What is Pain

As a Physical therapist for more than a decade (time flies, I don’t believe I just wrote that line), I’ve made a career out of pain. From that, I’ve seen so many iterations of pain; the acute pain resulting from an injury-think ankle sprains, chronic pain, nerve pain, muscle pain, the list goes on. From these experiences, I’ve also been able to see people’s responses to pain, which I find much more fascinating than the pain itself. From these responses, I find answers as well as more questions to what pain is. 

So what IS pain, and why is it so hard to pinpoint effective treatment? The trick here is that pain isn’t any one thing, but rather, an output of a multitude of factors. This is why treatment for pain, especially long standing pain, is so complex, and there is rarely, if ever, a magic bullet to help you solve your problem. 

For years, up until VERY recently, pain has been thought of as a reflex, almost a sensation that happens to you. For instance, the pre-eminent theory through history has been the Cartesian model of pain. This model was proposed by Rene Descartes, a philosopher in the early 1600’s, who mechanised how pain works; proposing that pain activates some specific nerves, then that information gets passed onto the brain. Then in the 1960s, the gate control theory emerged, proposed by Melzack and Katz, who further detailed how that pain signal or input was then changed or filtered through the spinal cord before it reached the brain. Now, neither of these theories are wrong, rather, they’re just incomplete. These theories focus on the signal input to the brain. Meaning, if you feel pain, there must be something wrong before that signal hits the brain. In many instances, this is correct! If your foot is near the fire and it’s starting to hurt or burn, remove your foot from the fire! As such, many medications to help with pain work in the body to “fix” something; think over the counter drugs such as Aspirin, tylenol, even lidocaine patches, creams, etc. However, have you ever been in pain when these types of treatments just haven’t helped? In that case, the missing piece of the puzzle is what role the brain plays. In recent years, we’ve been able to step back, and see that the brain itself plays much more of a role, and we’ve come up with the Bio-psycho-social model of pain. 

With this model, we can answer to the question “What is Pain”:  Pain is an output of your brain, a culmination of the biological (genetic makeup, physical state), psychological (your fears, depression, anxiety, mood), and the your social background (your beliefs of pain, cultural background, even your socioeconomic status). Up until now, our treatment of pain has just been focused on the biological aspect. But there is SO. MUCH. MORE. 

Because of this new focus on your brain’s role in pain, many people respond with the gut reaction of: well, is the pain in my brain? Yes. And No. But ask yourself this: why is it a bad thing that your brain affects your pain? 

I’ll be going into each of these different factors in future posts, as well as how your brain and body responds to each. For now though, just let this newfound knowledge you’ve just gained marinate for a while.

Think about the pain that you’ve had in the past, or if you’re struggling with pain now, think about things that have changed your pain that are NOT based on your physical surroundings or positions.

When did the pain feel more tolerable when you were in a better mood?

How about when you don’t know what was happening, what was causing the pain, or when you were scared of pain?

Can you think of times that you THOUGHT something would be painful, but really wasn’t? 

These are great journaling topics if that’s something that you’re doing currently as well, but if not, just something to ponder over!

I would love to hear your reflections, or revelations when they come up!


Melzack R, Katz J. The Gate Control Theory: Reaching for the Brain. In: Craig KD, Hadjistavropoulos T. Pain: psychological perspectives. Mahwah, N.J: Lawrence Erlbaum Associates, Publishers; 2004. ISBN 0-8058-4299-3.

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