There are people with atrocious MRIs who are pain-free. There are people with no obvious imaging issues with intense pain. Several weeks ago, BBC ran a piece on a woman who experience NO PAIN during pregnancy and delivery, accidents or surgery: https://www.bbc.com/…/uk-englan…/the-woman-who-feels-no-pain
For reasons we don’t fully understand, a lot of people experience pain when they are doing something beneficial or productive for the body. Those same people feel little pain while they avoid improvement, and they have a great reduction in symptoms while they actively make themselves less healthy and fit. Meanwhile, there are people who don’t experience much or any pain during damage; or they’ve even de-trained the feedback loops in the body which would hold them back from injury so they can’t rely on “pain” as a demarcation for discontinuing certain activities.
It’s a paradox. Sometimes you must suffer acute excruciating physical pain, mental, or emotional suffering, in order to improve. Other times, you must hold yourself back when there is no pain signal, because you may be doing harm anyway.
This doesn’t even scrape the surface of the psychological component of “perception.” I’ve seen people feel physical pain acutely when absolutely nothing physical is going on. I’ve seen my kids fall or take an impact trauma without acknowledging the event. Pain doesn’t tell the truth. We tell it what to do.
So there’s this multi-faceted skill with regard to pain. Some of it is genetic. Some of it is Pavlovian conditioning. Most of it is directed by how practiced or skilled you are at being in pain. Sympathetic over-activation comes in and takes over. And occasionally a reliably reproducible motion or angle can trigger it. But that doesn’t even mean you should avoid that motion or angle. Because pain lies. And it may be the very thing you need to do to improve and reduce your lifetime overall sensation of suffering.
I’ve had orthopedic pain and injuries, nerve damage and oppressive nerve pain. But a great eye-opener was when I had unrelenting body pain during an infection. I had joint pain, spine pain, and debilitating nerve pain from... nothing. As I reduced my physical activity it did basically nothing to reduce the pain. In fact, the only thing that got me out of the non-stop daily suffering was MORE pain from activity and lifting.
Likewise, from a whole litany of contributing factors, I had chronic hip pain from 1998-2008. 10 friggin years. I had to hobble some days. Ultimately this was resolved not through avoidance, but through embracing increases in pain as growth, such that my baseline of pain experience dropped out. Reliance on NSAIDs also worsened the situation, since they block tissue repair. I had to endure worsening to experience bettering.
And I’m not in any way insinuating that this is an analog for other people’s pain. It’s variant. It’s frustrating. In summary, however, it’s totally unreliable and misleading.
I’ve worked with hundreds of ankle sprains where we can get people better by making the tissue burn in a deep pain worse than ever experienced. Elbow tendinitis can be remedied sometimes THAT day with very high repetition excruciatingly painful sets of exercise. Persistent rotator cuff aggravation gets better when we increase motion and remove the ice, compression, and pain meds.
There isn’t an answer. It’s just food for thought. We can get so skilled at being in pain, and so emotionally adept at connecting fear to the cure, that we never really get better. We can lose the win by chasing momentary highs, escaping effort, and living a life punctuated by reaching for “relief.” But real relief never truly comes.
Only in desperation does someone find a way out. And it’s usually to go through the very door they’ve feared opening and stepping through.
When confronted with “no pain, no gain” I shake my head in disappointment. I’d much rather hear people tout the goodness of “no pain, no pain.” But, as I covered in the above paragraphs, a lot of people have been trying to follow the path of “no pain, no pain” only to live a life of pain. That physical pain reinforces itself by bleeding over into the mental, emotional, and psychological side of things, which, in turn, raise physical sensation of pain.
It’s a tough spot in which to find yourself. So surely we must show more compassion to others in pain and our own selves when in pain. That all said, the flip side of the coin is a a bold tough love with ourselves when we may really be digging a pit instead of building a ramp.
Pain is deceiving.