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Damage does not ’cause’ pain!

Painful, yet hilarious…

Why does a kick to the groin hurt so much more than a kick anywhere else?

It’s actually a good example of how the amount of pain doesn’t relate well to the amount of damage. Groin Kicks: pain = extreme; damage = moderate.

Damage to your body tissues does not ’cause’ pain. To clarify:

You can have pain with no tissue damage. The opposite is also true: You can have damaged or degenerated tissues yet experience no pain.

Why? Your brain decides whether or not you feel pain… not your injured body part. Pain is always the product of your nervous system (involving chemicals 1, emotions, memories 2, context, etc.) , with your brain having the final say (without you even being aware of it). 3

Note: this is true not only for persistent (chronic) pain, but also for new (acute) pain!

Don’t believe me? Let’s discuss some interesting examples, like groin kicks, paper cuts, and hanging yourself from the ceiling with hooks.

Then, we will talk about how pain really works.

So is pain always related to tissue damage?


Let’s think about this common assumption using some examples:

  • Paper cuts… hurt a ton!
  • Yet, you can wake up with a large bruise with no memory of how it got there!

Is tissue damage and pain matching up here? No! A big bruise can indicate a significant amount of tissue damage, but the onset obviously didn’t cause pain, or you probably would have remembered it!

Yet a little paper cut hurts a ton. Why? We can only speculate… is it because it cuts the sensitive nerve endings in your finger, but bruises don’t? Perhaps… but paper cut pain usually lasts only a few seconds to a minute… did the nerve endings heal that fast? I think not!

Perhaps we can think in evolutionary terms: before modern medicine, a cut was a huge infection risk. It could kill you! Perhaps our brains have decided this is tissue damage worth paying attention to… but a bruise is not.

  • Needles

Some people are terrified of needles and complain that they always hurt… yet others don’t even feel them. Great example of the role of context, previous experience, anxiety, and even belief on how people feel or don’t feel pain.

  • Your reaction to a little kid falling down

When a little kid falls and bumps their head, if you say “OMG are you okay?!” they start crying… but if you laugh and say “oops! that was funny!” they just get up and laugh too. It’s almost like you decide whether or not they get a boo-boo.

  • Kick to the groin

it’s pretty easy to find pictures like this on the internet

Males cringe at the thought. Yet, it’s really no more tissue damage than receiving a kick anywhere else.

Again… this is an important part of the body! It only makes sense that the brain would decide this is worth paying much more attention to.

  • Headaches

A good theory as to why many headaches occur (especially migraines) still doesn’t exist. Some headaches can be explained by stress and tension of neck muscles… But this is speculative; there’s a lot of debate by researchers, and we don’t know for sure.

But it’s a very good example of how excruciating pain can occur with no actual ‘damage’.

  • Low back pain

Perhaps the most important example of all.

Bulged (herniated) discs, degenerative disc disease, subluxation, scoliosis, osteoarthritis, pinched nerves, etc. etc. etc. are all things that could go wrong in your lower back. It has been long thought that chronic low back pain is the product of one of these seemingly permanent conditions.

However, x-rays, CT scans, and MRI’s have been used in study after study, consistently showing us that the presence of one or more of these ‘problems’ are completely unrelated to whether someone experiences pain or not 2, 3, 4, 5.

That’s right, you can have a bulged or degenerated spinal disc, maybe even impinging on one of your nerves, and still not have pain.

In fact, people who get MRI’s to investigate their low back pain end up doing no better than people who don’t 6. Interesting!

  • That totally random and sharp (but for no apparent reason) type pain

We all get it from time to time. You are walking along (or just sitting on the couch) minding your own business when you suddenly have to grab your foot because some crazy sharp pain just zapped through it. You rub it, angry at the universe, and keep walking. Pain disappears. Then you forget it ever happened.

What the $%*& was that?! Could you have just moved in a funny way and pinched a nerve in your skin, and your brain didn’t know what to make of it so it gave you a frigging panic attack to make sure it was nothing?

Whatever the reason may be, this pain can’t be explained by tissue damage.

  • Body Suspension

to each their own…

Extreme body piercing. Wanna try it? Why not? It’s only piercing your skin with hooks and hanging your body from the ceiling. You like a good challenge right?

What’s really interesting is that these people apparently enjoy this. They don’t complain of pain, and even describe feelings of euphoria!

  • Anecdotes from war

There are anecdotes from war where men are shot, but end up feeling no pain. Why? Because when you are injured in action, you are taken off the field, and may get to go home.

One minute you are living each moment with the good possibility you may be killed, and the next moment you’re going home. Once they are back to a safe place, they report no pain at the time of the injury… they are just happy to be alive. Perhaps the brain has decided (relative to their previous situation) they are no longer in danger.

The Bottom Line:

The degree of injury is not well related to the degree of pain:

You can have a lot of pain with little to no damage,


you could have a lot of damage with little to no pain.

That does not mean damage isn’t important! If you are clearly injured, painful or not, take care of it. See a physician if you are not sure. disclaimer

What’s important is that you realize that just because you have pain, it doesn’t mean there is any significant damage or degeneration occurring in your body. Learning this can be very relieving for people who are afraid they might have a serious problem.

Why is pain so weird?

Don’t let all of this confuse you.

It’s only confusing if you try to make sense of it all while still believing pain is always caused by some sort of damage.

When you understand that pain is a perception… an opinion formed by your brain to indicate danger, all the weird stuff described above begins to make a lot more sense.

Does this mean it’s “all in your head”? Well, your brain is in your head… but that does not mean it isn’t real. Pain is very real, just as real as seeing colors, being excited or scared at the movies, or being in love. Pain is an important topic, which is why there’s a whole section of this site dedicated to it.

What can I do about pain?

First, learn about it! It won’t take long. And understanding pain can actually lower it.

If you would like to learn more about how pain works and what you can do about it, check out the pain section of this site. For a great overview of how pain works, watch this 5 minute video. For an entertaining and more detailed explanation, watch this 15 minute video.

Hope this article was helpful.

Good luck!

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    15 Responses to Damage does not ’cause’ pain!

    1. The world needs to see this writing and meet you. We’re at somasimple.com

      Please write back, join us. All we want to do is share information. Free and non-commercial.

      • Tony Ingram says:

        Thank you Barret!
        Really appreciate such a comment coming from yourself. Actually, I am a member of somasimple.com, since I was in PT school. The collective knowledge there has influenced me as a therapist more than anyone or anything else. I’ve been following your writing as well, always insightful.
        Thanks again!

    2. Hillard says:

      For a first time reader of Tony’s writing I can tell you that his information is so right on and valuable that I’m going to post his blog on my wifes FaceBook page with 12,000 fans. In the past 8 years I have had my colon erupt, 3 operations…my meniscus on my left knee went, 1 operation…my right shoulder had a tear in the rotator cuff, bone spures and a torn labrum, 3 operations…I had my left hip replaced,1 operation…I have R/A and Osteoarthritis….I had my esophagus stretched last year because I was choking on my food. I have pinched nerves in my neck…..oh might I add I have an 8 year old son. I am 57 years old with a 42 year old wife…oh..she is only 41, her birthday is in May. I am telling you this because the pain that I should have had doesn’t stop me because I have made up my MIND I won’t let it and the pain is not that bad (except for those stupid paper cuts..Ouch). I am a Financial Advisor and I help my wife run her VERY successful online clothing business called Posh Little People, which is very demanding and we do it part time. She is a full time 10th grade English teacher. If it weren’t for the fact that I believed and trusted for most of my life what Tony is writing and researching about I would NEVER be able to accomplish all that I do with no more than 5 hours of sleep a day. Tony….you keep writing and hopefully more people will get the message and help thenselves to Retrain their Brain to feel no Pain.

      • Tony Ingram says:

        Hi Hillard!
        Great to hear you are being so strong in the face of all that potential pain. People need to take a positive attitude with their health, and stop being afraid of their pain… this is not to shrug it off like it’s not important. All pain is real. But the point is to avoid unnecessary fear and avoidance, and encourage recovery.
        Keep working hard and don’t let pain stop you from enjoying the life you deserve!
        Take care.

    3. Neil Pearson says:

      great post – just wanted to make certain you also know of the longer educational webcasts linked from the splash page of http://www.lifeisnow.ca . Similar info, with much more detail. Its a few years old now, and I would certainly include more on skin in the last section, thanks to Barrett, Diane and somasimple, but all-in-all there are over 2 hours of info there. (in the near future, one will need to opt-in (for free) to watch them, and gain access to my blogs)

    4. Robin says:

      Another one of your interesting posts, Tony. But will it make sense if it is said that the title is bit misleading? Or is it that extend of damage does not determine the type or intensity of the pain? Is there a tissue injury that does not cause pain at all?
      Will not perception of pain in relation to different body regions vary because of the sensitivity of the nerves in those regions? And how much will the Pain gate mechanism described by Wall, Melzack have a role in understanding the different pain perception between a large bruise and a paper cut ?
      Thank you for your continued insights into various topics which we come across in our practice.

      • Tony Ingram says:

        I’ll admit, it’s a bit sensationalistic of a title, because most of the time, damage does cause some pain. However, I do believe it’s still an accurate assertion in the strictest sense of causality. Check out the wiki article on causality and scroll down to the ‘Logic’ section.

        I would say damage may be a ‘sufficient’ cause of pain, but it’s not a ‘necessary’ cause. What is important about this is the main point of my article: just because you have pain, it does not mean the problem is any sort of damage or degeneration. Getting that through to people in persistent pain is an important message.

        You’re right though, other than a random bruise, I cannot think of many types of tissue damage (at least superficially) that do not lead to pain. I’m also not too sure how much the pain gate mechanism applies to those examples specifically. We can speculate, but research is in its infancy.

        Thanks for the comment Robin!

        • Tony Ingram says:

          Actually, now that I have thought about it a bit more, I can think of a few examples of damage that does not cause pain:

          – Muscle soreness (DOMS, PEMS) – the “damage” is immediate, but the pain isn’t.
          – Radiographic changes – Often degenerative changes are found on MRI’s with no pain.
          – Bruises – as stated above.
          – Injuries without pain – anecdotes from sports or war stories.

          It’s not much, but I think they are noteworthy.

          • Robin says:

            I too tried to think about those damages which did not cause a perception of pain by the nervous system. Wont there be other reasons for pain not immediately felt after damage in DOMS, like the accumulation of stimulants being below the threshold level for initiating a message in the pain fibers, or increased circulation during the exercise etc, rather than it having a direct relation to the damage of the muscle fibers itself?
            When we think about bruises dont we have to factor in the effect of pain gate mechanism on the immediate amount of pain perceived? Thoughts that come into mind is that the impact that causes the bruise also does cause enough stimulation of other receptors causing the large diameter fibers to fire thus masking the smaller fibers- will not that be a reason for the different pain levels with a large bruise and a small paper cut where one might not have enough large diameter fibers being stimulated?
            As u mentioned previously, regarding pain we are mostly in speculative mode even with the studies or researches since there hadnt been a definitive one answer to all pain, because even though ‘pain’ is an end product of brain sensation we have different reasons for pain. And thus every article is worthy enough to read and be tried.
            And your thought “the main point of my article: just because you have pain, it does not mean the problem is any sort of damage or degeneration. Getting that through to people in persistent pain is an important message.” is worth it when we come across such patients with persistent or chronic pain.

            • Tony Ingram says:

              Hi again Robin,

              I see you are trying hard to explain the phenomenon mentioned! I agree with you on some points. Still, the primary lesson in this article is that damage is not necessary for pain, nor does pain indicate damage.

              Even if pain was initiated by damage (like a sun burn), eliciting pain (through touching the sun burn, for example) does not imply further damage. In this case, it’s due to hypersensitivity of the receptors in the skin (because of chemicals and such, as you mentioned about DOMS), but not because touching the sunburn cause more of the same damage. Chasing the cause of pain isn’t always helpful either – some things can be corrected, but often times damage cannot be “reversed”, yet pain can be treated.

              I hope I am making the point of my article clear. It isn’t meant to be misleading – it’s simply meant to point out that things are more complex than “damage = pain”, which is an unhelpful belief no matter what the cause of pain is.

              Cool? :)


    5. Luke McManus says:

      Nice article Tony, thanks (although I’m a bit late).

      This is still a paradigm that is difficult to communicate to other health professionals here in Australia. The more that articles like this can be shared, the better educated patients will be as to truth about their pain, which can only be helpful.

      I’ve written a couple of similar posts on my blog, too. Hope to be in touch soon.

      Luke McManus

    6. Stijn says:

      I’ve had a tear in my meniscus, my doctor says i’d better not breakdance anymore but I don’t want to stop when I finally found a sport I really like. Should I trust the doctor, probably yes, or should I go on breaking at a very slow pace. I pose this question because I think a lot of bboys had this problem because of putting a lot of stress on it when doing footwork. Do you know people who had the same experience and went on breaking, and how THEY handled it? Sincerely

    7. Walter H says:

      Hi Tony. Great article. Do you think there is any therapeutic value in removing nociceptive stimuli? An extreme example would be, say, a knife in someone’s leg. You’re not going to give them pain education, it would make more sense to just remove the knife (at least, I hope you would agree if you found me with a knife in my leg!). I understand that there is a huge difference, however, between actual damage and no damage. But then, there is grey area. Couldn’t our pain be alerting us to potential damage? So, even if it hadn’t reached the point of actual damage, instead of writing our pain off as baseless fear, maybe we should pay attention to how we’re moving before we actually have an injury to protect?

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