Defining Pain

Jun 23

Pain can be understood as a sensation triggered by a perceived threat of harm, either consciously or subconsciously. Its purpose is to drive behavior changes that reduce this perceived threat.

While pain can result from tissue damage, it doesn’t require damage to occur. Pain is your body’s way of signaling a potential threat, even if the threat isn’t real.

Why This Happens

Your body’s survival instincts are cautious, often erring on the side of overreaction (a “Type 1 error”). For example:

You hear rustling in the bushes and assume it’s a tiger.
It turns out to be the wind, but the reaction kept you safe.

Similarly, pain can arise even when no actual injury is present, especially if your body perceives a risk.

Pain and Injury Correlation

The relationship between pain and injury varies based on several factors:

1. The Healing Timeline

Acute Stage: Pain and injury are strongly correlated during the initial inflammatory response, which is crucial for tissue healing.
Later Stages: As inflammation resolves, pain becomes less reliable as an indicator of ongoing injury.

2. Injury History

If you’ve experienced an injury in a specific area before, your body may be more sensitive to perceived threats there. This heightened sensitivity can trigger pain, even in the absence of a new injury.

3. Macrodamage vs. Microdamage

Macrodamage (e.g., a torn ligament):

Stronger pain-injury correlation than microdamage.
Often involves significant tissue damage, clear symptoms, and acute inflammation.

Microdamage (e.g., mild muscle strain):

Weak pain-injury correlation.
Microdamage is normal and necessary for strengthening tissues. Pain typically only occurs if:

Recovery is insufficient.
Past injuries heighten sensitivity.
Microdamage progresses into macrodamage.

Where Healthcare Goes Wrong

The problem arises when pain leads to imaging, and findings like disc bulges, arthritis, or cartilage wear are automatically blamed. These types of “microdamage” are common, often harmless, and not necessarily the cause of pain.

Key Takeaway

Pain doesn’t always mean injury, and injury doesn’t always mean pain. Understanding the nuances can help you move forward with confidence, knowing that pain is only one piece of the puzzle.