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How Pain Works, Part I – What Is It?

This is the first installment of a series of articles discussing how pain works, and what we can do about it. It’s important, long overdue, and I’m excited to finally write about it!

However, before we dive into the surprisingly interesting and not-so-scary science of pain, there’s a couple of important questions we should ask first:

What is pain? What is it for?

Understanding what pain is should put things into better perspective as we learn more about it. Let’s discuss!

What is pain?

You’ll get a different answer from everyone you ask. Healthcare professionals probably won’t agree either. Even when asking the worlds leading pain experts and researchers, you’ll still get slightly different answers. It seems people’s definitions of pain are as subjective as the experience of pain itself!

If you Google “pain definition”, you’ll get:

pain – Noun: 1. Physical suffering or discomfort caused by illness or injury. 2. A feeling of marked discomfort in a particular part of the body.

This is certainly how most people would describe pain. However, let’s look at a definition that was created with a little more care, consensus, experience, and expertise:

The International Association for the Study of Pain defines pain as:

pain – An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. 1

Notice that it says “actual or potential tissue damage, or described in terms of such damage”. Why would they say that? The answer is actually one of the most important lessons about pain:

Damage and pain do not match.

Most of the time, pain does indicate some sort of damage to a body tissue. However, just because something hurts, doesn’t mean there is any sort of physical or structural damage or degeneration – pain can occur without any sort of damage. It’s also true the other way around: you can have damage, injury or illness with no pain.

Damage and pain do not match. In many cases, they can occur without each other. Don’t believe me? Read some examples!


The Brain Processes Pain

Pain is the product of the nervous system. The brain does most of the processing, taking into account all sorts of information (neural signals, chemicals, context, memories, emotions, etc.) before pain is perceived. 23 From all of this, the final experience of pain emerges.

If pain isn’t just a simple signal from your body letting you know that damage is occurring, then what is it? What is the brain processing? What is it trying to tell you? What’s the point of pain?

Pain is for Protection

Here’s another way of thinking about what pain is, from an article written by Lorimer Moseley, one of the worlds leading pain researchers:

“pain can be conceptualised as a conscious correlate of the implicit perception that tissue is in danger”  3

In plain English: pain is your brains best guess at whether or not something is dangerous, for the purpose of protecting you from actual or potential damage. Pain is like an alarm, and it wouldn’t be very useful if it only happened when damage was already occurring.

If someone was breaking into your car, you would want your alarm to go off before they actually got inside, right? If you put your hand on something very hot, it usually hurts before you actually get burned!

Not every sensory signal that reaches your brain becomes painful (wouldn’t that be awful?). Before you feel pain, the brain asks how dangerous is this really?, analyzing the situation (using previous experience, context, and even your beliefs) to make the final decision. Most of this processing is unconscious – you don’t simply “think” yourself in and out of pain (that would be too slow)! If the signal is something you should be worried about, you get pain. Hopefully, you then react by avoiding a potentially harmful situation.

Understand this, and the examples mentioned previously begin to make much more sense – they all somehow set off the “pain alarm”, with or without damage!

What if there was no pain?

Some people are actually born without the ability to feel pain, a condition known as Congenital Insensitivity to Pain. It’s a genetic condition that’s not well understood. 45

People with this condition often fail to notice life threatening injuries and illnesses. In the past, they were known to pass away early – even during childhood.

Healthcare has since progressed significantly in the understanding of this condition. Thankfully, with the right help, these people can learn to live well.

Conclusion – Pain is good!

As you can see, pain is actually a good thing! It’s an alarm that goes off when your brain decides something is dangerous. It’s one of our most important methods of protection. Think about this the next time you complain about pain!

Of course, pain can sometimes become a problem itself – like an alarm that goes off too easily, or won’t shut off. This is often the case with chronic pain conditions. We’ll discuss how this happens in upcoming articles.

With a better understanding of what pain is and what it’s for, we can start exploring the science of how pain works. And with a better understanding of how it works, we can start exploring better ways to deal with it!

Thanks for reading and stay tuned!

P.S. – to those of you who provide healthcare for people in pain, comment below with your thoughts on what pain is, what it’s for, and how you would define it. It would be really interesting to see how different, or similar, our definitions can be!


1. IASP Taxonomy. Retrieved on Dec 15th, 2012 from http://www.iasp-pain.org/Content/NavigationMenu/GeneralResourceLinks/PainDefinitions/default.htm#Pain

2. Apkarian AV, Baliki MN, Geha PY. Towards a theory of chronic pain. Prog Neurobiol. 2009 Feb;87(2):81-97. doi: 10.1016/j.pneurobio.2008.09.018. Epub 2008 Oct 5. Review. PubMed PMID: 18952143; PubMed Central PMCID: PMC2650821.

ResearchBlogging.org3. Moseley, G. (2007). Reconceptualising pain according to modern pain science Physical Therapy Reviews, 12 (3), 169-178 DOI: 10.1179/108331907X223010

4. Nagasako EM, Oaklander AL, Dworkin RH. Congenital insensitivity to pain: an update. Pain. 2003 Feb;101(3):213-9. Review. PubMed PMID: 12583863.

5. Danziger N, Willer JC. [Congenital insensitivity to pain]. Rev Neurol (Paris). 2009 Feb;165(2):129-36. doi: 10.1016/j.neurol.2008.05.003. Epub 2008 Jul 9. Review. French. PubMed PMID: 18808773.

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    9 Responses to How Pain Works, Part I – What Is It?

    1. Tony,

      Great piece. Keep up the good work and Happy Holidays! Will be sharing this with my patients to compliment some of my conversations with them.


      • Tony Ingram says:

        Thanks Chris!

        Glad to know you are using my writing this way. I try to hit a balance between writing that’s useful for both patients and professionals. Happy holidays to you too!


    2. Fascinating piece written in a wonderfully accessible style. Really looking forward to the next installment.
      Wishing you all the best over Christmas Tony.

    3. Tony,
      Great stuff man and thanks for putting this info in simplistic terms. As for defining pain, this may never be agreed upon! With my internship program, I have a 10 question quiz or test prior to the student starting. One of the questions is, ‘what is pain?’ I actually get good answers from my students but just got me thinking…maybe I should get my patients to write down their answer while I am with them on initial eval. Would be a good start to educate and a way to get into their beliefs, contexts, etc.

      What do you think?

      • Tony Ingram says:

        That’s a great idea Harrison! It’s interesting – there may never be a perfect definition, but there are certainly “less wrong” definitions. Reading a patients definition can identify unhelpful beliefs for sure. I’m willing to bet most people’s definition would be closer to the google definition I quoted at the beginning.

        • Harrison Vaughan says:

          Yeh I agree. Doing any clinical trials on this (pain education). I’ll be interested in a clinical site if you do. Email me. harrisonvaughanpt@gmail.com

          • Tony Ingram says:

            I believe the folks at http://www.bodyinmind.org are planning to do a trial. I’m looking forward to the results. Even if it (pain education) doesn’t lower pain, I would be very surprised if it didn’t lower fear avoidance and a number of other important factors. And even if it didn’t, I’d still educate patients, just so they understood what was going on. It’s ethical. I’m sure telling someone they have any other disease doesn’t treat it, but you still tell them!

    4. Connie Posigian says:

      It’s profound to think that this “new” science about pain continues to be verified by research. This article, written in 2012, could now reference hundreds of scientific papers to back up these theories.

      Thank you, Tony for providing a good, basic explanation of what pain is! I’m trying to do the same at my workplace. It’s amazing how positive people in pain become when learning pain does not mean their body is damaged!

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