Why does something hurt?

Until about 40 years ago, pain was seen in scientific and medical circles as a quite simple phenomenon.

Back then, it was thought that the cause of pain was always structural in nature.
It was thought that there must be anatomical damage to some tissue (muscle, nerve, cartilage, etc.) if there is pain.

This (outdated) way of understanding pain is called “pathoanatomical model of pain”.
Today we know that this way of observing and understanding the pain system is not correct.
Pain is a very complex phenomenon, the origin and survival of which is influenced by many factors, and it can exist without any structural damage.

This (better) way of understanding pain is called the “biopsychosocial model of pain”

(Cholewicki et al. 2019; Hartvigsen et al. 2018).

Pain is more an indicator of the sensitivity of the nervous system than an indicator of tissue damage (O’Sullivan et al. 2019).

Imagine two very common occurrences of pain in everyday life: headaches and painful menstruations.

Almost no one ever thinks that it is necessary to do an emergency X-ray or MRI in these situations.

The pain is often very intense, but there is no damage to blame for it.

We simply accept that the head can sometimes hurt for various (more or less clear) reasons.

Also, often in these situations (headaches) we think:
“What could I have done that made this pain worse?”

Because we know and it is socially accepted that things like alcohol, dehydration, stress and lack of sleep can affect headaches.

This is how we should observe and analyse other pains of the musculoskeletal system, such as back pain.

Due to inadequate education and slow transfer and acceptance of new knowledge from the
scientific literature to educational institutions, pain is still viewed too mechanically, too anatomically and too structurally.

However, due to the large number of studies published in the field of pain pain science,
today we know that pain is an extremely complex multifactorial phenomenon.

For example, if we take 1000 people aged 60 who DO NOT have any back pain and do an
MRI on them, we will see that 60-70% of these people have various degenerative changes in
the spine such as disc herniation, disc protrusion, disc degeneration, etc. (Brinjiki et al. 2015)
Horga et al. (2020) showed on a sample of 230 asymptomatic (painless) knees that

degenerative changes were present in 97% of cases.

Other similar studies have reached the same conclusions for other joints.
Such evidence tells us that the anatomical structure is not the only factor that affects pain,
and that anatomical structure cannot always be fully blamed when something hurts.

This is especially the case with chronic, long-term pain.

If our back or knees hurt, it does not necessarily mean that there is tissue damage.
And if there is tissue damage, it does not mean that this damage is the (only) cause of the pain.

In other words, if your back hurts and the MRI shows that you have degenerative disc
changes or a protrusion, this does not automatically mean that the pain was caused by
these changes, nor that the pain will disappear if these changes are removed or modified in any way.

What are the factors that can affect the occurrence and intensity of pain?
Every day we come to new knowledge, but from what we know so far, these are some of
the most important factors that influence the occurrence and intensity of pain:

1. Insufficient physical activity
2. Too much physical activity (“too much too soon”)

3. Poor quality of sleep
4. Insufficient hours of sleep
5. High subjective perception of stress
6. Smoking cigarettes
7. Dissatisfaction with work
8. Bad social life

9. Kinesiophobia (fear of movement and fear that exercise will worsen pain)

10. Anxiety
11. Depression

12. Catastrophizing (negative expectations)

13. Obesity

14. Spending large amounts of time in the same position

15. Other diseases
16. Inadequate training plan
17. The list goes on…