The Complexity of Pain: More Than Just Physical Damage

When I started studying physiotherapy, I had no idea what pain was. My definition was: “Pain is a result of damage.” Now, in my second year, I see pain as something much more complex and have learned that pain often isn’t even related to damage in the body.

Even though a lot of research has been done on pain — its purpose, how it arises, and what we can do to relieve or stop different types of pain — there’s still so much we don’t fully understand about its origins.

So, what is pain exactly?

Imagine watching a video on social media. In the video, you see a dark door, hear a creepy sound, and suddenly, a scary figure jumps out at the camera. You flinch, even if you know it’s fake because it looks so real. This happens because your brain is excellent at detecting danger — even when it’s not real. It evaluates all the information it’s receiving: the context (a dark door and a creepy sound), the expectation (you sense something is about to happen), and the visual cues (the figure leaping toward the camera). Your brain perceives danger and reacts with a startle reflex, even though there’s no actual threat.

You can think of our pain system in the same way. Pain isn’t just caused by direct damage to your body; it’s also influenced by how your brain interprets signals to protect you. Your brain can respond to things or situations that seem dangerous, even if they aren’t.

different types of pain

It’s helpful to understand the different types of pain and their symptoms. Normally, we feel pain when tissue damage occurs, such as a cut on the skin, without damage to the nerves themselves.

This is called nociceptive pain. It’s typically localized, constant, and often feels sharp or throbbing.

Apart from pain caused by physical tissue damage, there’s another, more complex type of pain:

neuropathic pain, which arises from damage to your nervous system. Think of a herniated disc (radiculopathy), where inflammation or compression of a nerve root leads to symptoms like tingling, numbness, reduced limb sensation, and changes in muscle function. Neuropathic pain can also occur when nerve tissue is pinched or damaged, called neuropathy. Symptoms may include tingling and numbness in a specific part of an arm or leg. Examples of this include carpal tunnel syndrome and piriformis syndrome.

And then there’s chronic pain. In medical terms, pain is considered chronic when it lasts longer than three months, well beyond the usual healing time for tissue. In people with chronic pain, there’s often an increased sensitivity to pain. This happens because the body processes pain signals differently in the brain and spinal cord, leading to an exaggerated response to pain (central sensitization). While this is a normal protective response, it becomes problematic when it persists and affects daily life.

I experienced this myself. The pain in my back lingered, and my body’s “alarm system” became overly sensitive, even though I didn’t have any physical or neurological damage. My physiotherapist quickly realized that nothing was wrong with me apart from the pain. She explained that I should think of my body as a house with a burglar alarm. Normally, the alarm goes off when someone breaks in. But in my case, the alarm was so sensitive it went off for something as small as an ant entering the house.

So, what can you do about it?

It’s both incredibly simple and difficult: keep moving, but let pain guide you.

Movement is incredibly healthy — on that, we can all agree. But it’s even more important to move while listening to your body and doing what you enjoy.

If you’re dealing with central sensitization, you need to retrain your body, reprogramming your brain to understand that movement isn’t dangerous. This means exercising with a little bit of pain. Start small and build up gradually.

After a few basic training sessions, you can do anything you enjoy — cycling, swimming, fitness, walking, yoga, football, dancing, you name it.

Pain isn’t just a signal of damage; it’s a complex process influenced by your brain, emotions, and environment. By understanding how pain works, we can learn how to manage it better.

This was just a brief introduction to the vast topic of pain. I hope I’ve sparked your curiosity. In a future story, I’d like to dive deeper into how your emotions, environment, and stressors can negatively impact pain.