The Science of Pain

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Pain is quite weird and often misleading. If you have chronic pain, it can be a huge help to understand things like why injuries sometimes heal slowly or how insomnia makes pain so much worse, or all the possible surprising causes of pain. On the other hand, there’s a lot you don’t need to worry about, like your back being out of alignment or bad posture or how inflexible you are — all major examples of highly over-rated causes of pain. But that’s the tip of the iceberg…

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Fundamentals: the science of pain

• Painful Lessons — What I’ve learned from twenty-five years of studying pain and injury.
• Pain is Weird — Pain science reveals a volatile, misleading sensation that comes entirely from an overprotective brain, not our tissues
• The 3 Basic Types of Pain — Nociceptive, neuropathic, and “other” (and then some more).
• Counterstimulation, Counterirritation, and Gate Control — Minor but reliable, counterstimulation is the most basic pain-killing mechanisms in biology… and maybe there’s a fancier version that’s more useful.
• Cramps, Spasms, Tremors & Twitches — The biology and treatment of unwanted muscle contractions.
• 38 Surprising Causes of Pain — Trying to understand pain when there is no obvious explanation.
• Sensitization in Chronic Pain — Pain itself can change how pain works, resulting in more pain with less provocation.
• Chronic, Subtle, Systemic Inflammation — One possible sneaky cause of puzzling chronic pain. MEMBERSThis article contains a members-only area. There are ten large members-only areas (highlighted items) scattered around the site, plus a growing selection of articles with smaller members-only sections. In most cases, the exclusive content is digressive and interesting, a bonus for members, while the most useful/essential points remain freely available to all visitors. Most PainScience.com content is free and always will be.
• Vulnerability to Chronic Pain — Chronic pain often has more to do with general biological vulnerabilities than specific tissue problems.
• Placebo Power Hype — The placebo effect is fascinating, but its “power” isn’t all it’s cracked up to be.
• You Might Just Be Weird — The clinical significance of normal — and not so normal — anatomical variations.
• The Trigger Point Identity Crisis — The biological evidence that a trigger point is a lesion in muscle tissue.
• A Painful Biological Glitch that Causes Pointless Inflammation — How an evolutionary wrong turn led to a biological glitch that condemned the animal kingdom — you included — to much louder, longer pain. MEMBERSThis article contains a members-only area. There are ten large members-only areas (highlighted items) scattered around the site, plus a growing selection of articles with smaller members-only sections. In most cases, the exclusive content is digressive and interesting, a bonus for members, while the most useful/essential points remain freely available to all visitors. Most PainScience.com content is free and always will be.
• Why Do Muscles Feel Stiff and Tight? — Maybe your range of motion is actually limited, or maybe it just feels that way.

One of the principle qualities of pain is that it demands an explanation.

Plainwater, by Anne Carson

Pain & the mind

• Chronic Pain and Inequality — The role of racism, sexism, queerphobia, ageism, and poverty in health and chronic pain
• Mind Over Pain — Pain can be profoundly warped by the brain, but does that mean we can think the pain away? MEMBERSThis article contains a members-only area. There are ten large members-only areas (highlighted items) scattered around the site, plus a growing selection of articles with smaller members-only sections. In most cases, the exclusive content is digressive and interesting, a bonus for members, while the most useful/essential points remain freely available to all visitors. Most PainScience.com content is free and always will be.
• Chronic Pain as a Conditioned Behaviour — If pain can be learned, perhaps it can be unlearned
• The Mind Game in Low Back Pain — How back pain is powered by fear and loathing, and greatly helped by rational confidence.
• What if You Could Wipe the Chronic Pain Slate Clean? — A short, poignant thought experiment for chronic pain sufferers.
• Why Do We Get Sick? — The curious and tangled connections between pain, poor health, and the lives we lead.
• Stuck in My Throat — A “globus pharyngeus” nightmare, with a side of science. Globus is a curious hybrid of pain and “discomfort,” that is unusually sensitive to psychological distress.
• Pain Relief from Personal Growth — Treating tough pain problems with the pursuit of emotional intelligence, life balance, and peacefulness.
• Anxiety & Chronic Pain — A self-help guide for people who worry and hurt. MEMBERSThis article contains a members-only area. There are ten large members-only areas (highlighted items) scattered around the site, plus a growing selection of articles with smaller members-only sections. In most cases, the exclusive content is digressive and interesting, a bonus for members, while the most useful/essential points remain freely available to all visitors. Most PainScience.com content is free and always will be.
• Autonomous Sensory Meridian Response — That nice, weird tingly head feeling (and its possible relevance to healthcare and treating pain, especially with massage).
• Bone on Bone — How often are those dirty words about arthritis a harmful exaggeration? And should we ever use them, even when it’s accurate? BOB is one of the most common and dramatic examples of a (potential) nocebo, but it’s complicated — so it gets its own big article. MEMBERSThis article contains a members-only area. There are ten large members-only areas (highlighted items) scattered around the site, plus a growing selection of articles with smaller members-only sections. In most cases, the exclusive content is digressive and interesting, a bonus for members, while the most useful/essential points remain freely available to all visitors. Most PainScience.com content is free and always will be.

Factors in pain and injury (both underestimated & over)

• Your Back Is Not Out of Alignment — Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain. MEMBERSThis article contains a members-only area. There are ten large members-only areas (highlighted items) scattered around the site, plus a growing selection of articles with smaller members-only sections. In most cases, the exclusive content is digressive and interesting, a bonus for members, while the most useful/essential points remain freely available to all visitors. Most PainScience.com content is free and always will be.
• The Still Life — Back pain and worse hazards of sitting in chairs way too much.
• The Insomnia Guide for Chronic Pain Patients — Serious insomnia-fighting advice from a veteran of the sleep wars.
• Is Running on Pavement Risky? — Hard-surface running might be a risk factor for running injuries like patellofemoral pain, IT band syndrome, shin splints, and plantar fasciitis.
• Smoking and Chronic Pain — We often underestimate the power of (tobacco) smoking to make things hurt more and longer.
• Vitamin D for Pain — Is it safe and reasonable for chronic pain patients to take higher doses of Vitamin D? And just how high is safe?. MEMBERSThis article contains a members-only area. There are ten large members-only areas (highlighted items) scattered around the site, plus a growing selection of articles with smaller members-only sections. In most cases, the exclusive content is digressive and interesting, a bonus for members, while the most useful/essential points remain freely available to all visitors. Most PainScience.com content is free and always will be.
• Muscle Pain as an Injury Complication — The story of how I finally “miraculously” recovered from the pain of a serious shoulder injury, long after the injury itself had healed.
• MRI and X-Ray Often Worse than Useless for Back Pain — Medical guidelines “strongly” discourage the use of MRI and X-ray in diagnosing low back pain, because they produce so many false alarms.
• The Functional Movement Screen (FMS) — The benefits of the popular screening system for athletes might be over-sold by some professionals.
• Does Posture Matter? — A detailed guide to posture and postural correction strategies (especially why none of it matters very much).
• Spinal Subluxation — Can your spine be out of alignment? Chiropractic’s big idea has been misleading patients for more than a century.
• Does Hip Strengthening Work for IT Band Syndrome? — The popular “weak hips” theory is itself weak.
• Neuropathies Are Overdiagnosed — Our cultural fear of neuropathy, and a story about nerve pain that wasn’t.
• Flexibility — Flexibility is nice, but does it having anything to do with pain and injury? MEMBERSThis article contains a members-only area. There are ten large members-only areas (highlighted items) scattered around the site, plus a growing selection of articles with smaller members-only sections. In most cases, the exclusive content is digressive and interesting, a bonus for members, while the most useful/essential points remain freely available to all visitors. Most PainScience.com content is free and always will be.
• Don’t Worry About Lifting Technique — The importance of “lift with your legs, not your back” to prevent back pain and injury has been exaggerated.

Articles that delve into more obscure pain causes and factors

• Guide to Repetitive Strain Injuries — Five surprising and important ideas about repetitive strain injuries for patients and professionals. MEMBERSThis article contains a members-only area. There are ten large members-only areas (highlighted items) scattered around the site, plus a growing selection of articles with smaller members-only sections. In most cases, the exclusive content is digressive and interesting, a bonus for members, while the most useful/essential points remain freely available to all visitors. Most PainScience.com content is free and always will be.
• Vitamin D for Pain — Is it safe and reasonable for chronic pain patients to take higher doses of Vitamin D? And just how high is safe?.
• The Mind Game in Low Back Pain — How back pain is powered by fear and loathing, and greatly helped by rational confidence.
• 6 Main Causes of Morning Back Pain — Why is back pain worst first thing in the morning, and what can you do about it?. MEMBERSThis article contains a members-only area. There are ten large members-only areas (highlighted items) scattered around the site, plus a growing selection of articles with smaller members-only sections. In most cases, the exclusive content is digressive and interesting, a bonus for members, while the most useful/essential points remain freely available to all visitors. Most PainScience.com content is free and always will be.
• The Respiration Connection — How dysfunctional breathing might be a root cause of a variety of common upper body pain problems and injuries.
• A Painful Biological Glitch that Causes Pointless Inflammation — How an evolutionary wrong turn led to a biological glitch that condemned the animal kingdom — you included — to much louder, longer pain. MEMBERSThis article contains a members-only area. There are ten large members-only areas (highlighted items) scattered around the site, plus a growing selection of articles with smaller members-only sections. In most cases, the exclusive content is digressive and interesting, a bonus for members, while the most useful/essential points remain freely available to all visitors. Most PainScience.com content is free and always will be.
• Psoas, So What? — Massage therapy for the psoas major and iliacus (iliopsoas) muscles is not that big a deal.
• A Recipe for Chronic Neck Pain After Whiplash — Researchers discover some surprising risk factors for chronic neck pain in the aftermath of whiplash.

Science itself: evidence, research, and critical thinking

• Most Pain Treatments Damned With Faint Praise — Most controversial and alternative therapies are fighting over scraps of “positive” scientific evidence that damn them with the faint praise of small effect sizes that cannot impress.
• The Power of Barking: Correlation, causation, and how we decide what treatments work — A silly metaphor for a serious point about the confounding power of coincidental and inevitable healing, and why we struggle to interpret our own recovery experiences.
• 13 Kinds of Bogus Citations — Classic ways to self-servingly screw up references to science, like “the sneaky reach” or “the uncheckable”.
• Is Diagnosis for Pain Problems Reliable? — Reliability science shows that health professionals can’t agree on many popular theories about why you’re in pain.
• Statistical Significance Abuse — A lot of research makes scientific evidence seem much more “significant” than it is.
• Ioannidis: Making Medical Science Look Bad Since 2005 — A famous and excellent scientific paper … with an alarmingly misleading title.
• Statistical Significance Abuse — A lot of research makes scientific evidence seem much more “significant” than it is.
• A Historical Perspective On Aches ‘n’ Pains — Why is healthcare for chronic pain and injury so bad?.
• Palpatory Pareidolia & Diagnosis by Touch — Tactile illusions, wishful thinking, and the belief in advanced diagnostic palpation skills in massage and other touchy health care.
• Science versus Experience in Musculoskeletal Medicine — The conflict between science and clinical experience and pragmatism in the management of aches, pains, and injuries.
• Speculation-Based Medicine — Alternative medicine prioritize experience and speculation over evidence (and then tends to ignore the evidence when it finally arrives).
• Why So “Negative”? — Answering accusations of negativity, and my reasons and methods for debunking bad treatment options for pain and injury. (This might seem off-topic, but it has some sections about the null hypothesis at the end, which is actually some of my own favourite writing about science.)