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Pain doesn’t equal tissue damage

All pain is real, no matter what’s causing it. What surprises most people is that you can have pain when there is no tissue damage. That is, when there’s no damage to muscles, tendons, nerves or any of the linings within the body.

There is much to learn, but the most important ideas are covered here in several languages (scroll to the bottom to find).

Maybe the damage was there once, but pain keeps occurring long after the damage has healed.

What’s also unexpected is that you can have an abnormal scan unrelated to your pain. In fact, there’s a vast amount of research that convincingly shows many people with ‘abnormalities’ on scans have no pain and can’t recall ever having an injury. As you age, it’s actually more normal to have them than not.

The reason there can be such a big difference between pain and damage is simple. Tissue can withstand only a certain amount of load (movement, strain or pressure) before it’s damaged. However, our pain system is extraordinarily complex and is triggered by more than just tissue load. Psychological and social factors can also cause pain – these are called non-tissue factors.

For instance, in 1995, the British Medical Journal reported the case of a builder in excruciating pain from a 15cm nail, which pierced his work boot. But when the doctors removed it, they found the nail had passed between his toes and missed his foot completely.

Thanks to pain science, we now know that:


  1. Most pain episodes occur to prevent tissue damage
  2. With persistent pain, the pain system becomes more efficient and can be overprotective
  3. When pain persists, it often gets stronger and lasts longer
  4. With persistent pain the influence of non-tissue factors usually becomes greater
  5. Non-tissue factors include stress, anxiety, fear of injury, poor sleep, worry about returning to work, or even a long commute
  6. Abnormalities on scans aren’t necessarily the reason for pain
  7. Even how you are told about these scan results can cause pain
  8. Humans have an amazing capacity to heal, repair and adapt.

This fact sheet is not specific medical advice. But we really hope that, once you’ve read it, you’ll understand more about pain and the latest ways of managing it.

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Arabic - الألم لا يساوي تلف الأنسجة

Italian - Dolore non significa danno ai tessuti

Japanese - 痛みと組織の損傷は、同じではありません

Portuguese - Dor não é igual a lesão

Spanish - Dolor no equivale a una lesión en el tejido

Traditional Chinese - 疼痛不等於組織受傷

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