Ooh! That’s a statement that screams controversy. None the less the statement is true. It’s a very good illusion and it has to be, it needs to protect you from danger after all. It is easy to think that pain is the problem. That pain is what needs to be fixed. That if you have pain then there must be damage somewhere. But that simply isn’t the case. Stick with me and I’ll see if I can convince you it’s all an illusion.
Tissue Damage = Pain(?)
I remember once, when hiking in Peru, I’d brushed past an aloe vera plant with my left shoulder. I remember doing it but didn’t realise until a good ten minutes later when someone said to me “What have you done to your arm?” I looked down to see a hole in my shirt and below it a rather alarming red sleeve. After realising the injury from this scalpel like slice in my shoulder the area began to throb like crazy. We dressed the wound and it was uncomfortable for another couple of days. The scar it left is one to the neatest I have!
You may have a similar story of someone else noticing you are bleeding. I tell this story because it highlights a phenomena – You can have tissue damage yet no pain.
This phenomena has been shown scientifically in a large MRI study of spines. Researchers wanted to know what a pain free spine looks like at various ages. So they scanned over 3000 people that had no back pain. What they found changed the way we see pain.
The results showed that, in my age category 40-50, 69% of people had significant degeneration of the spine. You’d be in the minority if your were 43 years old and had no spinal degeneration. So if I did have back pain an MRI result showing spinal degeneration would not actually be significant. That’s a hard one to wrap your head around.
So tissue damage does not equal pain. Even though we usually experience pain when we injury our tissues.
Pain = Tissue Damage(?)
Let’s look at this the other way around. If we have pain, does that mean we must have tissue damage somewhere?
Dr Lorimer Mosely, the leading pain scientist today, tells a personal story to highlight this in his Ted Talk on pain. He talks of walking in the bush (he’s Australian) and feeling a scratch. Thinking nothing of it, he goes about his activity unaware that he’ll soon be waking up in hospital having been bitten by an Eastern Brown Snake. It was Tissue Damage but no pain, like we discussed earlier. He then goes on to tell us that a year or so later, walking in the bush again he feels a scratch, which makes him fall to the floor in searing agony, only to be told by his friends he just scratched his leg on a twig. Enormous pain but no tissue damage.
All tissues heal in about 3 months if no pathology is present (like osteoarthritis). Despite this people can feel pain for years, even decades and an injury. They’ve often seen every type of therapist and have several detailed scans with the orthopaedic consultant only to be told there is nothing to heal. It’s immensely frustrating for the patient because nobody seems able to help them. It feels like they are saying the pain is all in your head. The truth is, all pain is just in the head.
What is Pain?
So we now know that tissue damage doesn’t equal pain and pain doesn’t equal tissue damage. So what is pain?
Pain is just an output from the brain to warn you of danger. A signal comes in from your sensory tissues that the brain either responds to or filters out and ignores. If the signal gets through the filtering system and gets to the higher brain, the brain then computes many things to decide what to do. It looks at past experience (like prof moseley’s snake bite), held beliefs, even what an injury like this could do to your financial situation or your competition season prospects. If the brain decides this is a threatening situation it decides to protect you by causing a sensation we call pain.
In Professor Moseley’s Ted Talk, he shows how the brain can even make faulty assumptions of where the pain is by feeling pain in somebody else’s arm instead of their own. This illustrates how the brain is projecting the sensation rather than it being “real”.
The Painful Truth
“Pain is an illusion 100% of the time” says Lorimer Moseley. I’m pretty sure you’re thinking about many situations in which you can disagree with this statement because it is hard to change a belief of a lifetime. Believe me, I’ve heard all the arguments.
Whilst this article probably leaves a bitter taste and possibly makes you think I’m crazy and should be avoided at all costs, I want you to realise that this knowledge can be liberating if you suffer from persistent pain. Passive treatments like Chiropractic, Osteopathy, Massage or even Orthopaedics often don’t help because they assume your pain is always due to tissue damage. What we do in clinic is to help people with long-term chronic uncover the illusion so that their brain no longer outputs a pain sensation. We don’t just tell you to get over it! It’s an active method of shared experience rather than passive treatment or an instruction to stop feeling the pain because it’s in your head. So if you’ve been everywhere and tried everything, then let’s talk. It could be the experience you need to finally make progress again.