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Pain can interfere with work, everyday activities, and affect quality of life. Most pain can be treated without prescribed opioids with the help of a physical therapist. Physical therapists are movement experts who treat pain through hands-on care, patient education, and prescribed movement. 

Here are nine things physical therapists want you to know about pain. 

1. Pain is output from the brain.

We used to believe that pain originated within the tissues of our body. We now understand that pain does not exist until the brain determines it does. The brain uses a virtual "road map" to direct an output of pain to tissues that it suspects may be in danger. This process is a means of communication between the brain and the tissues of the body, and serves as a defense against possible injury or disease.

2. The degree of injury does not always equal the degree of pain.

Research has demonstrated that we all experience pain in individual ways. While some of us can experience a major injury with little pain, others have a minor injury with a lot of pain (think of a paper cut).

3. Despite what diagnostic imaging (MRIs, x-rays, CT scans) shows us, the finding(s) may not be the cause of your pain.

A study on people 60 years or older who had no symptoms of low back pain found that:

  • 36% had a herniated disc.
  • 21% had spinal stenosis.
  • More than 90% had a degenerated or bulging disk, upon diagnostic imaging.

4. Psychological factors, such as depression and anxiety, can make your pain worse.

Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed before a total knee replacement were linked to a patient's experience of long-term pain following the operation.

5. Your social environment may influence your perception of pain.

Many patients state their pain increases when they are at work or in a stressful situation. Pain messages can be sent when a person is in an environment or situation that the brain interprets as unsafe. It is a basic form of self-protection.

6. Understanding pain through education may reduce your need for care.

A large study looked at people in the military and found that those who were given a 45-minute educational session about pain sought care for low back pain less than their peers.

7. Our brains can be tricked into developing pain in prosthetic limbs.

Studies have shown that our brains can be tricked. They can develop a "referred" feeling in a limb that has been amputated, and cause "pain" that seems to come from a prosthetic limb – or the "phantom" limb. The feeling is generated by the association of the brain's perception of what the body is from birth (whole and complete) and what it currently is (after amputation).

8. The ability to determine left from right may be altered when you experience pain.

Networks within the brain that help you determine left from right can be affected when you have severe pain. If you have pain, and have noticed your sense of direction is a bit off, it may be because the "roadmap" in the brain that details a path to each part of the body may be a bit "smudged." (This is a term we use to describe a part of the brain's virtual roadmap that isn’t clear. Imagine spilling ink onto paper roadmap and then trying to use that map to get to your destination.)

9. There is no way to know whether you have a high tolerance for pain or not. Science has yet to determine whether we all experience pain in the same way.

While some people claim to have a "high tolerance" for pain, there is no accurate way to measure or compare pain tolerance among people. While some tools exist to measure how much force you can resist before experiencing pain, it can’t be determined what your pain "feels like."

If you have pain that limits your movement or keeps you from taking part in work, daily living, and other activities, a physical therapist can help. Physical therapy is a safe treatment for people with acute or chronic pain. 

You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.

Find a PT Near You!


Read more about Pain and Chronic Pain.

The American Physical Therapy Association is working to raise awareness about the risks of opioids and the benefits of physical therapy for safe pain management. Learn more about safe pain management.

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Allegri M, Montella S, Salici F, et al. Mechanisms of low back pain: a guide for diagnosis and therapy [revised]. F1000Res. 2016;5:F1000 Faculty Rev-1530. 

George SZ, Childs JD, Teyhen DS, et al. Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial. BMC Med. 2011;9:128.

Carroll I, Wang J, Wang M, et al. Psychological impairment influences pain duration following surgical injury. J Pain. 2008;9 (Suppl 2):21.

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