Understanding pain changes everything — including how much of it you feel.
TL;DR — Pain is your brain’s best guess at keeping you safe. It is not a damage report. Hurt and harm are different things. Acute pain, persistent pain, temporary pain, and emotional pain all work through the same system — but for different reasons. The science is clear. And once you understand it, you cannot un-understand it.
Let me tell you about a patient I treated years ago. I won’t use her name. She came in holding a stack of imaging reports, as if they were a verdict. MRI. X-ray. A note from her orthopedist. She sat down, put them on the table between us, and looked at me like I was about to tell her how long she had to live.
She had been in various levels of pain for over two years. Real pain. Daily, exhausting, life-limiting pain. And every doctor she’d seen pointed to that stack of papers and explained exactly what was wrong with her body.
The problem? Her pain hadn’t gotten any better. In fact, the more she learned what was “wrong” with her, the worse it got. Much like her stack of reports and images, her pain grew.
I’ve thought about her a lot over the years. In particular, about the moment I realized that the way we talk about pain — the story we tell people about what’s happening inside them — actually changes how much they hurt. Not metaphorically. Biologically.
That realization changed how I practice. It changed what I say in the first five minutes with a patient. And that’s why I’m writing this.
Even more, it’s one of the main reasons Recharge exists. In order to have challenging, complicated, and often confusing conversations.
Because if you’ve ever had pain that confused you, scared you, or just wouldn’t quit — you deserve to understand what’s actually going on.
Pain Is Not a Damage Report
Here’s the thing that blew my mind early in my career and never stopped blowing it: pain is created by your brain. Not received by it. Created.
When something happens to your body — you step wrong, you lift something heavy, you sit in a terrible chair for six hours — your tissues send signals toward the brain. These signals are called nociception. They carry information about potential danger. Temperature. Pressure. Chemical changes.
Then your brain evaluates everything. Your history. Your current stress level. What you believe is happening. What you’re afraid of. Whether you think this is serious. And then — based on all of that — it decides whether to produce pain. And how much.
Pain is the output. Not the input.
Pain is not a measure of what’s wrong with your body. It’s your brain’s best guess about whether you need protecting.
Pain researcher Lorimer Moseley has spent his career making this case, and the evidence is now overwhelming. In highly controlled research settings, the relationship between the extent of tissue damage and the pain a person experiences is, to put it bluntly, inconsistent.
Two people with identical injuries can have wildly different experiences. One person can have serious structural findings on imaging and no pain. Another can have debilitating pain with nothing remarkable on their MRI.
This is not a weakness. This is not being dramatic. This is how the system was designed.
The Science — Without the Textbook
I know some of you are going to want the nerdy stuff. This is for you. And also for everyone who’s been told something confusing by a doctor and never had it explained in plain language.
Nociceptors — Your Body’s Danger Detectors
Your tissues are full of specialized nerve endings called nociceptors. These aren’t “pain nerves” — they are danger detectors. There’s an important difference. They respond to potentially damaging stimuli: extreme heat, extreme pressure, or certain chemicals released when tissue is stressed or damaged. When they activate, they send an electrical signal up toward your spinal cord and brain. That signal is nociception. It is information, not pain. Pain hasn’t happened yet.
A-Delta and C Fibers — Two Different Messengers
Two types of nerve fibers carry that danger signal. A-delta fibers are fast. They carry sharp, immediate, localized sensation — the kind that makes you pull your hand off a hot stove before you’ve even processed what happened. C fibers are slow. They carry dull, aching, burning, spreading sensations — the kind that lingers. When you stub your toe, the sharp jolt is A-delta. The deep throb afterward is C fiber. Both are normal. Both are doing their job.
The Brain’s Role — The Part Nobody Tells You
Once nociception reaches the brain, it goes through a process that is far more complex than most people realize. Your brain cross-references the incoming signal with your beliefs, your memories, your emotional state, your context, and your expectations. If the brain decides the signal represents a genuine threat that requires action, it produces pain. If it doesn’t, it may suppress the signal entirely. This is why soldiers can be wounded in battle and feel nothing until they reach safety. The context — survival — suppressed the output. The injury was real. The pain was not the priority. This is not willpower. It is neuroscience.
“Pain Tolerance” Is Not a Real Thing
Let’s retire this phrase. When people say someone has a high pain tolerance, what they’re really describing is a person whose brain assigns a lower threat level to a given signal — or whose context, history, or beliefs lead to a different output. Pain is not a fixed measurement that people tolerate at different thresholds. It is a deeply personal, highly variable experience that is shaped by factors that have nothing to do with toughness. Two people can experience the same stimulus and have completely different pain experiences — not because one is stronger than the other, but because their brains are running different calculations. There is no universal scale. There is no objective threshold. Pain is individual. Always.
When Pain Has a Job
You roll your ankle at the bottom of the stairs. Pain shows up immediately, loud and specific. This is acute pain, and it is doing exactly what it is supposed to do.
Acute pain is the alarm system working correctly. It draws your attention to an area that needs it. It changes your behavior — you stop putting weight on that ankle, you rest, you protect the area while healing happens. The inflammation that follows — the swelling, the heat, the tenderness — is not a problem. It’s the repair crew. Your body mobilizing resources to the site of damage.
Most people experience acute pain as frightening. That’s understandable. Pain is scary by design. But acute pain tied to real tissue damage almost always follows a predictable course. It peaks, and then it subsides as healing occurs.
The important thing to know: even in acute pain, the intensity of what you feel does not map directly to the severity of what happened. A paper cut on your fingertip can feel disproportionately terrible because your fingertips are loaded with nerve endings. A more significant muscle strain in a less innervated area might produce surprisingly little pain initially. Your experience is real. What it tells you about the damage is… approximate.
When the Alarm Won’t Turn Off
This is the one I want you to really sit with. Because this is where people suffer the most, and where the medical system has failed the most people.
Persistent pain — sometimes called chronic pain — is when pain continues well beyond the point that tissues have had time to heal. And here is the critical line, the one I wish someone had told that patient sitting across from me with her stack of papers:
The relationship between pain and the actual state of your tissues gets weaker the longer pain persists.
The evidence for this is overwhelming. Research across back pain, neck pain, knee osteoarthritis, and shoulder pain consistently shows that structural findings on imaging exist in large percentages of people who have zero pain. Disc changes. Rotator cuff tears. Arthritis. Found in people going about their lives without a complaint.
So what’s happening in persistent pain if it’s not ongoing damage?
Your nervous system has become sensitized. The alarm has been on so long that it has recalibrated. What used to take a significant signal to trigger pain now takes almost nothing. The volume is turned all the way up, and it has forgotten how to come back down. Moseley describes this as the brain becoming increasingly convinced that protection is needed — even when the original threat is long gone.
This is not a character flaw. This is not a weakness. This is your nervous system doing what nervous systems do when they’ve been exposed to prolonged threat signals. It becomes more protective. More sensitive. More alert to anything that might represent danger.
The harder truth: fear of pain is one of the strongest predictors of ongoing pain and disability. The moment pain becomes something to fear rather than understand, the nervous system gets even louder.
Research from Moseley and Butler published in the Journal of Pain found that people who understand why they hurt actually hurt less. Not because they talked themselves out of it. Because understanding pain changes the brain’s threat assessment. Knowledge is — and I mean this clinically — an intervention.
Your MRI is not your identity. Your pain is real. But it is not the whole story.
Hot Sauce and What It Proves
Here is my favorite example to give people when they need proof that hurt and harm are different things.
You eat something spicy. Your mouth is on fire. You are sweating. You are questioning every decision that led to this moment. Your eyes might be watering.
You look ridiculous.
Are you damaged? No. Not even slightly.
Capsaicin — the compound that makes hot food hot — activates the exact same heat receptors your body uses to detect genuinely dangerous temperatures. Your brain gets the signal. It produces the pain. And nothing was harmed.
This is the clearest demonstration in everyday life that pain is about perceived threat, not actual damage. The sensation is real. The suffering is real. The damage is not.
The same logic applies to the throbbing soreness after a hard workout. Your muscles are stressed and adapting. The sensation is real. But if you’ve been exercising regularly and you understand what’s happening, your brain interprets that soreness very differently than it would if you were new and afraid something was wrong. Same biology. Different output. Because context changes everything.
Think about the bed frame you’ve stubbed your toe on forty times. Same corner. Same force. And yet — it hurts more in the dark. Because in the dark, your brain can’t confirm the source quickly, and uncertainty increases the threat level. More threat. More pain. Same toe.
The Pain Nobody Takes Seriously
I’ve been practicing for a long time. And for too much of that time, I — like many clinicians — treated the body without fully accounting for the mind. I knew better, intellectually. But knowing and doing are different things.
Over time, I came to understand what the research had been saying for years: emotional pain is not a metaphor. It is real pain, processed through real neural tissue, sharing the same neural machinery as physical pain.
Researchers at UCLA found that social rejection activates the anterior cingulate cortex — a region central to processing physical pain. In follow-up work published in PNAS, researchers showed that people who had recently gone through a breakup activated the same somatosensory regions when shown a photo of their ex-partner as when they experienced physical pain. Not regions adjacent to them. Not similar patterns. The same regions.
One study went further: participants who took acetaminophen — a physical painkiller — reported reduced feelings of social rejection. A pain reliever worked on a broken heart. Because to your brain, there is less separation between these experiences than we were taught to believe.
Here is the clinical reality that I want you to carry with you: emotional pain and physical pain interact. Increased stress, grief, loneliness, anxiety — these don’t just hurt emotionally. They raise your nervous system’s baseline threat level, which amplifies every other pain signal you’re already carrying.
This is why, in ‘A New Relationship’ — a piece I wrote several years ago — I argued that physical therapists need to work alongside mental health professionals. Not as a nice-to-have. As a clinical necessity. Helping people with their bodies without giving their minds the same attention, as I wrote then, is like building a house on an unstable foundation. It may stand. But it won’t stand well.
Many people are hurting long before they are in pain. Stress, anxiety, depression — these live in the body before they ever get a name. And when something physical happens on top of that already-loaded system, the response is amplified.
You are not separate parts. You never were. The system feels it.
What To Do With This
I’m not going to tell you that understanding pain will make it go away. That would be misleading.
What I will tell you is what the evidence says: people who understand why they hurt are less afraid of their pain. Being less afraid means a lower threat level. Lower threat level means the nervous system turns down the volume — even a little. And that matters.
It also means you stop making decisions based on fear. You stop avoiding movement because movement might mean damage. You stop treating your body like a fragile thing that might break at any moment. You start asking better questions. You start working with your body instead of against it.
The goal here at Recharge has never been to fix you. I don’t think you’re broken. The goal is to help you understand what’s happening — so you can move through it differently.
Pain is not the problem.
Misunderstanding it is.
References
Moseley GL, Butler DS. Fifteen Years of Explaining Pain: The Past, Present, and Future. J Pain. 2015;16(9):807-813.
Moseley GL. Reconceptualising pain according to modern pain science. Physical Therapy Reviews. 2007;12(3):169-178.
Eisenberger NI, Lieberman MD, Williams KD. Does rejection hurt? An fMRI study of social exclusion. Science. 2003;302(5643):290-292.
Kross E, et al. Social rejection shares somatosensory representations with physical pain. Proc Natl Acad Sci USA. 2011;108(15):6270-6275.
MacDonald G, Leary MR. Why does social exclusion hurt? The relationship between social and physical pain. Psychol Bull. 2005;131(2):202-223.
Waddell G, et al. Normative data on the Roland Morris Disability Questionnaire and the low back outcome score. Spine. 1998.