Is the pain in the brain, or is the issue in the tissue?

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In recent years pain research has come on in leaps and bounds, leading to better understanding of what pain is and how and why we experience it. A big part of these discoveries is a better understanding of the role that the brain and nervous system play in pain, leading to a shift of focus more towards the mind aspects of pain, and away from the physical / bodily causes.

So is pain all in the mind? In this post we briefly talk about pain, where it comes from, what it is and it’s connections to the body and mind.

Acute short-term pain:

Short-term pain is an immediate response to injured tissue, whether that is a strained muscle, a damaged joint or broken bone.

Damage to body tissues causes the release of chemicals related to the healing process, these chemicals also stimulate nociceptors (pain sensitive nerve fibers), which relay a signal to the brain that something has happened in a specific area of your body.

fig 1

fig 1
Within your brain there are maps of your body which help pinpoint the location of a stimulus, an injury to your right hand will stimulate the “hand part” of the left side of your brain (as seen in figure 1 above), which will create the experience of pain leading to protective behaviors that prevent further injury, and allow recovery.

Brains interpretation and short-term pain:

The experience of pain isn’t always directionally proportional to the amount of damage that occurs. Pain is an output of the brain, and the brain will create that experience based on interpretation. The amount of pain you feel is strongly related to how dangerous or unpleasant you perceive the event as being, as well as your emotional state at the time. As an example image stubbing your toe whist celebrating winning the lottery, and contrast that with stubbing your toe whilst moping around on a cold dreary morning after hearing some bad news, the same stimulus (a stubbed toe) would lead to very different experience of pain in the two contrasting situations.

For a more detailed explanation and an excellent example of this watch this:

In summery short term pain is useful, it is there to protect us and motivate the appropriate response, which is to limit pain-causing activities to allow recovery and repair to take place, followed by a gradual progressive return to activities.

Long-term chronic pain:

The short-term pain described above is very different from chronic long-term pain. Gradual changes occur, and the pain progressively moves from being stimulated by damaged tissues, to being amplified and even generated in the brain and central nervous system.

Sensitisation is the process where, through repeated exposure to pain our body and brain become more adapt at experiencing and producing it. In this state a stimulus that wouldn’t have normally caused pain or discomfort now does, and a physical stress that isn’t enough to cause any physical damage can lead to severe pain experience. This occurs partly through the loss of the brains ability to inhibit pain, and through an increased ability to sense it through enlargement and sensitization of the body map (fig 1), these maps also become blurred leading to poorer control and coordination of the area.

The effects of chronic pain are further exacerbated by the anxiety and stress that the pain causes, as our interpretation directly effects the severity of pain.

Reducing threat:

An important part of reducing the discomfort caused by this centrally generated pain is in education to better understanding the pain. Once it is known that the pain isn’t necessarily indicative of damage or danger it can be interpreted differently leading to a reduction in pain.

For some long term pain sufferers this can play an important part in the recovery process. This form of patient education is the focus of many talk-based sessions that occur in pain management clinics and can be very beneficial, an excellent resource is the book Explain Pain by Lorimer Mosley and David Butler, well worth checking out.

Physically treatable causes of pain:

The explosion of research on pain, and the involvement of the brain and nervous system has lead for many to a large shift away from body focused therapies towards more mind / brain focus.

Whilst information on the brains involvement in pain is useful and interesting, the brain, mind and body are not separate and shouldn’t be treated as such. The modern focus on “pain in the brain’ theories, has lead to some patients to being shunted into talk / education based therapies, in order to learn to control and live with their pain, when many of them still have a lot of what can be termed physically treatable causes of pain.

So to answer the question, yes pain is always in the brain, but that doesn’t mean that the body isn’t an important part of it.

Working with the body, either through manual therapy or exercise can help to reduce pain in several ways:

  • Muscle spasms which can be reduced leading to improved circulation and tissue health aiding healing and recovery
  • Gentle mobilastion of joints can improve range and ease of movement decreasing stress on the body, and also to reeducate the nervous system
  • Pain free movement can help to re-educate the brain and central nervous system, and help patients to gain confidence
  • Relaxation experienced in manual/ massage therapies reduces stress which improves the brains ability to moderate pain
  • Improvements in posture and movement ability lead not only to reduced stress on the body, but just as importantly create positive movement experiences, which are key to reducing pain and improving quality of life.

I firmly believe that a holistic approach is best, and that combining movement and manual therapy along with improved understanding / pain education, and small lifestyle changes will bring best results.

I hope you enjoyed this post, and that it helped you to better understand pain. If you have any questions either about treatments and pain reduction, or other resources of information on the subject please feel free to get in touch.


Biolosky, J.E. Et el 2009.The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model

Butler, D,. Mosely, L. 2003. Explain pain. Niogroup publication

Tsao, H., Gales,M,P., Hodges,P,W. 2008. Reorganisation of the motor cortex is associated with postural control deficits in recurrent low back pain


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