®Definition
What is pain?
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
International Association for the Study of Pain (IASP), 2020. The six notes added to the definition:
Pain is always a personal experience that is influenced to varying degrees by biological, psychological and social factors.
Pain and the danger signals carried by nerves are different things. Pain cannot be inferred solely from activity in sensory nerves.
Through their life experiences, people learn the concept of pain.
A person’s report of an experience as pain should be respected.
Pain usually serves a protective role; but it may have adverse effects on function and on social and psychological well-being.
Describing it in words is only one of several ways to express pain; being unable to communicate does not mean there is no pain.
Try it
Your body’s alarm system
Pain can be compared to a fire alarm: the same smoke makes a sensitively set alarm ring much louder. Choose the factors below and see how the sound of the alarm changes. This is a teaching analogy; the numbers are illustrative and do not measure your pain.
Signal from the tissues
Things that make the alarm more sensitive
Things that calm the alarm
Scans do not tell the whole story
On the lower back MRIs of people without pain
A review of 33 studies covering 3,110 people with no back pain at all. These findings increase with age, often without causing pain.
What can help with long-lasting pain?
- Gradual movement: Increase it little by little and regularly, while monitoring your pain. The pain during exercise traffic light can guide you.
- Sleep: You can look at the sleep guide.
- Stress: For breathing and relaxation, Three Doors and the stress guide.
- Understanding: Talking to a doctor or physiotherapist about what your pain means.
This page does not replace an examination
- Pain that is new, very severe or getting steadily worse
- Pain that started after a fall or a blow
- Pain with fever, unexplained weight loss or a history of cancer
- Numbness, weakness, or problems controlling your bladder or bowels
In these situations, see a doctor without waiting.
Frequently asked questions
So is my pain all in my head?
No. Pain is always a real experience. According to the International Association for the Study of Pain’s definition, a person’s report of pain should be respected. The fact that pain is produced in the brain does not mean it is “in your head” or made up; all pain is produced in the brain.
Does pain always mean there is damage?
Not always. Pain and the danger signal from the tissues are not the same thing; how much it hurts does not always reflect how much damage there is. For example, disc changes are very common on the lower back MRIs of people without any pain.
My MRI report mentions a herniation or degeneration. Is that the cause of my pain?
It may be, but not necessarily. These findings are common in people without pain and increase with age. Your doctor interprets the MRI together with your examination findings and symptoms.
Does understanding pain really help?
In a review of 12 randomised trials, pain neuroscience education on its own brought only small improvements in pain and daily function; but it meaningfully reduced the fear of movement in the short term. Patients found education more helpful when they were able to tell their own story.
Sources
- International Association for the Study of Pain. IASP announces revised definition of pain. 16 July 2020.
- Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816.
- Watson JA, Ryan CG, Cooper L, et al. Pain neuroscience education for adults with chronic musculoskeletal pain: a mixed-methods systematic review and meta-analysis. J Pain. 2019;20(10):1140.e1–1140.e22.