Pain Does Not Equal Tissue Damage

Some Pain Neuroscience research is starting to understand that not all Pain is related to tissue damage.

Pain is Multi-factorial and is dependent on the biological, psychological and social state of a persons. This is why we all experience Pain in different ways.

Yes It does depend on factors like tissue damage, injury and inflammation.


it also depends on perceptions, thoughts, emotions and social stress. It is further complicated, meaning these different factors stated above interact in ways that are often individual, context-dependent, and unpredictable.

Tissue Damage does NOT always equal Pain.

Because pain depends on perception, tissue damage does not always cause pain, and pain can be felt in the absence of tissue damage. For example, people without pain frequently shows significant damage on MRI and backpain usually cannot be linked to any specific pathology. (Brinjikji 2015).

As you can see there are many discal herniations, protrusions meniscus injuries Mortons neuromas, which are common in the population however do not cause pain all the time.

So for example 37% of 20 year olds and 96% of 80 year olds have disc degeneration on scans without having any symptoms.


Anxiety catastrophising and fear of movement increases the risk of chronic pain. However optimism and self efficacy predict recovering from injury. Part of the purpose of providing education about how pain works is to favourably alter these variables to help enhance your recovery (Louw 2016).

When in doubt get it checked out 👈🏼 This will always hold strong 💪🏼

Only if you’re getting it checked out to get reassurance that there is nothing that bad, it is very important for sense of self and security – allowing yourself to continue at work and not take unnecessary sick leave.

Of course this is not always correct and accurately predictable, however this is why you can benefit from professional help.

This does not mean the pain is in the head! This is false! False.


O’Sullivan, P. B., Caneiro, J. P., O’Keeffe, M., Smith, A., Dankaerts, W., Fersum, K., & O’Sullivan, K. (2018). Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain. Physical Therapy, 98(5), 408–423.
Melzack, R. (2010). Pain and the neuromatrix in the brain. Journal of Dental Education, 65(12), 1378–1382.
Brinjikji, W., F. E. Diehn, J. G. Jarvik, C. M. Carr, D. F. Kallmes, M. H. Murad, and P. H. Luetmer. 2015. “MRI Findings of Disc Degeneration Are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis.” American Journal of Neuroradiology 36 (12).
Lederman, E. (2011). The fall of the postural-structural-biomechanical model in manual and physical therapies: Exemplified by lower back pain. Journal of Bodywork and Movement Therapies, 15(2), 131–138.
Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., … Woolf, A. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 391(10137), 2368–2383;
Riley, S. P., Swanson, B. T., & Dyer, E. (2018). Are movement-based classification systems more effective than therapeutic exercise or guideline based care in improving outcomes for patients with chronic low back pain? A systematic review. Journal of Manual & Manipulative Therapy, 1–10.

From the Preston Chiropractor Team
Getting You Back in Action & Enjoying Your Life Again
Serving the people of Preston and surrounding areas including Southport and Lytham St Annes

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