Pain: Is It All In the Head?

Pain is how our body tells us that something’s wrong. For most people, most of the time, it’s very accurate. Whether you bang your elbow, sprain your ankle or develop back pain from sitting at a desk all day, pain tells us when and where our tissues have been damaged, letting us rest the area or seek medical attention. The vast majority of our patients see us because they’ve felt pain in one way or another.

But pain can also be inaccurate, especially in the case of chronic pain, the definition of which is any pain that lasts longer than 12 weeks, but in practice this is not always correct and can be more complex. Sometimes, chronic pain is a result of tissue damage or nerve impingement, but in many cases it can have no physical cause at all, even if it started out as “normal” pain.

How does acute pain turn into chronic pain?

When you suffer an injury, your nervous system reports the tissue damage to your brain, which triggers the sensation of pain. During this time, this neural pathway reporting the pain becomes more sensitive, keeping you highly aware of the injury to stop you from making it worse. You’ve probably experienced this increased sensitivity yourself: think of how tender an injury can feel, where even slightest touch can be agonising.

Sometimes, this sensitivity in the neural pathway can remain even after the tissue damage itself has healed, especially if the injury has been ignored for too long or if its recovery was mismanaged.  Even fear and anxiety can contribute to neural sensitivity. This is one reason why we always urge people to see us as soon as possible if they’re feeling pain. If it’s ignored, pain that could have subsided in a few weeks might instead last for months or even years.

This over-sensitisation makes normal day to day activities very difficult as even the slightest pressure can be misreported as pain. In the case of chronic back pain, just bending down to take off your shoes can be agonising and in severe cases, people can become bed bound.

Chronic pain can also spread and travel around due to “neural smudging”, where the oversensitivity of one part of the brain can spread to a neighbouring area that controls different parts of the body.

Bad physiotherapy can make chronic pain even worse.

Because we’re so used to pain working as intended, sufferers of chronic pain sometimes don’t understand or may not be able to accept that their pain has no physical cause. This can result in them continuously looking for cures for a structural problem that doesn’t exist, leading to years of frustration, failed treatments or falling prey to quacks. In extreme cases, people can become addicted to drugs or alcohol in their attempt to reduce their pain.

Things like surgery or wrongly prescribed physiotherapy can make the pain even worse by continuously sensitising the affected area. If a physiotherapist doesn’t identify that there’s no physical cause for the pain, they’re at risk of prescribing exercises that would be perfect for an acute injury, but only increase pain if it’s a result of over-sensitisation.

The first step to using physiotherapy correctly is to make sure our patient understands that their pain doesn’t have a physical cause. This can be hard to accept, as their pain is no less “real” to them, but continuing to treat it as a physical problem will only make it worse.

Treatment for chronic pain is unlike our typical physiotherapy as we’re trying to desensitise the nervous system rather than fix tissue damage. This requires very slow, structural exercises in a highly specific programme that often only introduces one new exercise a week. We also need to work with our client to manage lifestyle changes to ensure they’re not continuing to over-sensitise the affected area while still remaining active. If required, we’ll also refer them to a pain specialist who can provide the correct painkillers to use in conjunction with our physiotherapy.

Overall, chronic pain is a difficult condition which needs to be treated with delicacy and sensitivity both physically and emotionally. The best way to avoid mismanaging pain is to understand how it works, which I hope I’ve explained with this blog, but if you want to learn more, I highly recommend ‘Explain Pain’ by David Butler.

Most importantly, don’t ignore your pain. Come and see us so we can get you back to normal (or even better) before it develops into something far more difficult to cure. Email or call 020 7939 1628 to book your appointment now.

Kam Physio BelgraviaKam Sowman  BSc (Physio) MCSP MHCP

Musculoskeletal and Sports Physiotherapist

For any other questions regarding this topic please do not hesitate to contact me at West London Physio on 0207 937 1628 or email