It’s Not that Most People don’t Understand Pain, They don’t WANT to Understand THEIR Pain

Table of Contents

• Introduction
• We Want Pain to Have a Villain
• "Are You Saying the Pain Is in My Head?"
• People Want Validation More Than Education
• A Damaged Body Is Easier to Understand Than a Sensitive Nervous System
• Understanding Pain Can Threaten Your Identity
• Fear is Powerful
• The Internet Can Make Everything Worse
• Understanding Pain Removes the Search for the Magic Fix
• People Confuse "Psychological" With "Imaginary"
• Sometimes We Don't Want Complexity
• Pain Education Doesn't Mean Ignoring the Body
• Understanding Your Pain Gives You Something Back
• Stop Asking Only, "Where Does It Hurt?"
• The Goal Isn't to Convince Yourself That Nothing Is Wrong
• Conclusion
• References

Introduction

Pain gets your attention. That's its job. Put your hand on a hot stove and your nervous system doesn't politely suggest that you consider moving it. It creates an immediate, unpleasant experience powerful enough to change your behavior. But chronic pain is different.

When pain sticks around for months or years, understanding it becomes incredibly important. You would think someone experiencing pain every day would want to learn everything possible about why it happens. Strangely, that isn't always the case.

Many people desperately want their pain to stop, but they aren't particularly interested in understanding it. They want the MRI. They want the diagnosis. They want the injection. They want the pill. They want someone to point at a damaged structure and say "There. That's the problem."

I understand the appeal. A simple explanation gives you a simple enemy. Unfortunately, chronic pain isn't always simple. And sometimes understanding pain requires accepting ideas that are considerably more uncomfortable than the pain itself.

We Want Pain to Have a Villain

Humans love simple explanations. My knee hurts because my cartilage is worn out. My back hurts because I have a bulging disc. My neck hurts because my posture is terrible. My shoulder hurts because I have arthritis. Sometimes those explanations are correct. But structural abnormalities and pain don't always correlate neatly.

Imaging studies have repeatedly found degenerative findings in people who have no pain at all. A major systematic review of imaging in asymptomatic people found that disc degeneration, bulges and other degenerative spinal findings became increasingly common with age, even among people without back pain.

That doesn't mean your MRI doesn't matter. It means your MRI isn't necessarily your entire pain story. And that's where things get uncomfortable. Because if the scan isn't the whole explanation, we have to start looking at something much more complicated: You. Not just your spine. Not just your knee. Not just your shoulder. We have to look at the entire biological system.

"Are You Saying the Pain Is in My Head?"

This may be the biggest obstacle in pain education. Tell someone that the brain plays a major role in chronic pain and there's a good chance they'll hear something completely different: "You're saying my pain isn't real." That's not what modern pain science says at all.

Pain is always real. But pain is also an experience produced by the nervous system. The International Association for the Study of Pain defines pain as both a sensory and emotional experience and specifically notes that pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.

That's incredibly important. Nociception is the nervous system detecting potentially threatening stimuli. Pain is the experience. Those things interact, but they're not identical. And once you understand that distinction, chronic pain starts looking very different.

People Want Validation More Than Education

Imagine hurting for five years. You've visited physicians. You've tried physical therapy. You've taken medications. Maybe people have told you nothing is wrong. Maybe family members think you're exaggerating. Maybe you've started questioning yourself.

Then someone begins explaining central sensitization, psychological influences, sleep, stress and nervous-system plasticity. You might not hear: "Here's a better explanation for your pain." What you might hear is: "Here comes another person telling me this isn't real." That's why pain education has to begin with validation.

The pain is real. The suffering is real. The limitation is real. But the explanation someone has been given for that pain may be incomplete. Those two things can exist simultaneously.

A Damaged Body Is Easier to Understand Than a Sensitive Nervous System

Structural explanations are incredibly intuitive. If a tire is flat, patch the hole. If a bone is broken, fix the bone. If a tendon is torn, repair the tendon. We naturally apply the same mechanical model to chronic pain. But the human body isn't a car.

It adapts. It learns. It changes. The nervous system can become more responsive to sensory information. Persistent nociceptive input can contribute to increased excitability within pain-processing pathways.

This is broadly associated with sensitization. Think of it like the alarm system protecting your house. Someone breaks a window. The alarm goes off. Good. That's acute pain.

Now imagine that six months later the alarm goes off when a delivery truck drives past. Then when the wind blows. Eventually, somebody walking across the lawn triggers it. The alarm isn't fake. The alarm is sensitive. That distinction changes everything.

Understanding Pain Can Threaten Your Identity

There's another side of chronic pain we don't discuss enough. People adapt their lives around it. You become: the person with the bad back, the guy with the terrible knees, the woman who can't exercise anymore, the person who needs to be careful, the person who can't lift anything, the person with the damaged spine.

Over time, those descriptions can become part of someone's identity. Then imagine being told that your body may be more capable than you think. That sounds positive. But it also creates responsibility. Because now there may be something you can do. You may have to move. Exercise. Build strength. Change habits. Improve sleep. Address fear. Challenge beliefs. Gradually expose yourself to movements you've spent years avoiding. That's harder than taking a pill.

Understanding pain can therefore be psychologically threatening because it sometimes requires changing the story you've been telling yourself about your body.

Fear Is Powerful

Pain teaches avoidance incredibly quickly. Bend over. Your back hurts. Your brain learns that bending = danger. So you stop bending. Then you try again three months later. You're stiff. You're weak. You're nervous. The movement hurts. And your brain receives confirmation. Bending really is dangerous.

This creates a nasty cycle:

Pain -> fear -> avoidance -> deconditioning -> increased sensitivity -> more pain

This doesn't happen because someone is weak-minded. It happens because avoidance is an incredibly effective short-term survival strategy. If something hurts, don't do it again. That strategy is brilliant when you're dealing with an acute injury. It can become disastrous when applied indefinitely to chronic pain.

The Internet Can Make Everything Worse

Search for almost any painful condition online and you'll encounter catastrophic language.

"Bone on bone." "Degenerated spine." "Destroyed cartilage." "Pinched nerves." "Bad posture." "Misaligned pelvis." "Your back is out."

These descriptions are powerful because language changes how we think about our bodies. If someone tells you your spine is unstable, you're probably going to protect it. If you're told your knee is bone-on-bone, you're probably going to avoid loading it. If you're convinced your neck is misaligned, normal movement can start feeling dangerous.

This is where the nocebo effect becomes relevant. Expectations and contextual information can influence symptoms. Negative expectations can increase pain, just as positive therapeutic context can sometimes decrease it. Words matter. Especially when someone is already afraid.

Understanding Pain Removes the Search for the Magic Fix

There is an enormous marketplace built around pain. Creams. Braces. Massagers. Supplements. Injections. Devices. Adjustments. Stretching systems. Recovery gadgets. I know! I run a company that makes pain relief cream! (A shameless plug for the best, all natural & organic topical analgesic, Battle Balm!)

Lots of these interventions are useful. I'm not discounting their effectiveness. But chronic pain creates the perfect customer because desperation makes certainty extremely attractive.

Someone says: "I know exactly what's causing your pain." Suddenly there's hope! Then comes: "And this is what fixes it." Even better.

Pain science offers something less exciting. Your pain may involve multiple interacting biological, psychological and social factors, and improving it may require several interventions performed consistently over time.

That's a terrible advertisement. But it may be a much more useful model.

People Confuse "Psychological" With "Imaginary"

This misunderstanding has probably done enormous damage to chronic-pain treatment. Stress can affect pain. Anxiety can affect pain. Depression can affect pain. Sleep can affect pain. Attention can affect pain. Expectations can affect pain. Fear can affect pain.

None of that means pain is imaginary. Your emotional state affects heart rate. That doesn't make your heartbeat imaginary. Stress affects digestion. That doesn't make your intestines imaginary. Sleep deprivation affects immune function. That doesn't make your immune system imaginary. The nervous system is biological. The brain is biological. Emotions are accompanied by biological processes. Pain doesn't suddenly become fake because the brain is involved. The brain is involved in every pain you've ever experienced.

Sometimes We Don't Want Complexity

There's another reason people resist understanding pain. Chronic pain science can be frustratingly complicated. There may not be one cause.

A painful knee might involve osteoarthritis, reduced quadriceps strength, poor sleep, decreased activity, fear of movement, previous injury, sensitization and inflammatory factors simultaneously.

Which one is causing the pain? Possibly several. And their relative importance can change over time. Humans don't particularly like explanations like that.

People prefer:

Problem -> Solution.

Chronic pain often looks more like:

Problem + nervous system + environment + behavior + health + history + context => changing pain experience.

Understanding chronic pain therefore requires tolerating uncertainty. That's difficult when you're hurting.

Pain Education Doesn't Mean Ignoring the Body

There is a danger at the opposite extreme. Once people learn about central sensitization and pain neuroscience, they can start treating every chronic pain problem as if tissue doesn't matter.

That's equally misguided. Sometimes the knee hurts because something is wrong with the knee. Sometimes a nerve is compressed. Sometimes there is inflammatory disease. Sometimes there is significant tissue pathology. Sometimes persistent or changing pain requires medical investigation.

Modern pain science doesn't tell us to ignore anatomy.

It tells us that anatomy is one part of the pain experience, not necessarily the entire experience. That's a much more useful position.

Understanding Your Pain Gives You Something Back

Here's why all of this matters. If you believe your body is damaged beyond repair, the logical response is protection. If you believe movement is destroying your joints, the logical response is avoiding movement. If you believe every painful sensation represents additional tissue damage, the logical response is fear.

But if you understand that pain is protective rather than a perfect damage meter, your options expand. You can begin experimenting. You can gradually move. You can rebuild strength. You can improve cardiovascular fitness. You can improve sleep. You can manage stress. You can work with healthcare professionals to identify what actually requires treatment. You can discover that some movements you thought were dangerous are simply uncomfortable. And slowly, you can begin building confidence in your body again.

Stop Asking Only, "Where Does It Hurt?"

The question isn't useless. It's simply incomplete. For chronic pain, we need better questions. When does it hurt? What makes it better? What makes it worse? How well are you sleeping? What movements are you afraid of? How active are you? How strong are you? What do you believe is happening inside your body when it hurts?

That last question might be one of the most important. Because the story you tell yourself about pain influences what you do next.

The Goal Isn't to Convince Yourself That Nothing Is Wrong

Understanding pain doesn't mean repeating positive affirmations while ignoring your symptoms. It means becoming more accurate. Maybe there is tissue damage. Treat it. Maybe you're weak. Get stronger. Maybe you're sensitized. Gradually expose the nervous system to safe movement. Maybe you're sleeping five hours a night. Improve your sleep. Maybe you're terrified of bending because somebody told you ten years ago that your spine was "degenerating." Challenge that belief with appropriate professional guidance. The objective isn't positive thinking. It's better information.

Conclusion

Most people don't want pain. But wanting pain to disappear and wanting to understand pain are two very different things. Understanding pain can be uncomfortable. It may challenge what you've been told. It may challenge what you believe about your body. It may require accepting that an MRI doesn't contain the entire answer. And it may mean acknowledging that recovery requires participation rather than simply finding the right person, pill, procedure or product.

But that knowledge can also be incredibly liberating. Because once you stop viewing your body as a collection of damaged parts and start understanding pain as a protective experience created by a living, adaptable nervous system, something changes. You stop being terrified of every signal. You start asking better questions. You start moving. You start rebuilding capacity. You start trusting your body again. Pain demands your attention. Understanding pain gives you some of that attention back.

References

1. Vader, K., Ushida, T., Tutelman, P. R., Sullivan, M. D., Stevens, B., Song, X.-J., Sluka, K. A., Ringkamp, M., Mogil, J. S., Keefe, F. J., Gibson, S., Flor, H., Finnerup, N. B., Cohen, M., Carr, D. B., & Raja, S. N. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 161(9), 1976–1982. https://doi.org/10.1097/j.pain.0000000000001939