as your body's danger alarm, not a damage detector. The brain constantly receives information from the body and interprets those signals based on many factors, including past experiences, emotions, beliefs, memories, and the environment. The result of that interpretation is the experience of pain.
In other words, pain is a perception created by the brain to protect you.
Perception Is Contextual
How we experience pain depends heavily on context.
Imagine hearing a loud noise in the middle of the day at a construction site. You might barely notice it. The same noise in the middle of the night while home alone may feel alarming. The situation changes how your brain interprets the event.
Pain works in a similar way.
One famous example involves a construction worker who accidentally stepped on a large nail that appeared to go through his boot. He was in such severe pain that medical staff had difficulty removing the boot. Yet when the boot was finally removed, the nail had passed harmlessly between his toes. There was no tissue damage at all. The pain was completely real, but it was generated by the brain's assessment of danger, not by physical injury.
The opposite can also happen. People who suffer significant injuries during emergencies, such as soldiers in combat or individuals bitten by sharks, may initially feel little or no pain. In those moments, survival is the priority. Pain often emerges later, once the immediate threat has passed and the nervous system recognizes it is safe enough to process the injury.
These examples highlight an important truth: pain is influenced by far more than what is happening in the tissues.
What Can Influence Your Pain Experience?
Pain is affected by a wide range of factors beyond physical injury.
Thoughts and Beliefs
What we think about our pain matters.
If you believe that pain means you are seriously damaged, that you will never recover, or that movement is dangerous, your nervous system may become more protective. These thoughts can increase fear, stress, and vigilance, making pain feel more intense.
On the other hand, understanding pain and developing confidence in your body's ability to heal can help reduce the sense of threat and support recovery.
Emotions
Pain and emotions are closely linked.
Common emotions associated with pain include:
Fear
Anxiety
Stress
Frustration
Anger
Sadness
Grief
Depression
When we experience negative emotions, the body's fight-or-flight response becomes more active. This heightened state of alertness increases our sensitivity to potential threats, including physical sensations. As a result, normal sensations may be interpreted as dangerous, creating a cycle where pain and emotional distress reinforce one another.
Past Experiences
Previous experiences shape how we interpret pain.
For example, some individuals who were injured during military service report increased pain years later when hearing a helicopter. The sound itself is not causing tissue damage, but the brain has learned to associate it with danger and injury.
Our nervous system is designed to learn from experience, and sometimes those learned associations can continue to influence pain long after the original injury has healed.
Sleep, Activity, and Coping Strategies
Many lifestyle factors can influence pain sensitivity, including:
Poor sleep
High stress
Inactivity
Avoidance of movement
Overprotective behaviours
Reduced social engagement
When these factors accumulate, the nervous system often becomes more sensitive and protective.
What About Imaging Findings?
One of the most valuable things people learn about pain is that structural changes on imaging do not always explain symptoms.
Research has shown that many people without pain have findings such as:
Disc degeneration
Disc bulges
Arthritic changes
For example, studies have found that a large percentage of adults over age 50 have degenerative changes in their spine despite having no pain at all.
This does not mean imaging is useless. Rather, it reminds us that structural findings must be interpreted within the context of the whole person. Pain cannot be fully explained by scans alone.
What Are 3 Key Concepts You Should Know About Chronic Pain?
1. Pain Does Not Always Mean Your Body Is Damaged
One of the most empowering lessons in pain science is that pain and tissue damage are not the same thing.
Pain is the body's protective response to perceived danger. Sometimes that danger reflects actual injury, and sometimes it reflects a nervous system that has become highly protective.
Understanding this distinction can help reduce fear and create opportunities for recovery.
Just because pain is present does not automatically mean further damage is occurring.
2. Thoughts, Emotions, and Experiences Affect Pain
Pain is not "all in your head," but your brain does play a critical role in how pain is experienced.
Persistent pain is influenced by a combination of:
Physical factors
Thoughts and beliefs
Emotional responses
Stress levels
Past experiences
Environmental factors
Many people with chronic pain become trapped in a cycle of fear and avoidance. They begin to worry that movement will cause harm, so they move less. This can increase sensitivity, reduce confidence, and contribute to ongoing pain.
Understanding these influences allows us to address more than just the physical tissues. It gives us more tools to help reduce pain and improve function.
3. You Can Retrain an Overprotective Pain System
Perhaps the most hopeful message in modern pain science is that the nervous system can change.
This concept is known as bioplasticity, which refers to the body's remarkable ability to adapt and reorganize itself in response to experience. While many people are familiar with neuroplasticity, bioplasticity extends beyond the brain to involve the body's broader protective systems.
For individuals living with persistent pain, this means that an overprotective pain system can learn to become less sensitive over time.
Approaches that may help include:
Pain education
Gradual movement and exercise
Improving sleep and stress management
Building confidence in the body
Pain Reprocessing Therapy
Cognitive Functional Therapy
A key shift is learning to respond to pain rather than automatically react to it.
Instead of assuming every painful sensation means damage, we can become curious:
What else may be influencing my pain today?
Am I stressed, tired, or worried?
Is my body responding to threat rather than injury?
How can I move in a way that feels safe and confident?
These questions help shift the nervous system away from protection and toward recovery.
Looking for Support?
If you're living with ongoing pain, you don't have to navigate it alone. Kaz Kikuchi is our pain specialist at MoveMed Physiotherapy and has a special interest in helping people understand and manage persistent pain. Through evidence-based approaches and individualized care, he can help you better understand your pain and develop a plan to get back to the activities that matter most to you.
Book an appointment with Kaz today to learn more about your pain and start moving forward with confidence
Blog Post Written by, Meg Ackerman, BHES
Munro, N. R., Teague, S., Somoray, K., Simpson, A., Budden, T., Jackson, B., Rebar, A., & Dimmock, J. (2026). Effect of exercise on depression and anxiety symptoms: Systematic umbrella review with Meta-meta-analysis. British Journal of Sports Medicine, 60(8), 590–599. https://doi.org/10.1136/bjsports-2025-110301