Pain is a universal human experience, yet it remains one of the most misunderstood aspects of healthcare. Whether it’s a lingering ache, a sharp injury-related sensation, or a chronic issue that has persisted for years, pain is complex. It’s more than just a signal from the body—it is an experience shaped by biological, psychological, and social factors.
What is Pain? A Biopsychosocial Perspective & How Physiotherapy Can Help
Pain is a universal human experience, yet it remains one of the most misunderstood aspects of healthcare. Whether it’s a lingering ache, a sharp injury-related sensation, or a chronic issue that has persisted for years, pain is complex. It’s more than just a signal from the body—it is an experience shaped by biological, psychological, and social factors.
This modern understanding of pain, known as the biopsychosocial model, moves beyond the outdated idea that pain simply equals tissue damage. In this article, we’ll explore what pain really is, how it works, and how physiotherapy can help you move forward.
Pain: More Than Just Tissue Damage
Many people believe that pain is a direct indicator of injury or damage. While this can sometimes be true (such as in acute injuries), pain itself is actually a protective mechanism—not a measure of harm.
Pain Science 101: The Nervous System’s Role
Pain is produced by the nervous system and is influenced by multiple inputs:
- Biological Factors – This includes tissue changes (such as inflammation or injury), nervous system sensitivity, and overall health.
- Psychological Factors – Thoughts, beliefs, past experiences, stress levels, and emotions all impact pain perception.
- Social Factors – Environment, work demands, family support, and societal expectations can influence pain experiences.
Pain occurs when your brain perceives a threat, even if no actual damage is present. Research from Lorimer Moseley and David Butler has shown that people can experience significant pain without any structural damage on scans, just as some people with visible tissue damage may have little or no pain. For example, studies have found that degenerative changes in the spine or joints (like osteoarthritis or disc bulges) are present in many people without pain. This suggests that tissue damage does not automatically mean pain—our nervous system decides whether pain is needed as a protective response.
Acute vs. Persistent Pain: Understanding the Difference
- Acute Pain (Short-term): This is the body’s warning system—like when you touch something hot or roll your ankle. It helps protect you while healing occurs.
- Persistent (Chronic) Pain (Long-term): Pain that lasts beyond normal tissue healing time (often >3 months). This type of pain is more complex and is often linked to nervous system sensitivity rather than ongoing damage.
Persistent pain can sometimes feel like it’s coming from the original injury, but it’s often maintained by changes in the pain system itself—not just the tissues.
How Physiotherapy Can Help Pain
- Understanding & Reframing Pain
One of the most important first steps in pain management is education. This is where pain neuroscience education (PNE) comes in—helping people understand that pain does not always mean harm. Physiotherapists trained in pain science help reframe unhelpful beliefs about pain, teaching strategies to retrain the nervous system and reduce threat perception.
- Graded Movement & Strengthening
People with persistent pain often avoid movement due to fear of making things worse (fear-avoidance behaviors). However, this can lead to more stiffness, weakness, and increased pain over time. Physiotherapy focuses on graded exposure to movement, meaning:
- Starting with tolerable exercises
- Slowly increasing load or movement variety
- Rebuilding confidence in the body’s ability to move without harm
This approach desensitizes the nervous system over time, reducing pain and improving function.
- Hands-On Therapy & Manual Techniques
While manual therapy (such as joint mobilizations or massage) does not “fix” pain in the long term, it can be useful for modulating symptoms and improving movement comfort. This allows people to move more freely and engage in active recovery strategies.
- Addressing Lifestyle Factors
Pain is not just a physical issue—it is influenced by stress, sleep, nutrition, and overall well-being. A physiotherapist can provide guidance on:
- Improving sleep (as poor sleep can increase pain sensitivity)
- Reducing stress & tension (since stress heightens nervous system sensitivity)
- Exercise strategies that fit into daily life
Breaking Free from Pain: The Power of the Brain-Body Connection
A key takeaway from pain science research is that the nervous system is adaptable. Just as it can become overprotective, it can also be retrained. This means that:
✅ Pain does not always mean damage
✅ Your body is capable of more than it feels like in the moment
✅ Small, gradual changes in movement, beliefs, and lifestyle can have a big impact over time
If you are struggling with ongoing pain, working with a physiotherapist who understands pain neuroscience and the biopsychosocial approach can help you regain confidence in movement, reduce sensitivity, and get back to the activities that matter to you.
Final Thoughts: Moving Forward with Pain Management
Pain is real. It’s complex. But it’s also modifiable. Understanding that pain is influenced by biology, thoughts, emotions, and lifestyle opens up new opportunities for recovery beyond just “fixing” tissues.
If you are experiencing ongoing pain and are unsure what steps to take, reach out to a physiotherapist who specializes in pain science. There is always a way forward.
References & Further Reading:
- Moseley GL, Butler DS. Explain Pain. Noigroup Publications, 2017.
- O’Sullivan PB, Caneiro JP, O’Keeffe M, Smith A, Dankaerts W. Cognitive Functional Therapy: An Integrated Behavioral Approach for Managing Low Back Pain. Br J Sports Med. 2018.
- Dubois JD, Piché M, Cantin V. Pain Science Education in Physiotherapy: What Works and Why? J Pain Res. 2023.
Would you like to discuss your pain and movement goals? Get in touch today for a consultation with our physiotherapist.