You can trust your pain (mostly)

• May 14, 2024 • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

An old friend of the salamander wrote to me to vent about her pain: “I know pain likely isn’t indicative that there is something wrong with the tissues,” she said… but then she went on to explain how unlikely that seemed to her, because her pain was so persistent and reproducible in a specific situation.

Which seems like a reasonable doubt to me.

She was trying to respect the science-based (but contested) claim that pain is an unreliable indicator because the experience of pain is always being generated by a brain with unpredictable “opinions” about it. A claim she knows I have promoted (see Pain is Weird).

But how much have I promoted it lately? It’s a moving target, but even at the peak of my interest in the idea that pain is weird and unreliable, circa 2016, I never thought that it was mostly unreliable. Even many kinds of chronic pain always seemed quite likely to be meaningful signals, powered by an unsolved problem. Since then, I’ve been cultivating doubts about just how much brains actually “edit” our pain. In the last couple years, I’ve written about several problems with the evidence that pain can occur without damage. For example, see “The legend of Boot Nail Guy reconsidered” or “Can the mind create pain?”

And so, in fact, I think that pain likely is “indicative of something wrong with the tissues.” That’s the safe bet.

Yes, pain is truly screwy and weird for an unlucky minority (🙋🏻‍♂️), but most people can and should trust most of their pain, most of the time. Even my weird body still mostly gets it right. The most common way for pain to be “wrong” is probably just the volume, but shouting 20% too loudly doesn’t render the message nonsensical.

It would be bizarre if evolution produced a pain system that wasn’t quite good at warning you about real dangers. A little overkill around the edges, sure — better safe than sorry — but mostly reliable. Only a few kinds of pain cannot be trusted — and mostly due to pathology, I suspect, and not psychology.

Most pain can and should be trusted.