article by Céline Clément, PT
No one really wants pain. Once you have it you want to get rid of it. This is understandable because pain is unpleasant. But the unpleasantness of pain is the very thing that makes it so effective and an essential part of life. Pain protects you, it warns you about dangers, often before you actually become injured. It is your body’s alarm system. It makes you move differently, think differently and behave differently which also makes it vital for healing.
It is believed that all pain experiences are an excellent, though unpleasant response to what your brain judges to be a threatening situation. Even if problems do exist in your joints, muscles, ligaments, nerves or anywhere else, it simply won’t hurt if your brain thinks you are not in danger. The opposite is also true and concerns many chronic pain sufferers. Even if no problems whatsoever exists in your body tissues, nerves or immune system, it will still hurt if your brain thinks you are in danger. The best way to prove that statement is to look at phantom limb pain where sufferers feel pain in a part of the body which is not even there.
Through scientific research we are now aware of some of the thought processes which are powerful enough to maintain a pain state long after tissue damage is over. (1) Some of these thought processes can have you saying things like “I’m so afraid of my pain and of injuring my back again that I’m not doing anything”. These fears will naturally cause increased stress, which releases a hormone called cortisol in your body. Persistent increased levels of cortisol has been linked to slow healing, loss of memory, depression, despair and a decline in physical performance. (2) These fears will also cause you to drastically decrease your physical activities. But inactivity has tragic consequences on our overall health and healing abilities. Joints adore movement and regular compression which keeps them lubricated and well nourished. Moving keeps our muscles strong, increases blood flow, improves our lung capacity. Our bodies were simply made to move.
Physiotherapists can greatly assist chronic pain sufferers. By educating people about pain physiology, it is scientifically proven to reduce the threat value of pain. (3) Educated movement is brain nourishing. It helps restructure pathways in the brain laid low by fear and ignorance. This can help the brain understand that our body is no longer in danger, and tune down the level of pain signals you perceive. Physiotherapists can act as “coaches” and encourage patients to gradually increase their level of activity as well as understanding their fluctuating levels of pain. There are many methods used to achieve this and every treatment method will be customized to suit every patient individually. By being compassionate, enthusiastic and informed, your physiotherapist can assist you in mastering your situation.
(1) Price, D.D. Psychological Mechanisms of pain and analgesia. Vol. 15. 2000,
(2) Lovallo, W.R. Stress and health. 1997
Martin, P. The sickening mind. 1997
(3) Moseley, Hodges, Nicholas; A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain (In Press) 2003
Additional reading: Explain Pain by Butler and Moseley 2003