Understanding pain: why do we feel pain and what can we do?
More pain does not always mean a more serious injury. Understand what can influence pain, why it may persist and how an assessment and adapted care can help you return to activities that matter.
Pain is a real and personal experience that may be related to an injury or illness. However, more pain does not, on its own, mean a more serious injury. When pain continues, understanding what influences it can help you choose care and return to activities that matter to you.
What is pain and why do we feel it?
Pain involves what we feel in the body and the emotions that accompany this unpleasant experience. It may be associated with an injury or the possibility of being hurt, but it can also exist without an identifiable injury that explains it. Physical health worries and living conditions can influence pain differently from one person to another.
Pain often helps protect us: it may make us pull a hand away from a hot surface or protect an injured area. However, it can also continue and interfere with movement, rest, work and relationships. Understanding what it means requires knowing each person's circumstances.
Are pain and nociception the same thing?
You may have heard the term “nociception” or come across it in a Google search when looking for an explanation for your pain. It may have been presented as the answer to your question. But does it really explain your experience?
Nociception is a term used to describe how the nervous system detects and processes signals of something that could hurt us. When you touch a very hot surface, for example, nerve receptors detect the heat and send information through the nervous system. This detection is part of nociception. Pain is the unpleasant experience a person feels and cannot be explained by these signals alone.
To understand pain, it is important to listen to the person. An injury, previous experiences, worries and living conditions may all be relevant. Considering these factors helps us understand symptoms and does not make the pain any less real.
Does more pain mean a more serious injury?
An injury can cause pain and require protection or treatment. However, pain does not always increase or decrease in proportion to changes in muscles, joints or other parts of the body. Particularly when pain continues, feeling more pain does not automatically mean that a new injury has occurred or that an earlier injury has worsened.
This does not mean ignoring new pain or continuing any activity without an assessment. Understanding when it started, how it has changed, which tasks it makes difficult and whether there are other symptoms helps a healthcare professional decide whether tests or other care are needed.
When is pain considered chronic?
Pain is considered chronic when it persists or recurs for more than three months. This timeframe helps healthcare professionals organise assessment and care. It does not mean that all injuries will necessarily have healed by then, or that the person will be in pain forever.
There are two groups. In chronic secondary pain, an illness explains the pain. In chronic primary pain, the pain itself is the main problem: it causes significant distress or difficulties and is not better explained by another chronic pain condition. The two groups can coexist. An assessment is needed to distinguish them; duration alone, or even an MRI scan, is not enough.
Why can pain persist?
Persistent pain can have different explanations. An illness or injury may continue to cause symptoms. The way the nervous system responds to signals from the body can also change. Worries and life circumstances may matter too, to different degrees for each person.
Studies of muscle and joint pain report that symptoms tend to last longer in some people with severe initial pain, fear of movement, little support, or financial and social difficulties. Finding these circumstances together does not prove that they cause the pain, nor does it guarantee that addressing just one will make the symptoms disappear.
Simply saying that the nervous system is “too sensitive” may not explain the whole situation. It is necessary to understand whether an illness or injury needs treatment, which activities are difficult and what might help, without blaming the person.
What roles do fear of movement, sleep and stress play?
When a movement causes pain, it is understandable to fear repeating it. That fear can lead to avoiding activities such as walking, bending down or carrying objects. Studies show that people who are more afraid of pain also tend to have greater difficulties with activities and more distress. However, this does not prove that fear caused the pain.
Sleep, worries, work and relationships also deserve attention during an assessment. Asking about these aspects helps us understand how pain affects life and how life can influence the experience of pain. It does not mean concluding that sleeping better or reducing stress will be enough to eliminate pain.
A useful conversation explores what the person has stopped doing, what they fear and what support they have. Recognising these difficulties helps set goals that fit their circumstances, rather than simply asking them to “be less afraid” or “move more”.
What if tests do not explain the symptoms?
An X-ray or MRI scan allows us to look at parts of the body, but it does not measure pain. A scan without findings that explain the symptoms does not make the pain imaginary. No, the pain is not “all in your head”!
Finding a change does not mean it explains all the pain either. The result needs to be considered alongside what the person feels and what they can do.
To interpret a test, the healthcare professional needs to know the symptoms and assess the person. If symptoms change or new ones appear, another assessment may be needed. Even someone already living with persistent pain can develop a different health problem that requires different care.
What does a person-centred assessment involve?
The assessment begins by understanding when the pain started, how it has changed and when it occurs. It is important to know about relevant illnesses and treatments, understand the impact on sleep and activities, and listen to the person's concerns. Based on this conversation, the professional chooses what to observe and examine, including movements and tasks that are difficult.
It is also important to ask what the person would like to get back to doing. For one person, the goal may be returning to work; for another, going for a walk with family or doing a household task more easily. These goals help guide care and show, over the course of treatment, whether it is making a difference in everyday life.
How can Physiotherapy help?
Physiotherapy can help assess and manage pain in muscles, joints and nearby structures such as tendons. The plan may combine adapted exercise, explanations and everyday strategies, such as adjusting a task or planning a gradual return to an activity. When needed, care is coordinated with other professionals.
For chronic primary pain, some clinical guidelines recommend supervised group exercise adapted to the individual. This means choosing appropriate exercises and adjusting the effort and the pace at which activity increases.
Clinical Pilates can be one way of exercising within Physiotherapy. The choice should take into account the assessment, the movements the person can do and what they enjoy. The name of the approach alone does not guarantee that a programme is suitable or that it will produce particular results.
You may also benefit from more individual support, at least initially. Plans are not the same for everyone: the same programme does not suit every pain problem, and symptoms may call for adjustments or another assessment. Talk to a Physiotherapist at Bwizer Health and find the right way forward for you.
Is understanding pain enough to treat it?
Clear explanations allow you to ask questions, understand the options and take part in decisions about care. However, understanding pain better does not guarantee that it will decrease. You do not have to master a scientific explanation to improve: information should help you and accompany the care you need.
Pain neuroscience education programmes explain how the body and nervous system are involved in pain. Some studies suggest benefits when these programmes accompany other care, but results vary. It is still uncertain how much they add to pain relief or the ability to carry out activities. The programmes and the people studied also differ.
How can you recognise improvement when pain is still present?
Pain intensity matters, but it does not tell the whole story of recovery. Being able to walk for longer, return to an activity you enjoy or carry out a task more easily can all be meaningful improvements. It is possible to gain quality of life even while pain is still present.
This does not mean giving up on finding relief. It means looking at pain and at what you can do: walking with fewer pauses, for example, may be an improvement even with some discomfort. As symptoms vary from day to day, it is useful to track changes and discuss difficulties or worsening symptoms with your healthcare professional.
What can you do today?
You can start by gathering information to discuss with a professional, without trying to identify the cause of the pain on your own or forcing movements to test how far you can go.
- Choose an activity you would like to return to and describe what makes it difficult.
- Write down questions about what the pain means and any fears related to movement.
- Notice whether you can do more tasks, rest better or take part in activities, as well as paying attention to pain intensity.
- If you are unsure how to adjust activities or different symptoms have appeared, seek advice to decide what to do next.
When should you seek professional help?
Pain that limits activities, disrupts rest, recurs or leads you to avoid movement may warrant an assessment. You do not need to wait three months to ask for help: that timeframe is used to call pain “chronic”, not to decide when you should seek care.
If new symptoms appear, pain gets worse or it feels different from usual, seek another assessment. A medical assessment may be needed before starting or continuing exercise.
Frequently asked questions
Does chronic pain mean I will be in pain forever?
No. The term means that pain has lasted or recurred for more than three months. On its own, it cannot predict what will happen. How things progress and what care is needed depend on the problem and each person's circumstances.
Do I need to be pain-free before exercising again?
In some situations, exercise is part of care even when pain is present. The problem needs to be understood and activity adapted. A number from zero to ten on a pain scale does not, on its own, tell you whether it is safe to continue. The type of symptoms and your health also matter.
If psychological support is recommended, does that mean the pain is imaginary?
No. Psychological support can be part of care for some people with chronic primary pain, helping them cope with distress and everyday difficulties. The decision depends on the person's needs and preferences. This does not make pain any less real or remove the need to assess possible illnesses or injuries.
Bwizer Health can help
An assessment at Bwizer Health can help you understand how pain is affecting your everyday life and what you would like to get back to doing. Care from our Physiotherapists involves explaining the options, adapting care and checking whether it is helping, with referral to other professionals when needed.
Bringing specific examples of what you would like to do again can help that conversation. Rather than choosing a technique in advance, what matters is building a plan that makes sense for your circumstances and your life.
If pain is limiting your everyday life, book a Physiotherapy assessment at Bwizer Health to discuss the next steps.
This article is for information only and does not replace an individual assessment by a healthcare professional.
References
Cuenca-Martínez, F., Suso-Martí, L., Calatayud, J., Ferrer-Sargues, F. J., Muñoz-Alarcos, V., Alba-Quesada, P., & Biviá-Roig, G. (2023). Pain neuroscience education in patients with chronic musculoskeletal pain: An umbrella review. Frontiers in Neuroscience, 17, Article 1272068. https://doi.org/10.3389/fnins.2023.1272068
Dunn, M., Rushton, A. B., Mistry, J., Soundy, A., & Heneghan, N. R. (2024). The biopsychosocial factors associated with development of chronic musculoskeletal pain. An umbrella review and meta-analysis of observational systematic reviews. PLoS ONE, 19(4), Article e0294830. https://doi.org/10.1371/journal.pone.0294830
García Cancela, J., Conde Vázquez, O., Navarro Ledesma, S., & Pruimboom, L. (2025). The effectiveness of pain neuroscience education in people with chronic non-specific low back pain: An umbrella review with meta-analysis. Annals of Physical and Rehabilitation Medicine, 68(8), Article 102020. https://doi.org/10.1016/j.rehab.2025.102020
National Institute for Health and Care Excellence. (2021). Chronic pain (primary and secondary) in over 16s: Assessment of all chronic pain and management of chronic primary pain (NICE Guideline No. NG193). https://www.nice.org.uk/guidance/ng193
Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F. J., Mogil, J. S., Ringkamp, M., Sluka, K. A., Song, X.-J., Stevens, B., Sullivan, M. D., Tutelman, P. R., Ushida, T., & Vader, K. (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
Riley, S. P., Ware, E., Pitre, Z., Russell, N., & Flowers, D. W. (2025). Pain neuroscience education combined with any singular form of physical therapy intervention is not more effective than the single intervention itself: A systematic review. Journal of Manual & Manipulative Therapy. Advance online publication. https://doi.org/10.1080/10669817.2025.2584158
Rogers, A. H., & Farris, S. G. (2022). A meta-analysis of the associations of elements of the fear-avoidance model of chronic pain with negative affect, depression, anxiety, pain-related disability and pain intensity. European Journal of Pain, 26(8), 1611–1635. https://doi.org/10.1002/ejp.1994
Treede, R.-D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., Giamberardino, M. A., Kaasa, S., Korwisi, B., Kosek, E., Lavand'homme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., . . . Wang, S.-J. (2019). Chronic pain as a symptom or a disease: The IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain, 160(1), 19–27. https://doi.org/10.1097/j.pain.0000000000001384
van Rysewyk, S., Blomkvist, R., Chuter, A., Crighton, R., Hodson, F., Roomes, D., Smith, B. H., & Toye, F. (2023). Understanding the lived experience of chronic pain: A systematic review and synthesis of qualitative evidence syntheses. British Journal of Pain, 17(6), 592–605. https://doi.org/10.1177/20494637231196426
