Pain Is a Liar

Pain is the number ONE issue that causes people to think about going to see a physical therapist. We, as physical therapists, have continued to precipitate this emphasis by asking about pain, and performing techniques that are focused on pain relief, BUT we as therapists want to do so much more for our patients, and if we can understand that Pain is a Liar, we can.

There are a large number of sayings that we as PT’s use in relation to pain that can shed some light on one of the most misunderstood parts of life. Sayings like “pain is an output”, “pain is weakness leaving your body”, “pain is temporary” and of course “pain is a liar”.

Let’s use some of these sayings to shed some light on pain and how concentrating on pain can limit progress and continue the feeling of pain.

“Pain is an Output”

Pain is actually your brain’s interpretation of a signal from an area of dysfunction, injury, or nocioception.

In a recent study, they looked at two people who have a genetic disorder that does not allow them to experience pain. These are those people that can put their hand on a hot stove and report that their hand will feel warmer, but it’s not painful. They had each of these people receive a ‘pinprick’ stimulus, which would make most of us say “ow” or want to strike back at the tester. During the stimulus they performed a Functional MRI (An fMRI measures brain blood flow to display brain activity changes.) to evaluate was going on during the stimulus and did the same stimulus with a few age-matched normal people as comparison. What they found was that the key areas for the “pain matrix” would ‘light-up’ on fMRI for both groups in the similarly. The difference was that the “normal” people complained of pain, but the two people with the genetic disorder did not complain. So, when the researchers gave a pain stimulus, there are key areas of the brain that were activated in both of the groups. The “pain” input activating the ‘pain matrix’ does not mean it is pain. Pain occurs only when it becomes the output and the person feels the pain. The stimulus is not the pain. Pain is about the output, not the input.

When we understand the characteristic or pain as an output, it frees us (both as therapists and patients) to concentrate on the cause of the pain. It allows us to correct the movement disorder, muscle imbalance or poor muscle performance that has caused that output. If you had a splinter in your finger that REALLY hurt your finger, you would pull the splinter out of your finger. If we take care of the input (cause of the pain), the output goes.

"Pain is Weakness Leaving your Body"

A lot of people have heard this one, but not many people know where it came from or have even thought about its MANY meanings and uses.

First, this one started as propaganda by the US Marines Recruiting offices to get more people to join the Marines (and it was very effective at that).

Technically, it is not true. As we just said pain is your brain’s response to a stimulus to tell your body that something is wrong. It is telling you to stop what you’re doing and protect yourself from that input.