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One of the most important conversations I have with patients is this: pain does not always equal damage. For many people, pain feels like a warning sign that something is broken, torn, or beyond repair. While that can be true in some acute injuries, the relationship between pain and tissue damage is far more complex.

What is Pain?

Pain is an experience created by the nervous system. It's influenced by signals from the body (afferent input), but also shaped by how the brain interprets those signals and sends responses (efferent output). This interaction, often referred to as the "pain loop," helps explain why pain can persist even after tissues have healed.

Acute vs Chronic Pain

Acute pain is typically mechanical and protective - for example, pain after rolling an ankle. Chronic pain, however, often reflects changes in the central nervous system (CNS). The system becomes sensitised, meaning it can "over-report" danger signals even without ongoing tissue damage. This is why some patients with long-standing back or knee pain still experience symptoms even when scans don't show significant injury.

The Biopsychosocial Approach

To truly understand pain, we need to go beyond the tissues. The biopsychosocial model recognises that pain is influenced by:

• Biological factors: muscles, joints, nerves, inflammation
• Psychological factors: thoughts, beliefs, past experiences, mental health
• Social factors: lifestyle, environment, work demands, support networks

Factors like poor sleep, high stress, low mood, or negative beliefs about pain can amplify symptoms. Conversely, addressing these areas can help reduce pain and improve outcomes.

Function and Strength vs Pain Levels

An important point I share with patients is that improvements in function and strength don't always line up perfectly with pain levels. Someone may continue to experience pain but still become stronger, more mobile, and more capable in their daily life. That progress matters and it builds long-term resilience.

My Approach with Patients

When working with patients, I focus on three key strategies:

1. Reduce pain symptoms: using exercise, movement modification, and lifestyle changes.
2. Address impairments and deficits: improving mobility, strength, and control that may have been limited by pain.
3. Build capacity: gradually increasing strength and endurance to prevent flare-ups and future injuries.

This approach helps patients see beyond pain as the sole measure of progress. The bigger picture is confidence, independence, and the ability to return to meaningful activities.