All pain is real. It’s not imagined or exaggerated.

Pain is the body’s way of alerting you and trying to protect you. Pain is not a "wire from the body to the brain", it is a whole-system response involving sensation, memory, emotion, attention, and action. When we understand this more clearly, it becomes easier to see why pain can behave in complex ways — and why recovery often involves more than just treating one structure.
The main types of pain
In current Western medicine and pain science, pain is often described using three main mechanisms. This is one widely accepted way of organising pain, and many people experience a combination rather than just one.
1. Nociceptive pain (tissue-based pain)
Nociceptive pain comes from irritated, inflamed, or overloaded tissues such as muscles, joints, fascia, discs, ligaments, or internal organs. It often develops after an injury or strain, during periods of inflammation or swelling, or when tissues are repeatedly overloaded or held in guarded positions for long periods of time. This type of pain is commonly described as aching, sore, sharp, or throbbing, and it tends to relate to movement, posture, or how much load the body is taking. In many cases, nociceptive pain settles as irritated tissues calm and their tolerance to movement and load improves — essentially, the tissues are sending “something’s not happy here” signals.
2. Neuropathic pain (nerve-related pain)
Neuropathic pain occurs when there is irritation, compression, or injury to a nerve or to the nervous system itself. This can happen with things like nerve root compression (such as sciatica), nerve entrapment, or increased nerve sensitivity following surgery or inflammation. People often describe this type of pain as burning, electric, shooting, or stabbing, and it may be accompanied by tingling, numbness, or pins-and-needles sensations. Neuropathic pain often follows a nerve pathway rather than staying in one spot, and it tends to behave differently from tissue-based pain, which is why it usually responds best to a gentler, more nerve-aware approach.
3. Nociplastic pain (sensitised nervous system pain)
Nociplastic pain refers to pain that arises when the nervous system becomes more sensitive and protective, even without clear ongoing tissue damage or nerve injury. In these cases, the brain’s interpretation of signals plays a bigger role in how pain is felt. This has helped explain many persistent pain conditions. Nociplastic pain often lasts longer than expected and may fluctuate, spread, or change location, with increased sensitivity to movement, touch, stress, or fatigue. This doesn’t mean the pain is psychological or “all in your head” — it means the nervous system is staying in protection mode, even when there is no longer a clear physical threat.
Sensitised Nervous System
When the nervous system stays on high alert, it can amplify pain so that normally safe sensations — like light touch or gentle movement — begin to feel painful. This reflects activity in the body’s protective wiring, most of which operates below conscious awareness. You’re not choosing this — it’s the body’s alarm system staying on guard, sometimes like an overprotective guard dog reacting to anything that seems slightly off.
🐶 Barking Dog (Overprotective):
Sometimes, our nervous system acts like an overprotective dog—barking at harmless things, just in case.
🐶 Calm Dog (Regulated):
With support and safety, that same nervous system can learn to sit peacefully—alert, but not alarmed.
For example, if you hit your thumb with a hammer, it will hurt as the body responds to injury. If the area is irritated again and again, it can become sensitised. Later on, even a light touch may feel painful — not because of new damage, but because the system is staying in protection mode, even if the tissue itself has healed.  The pain experienced now does not equal damage, it equals protection from danger.
Most pain is a combination rather than a single type.
These pain categories aren’t boxes you have to fit into, and many people experience more than one at the same time. For example, back pain may involve both tissue irritation and nervous system sensitivity, nerve pain can persist even after the original compression has settled, and long-standing pain often includes a sensitised component. Understanding this helps explain why progress can sometimes feel uneven, and why supporting recovery often involves more than one approach.
A note on scans and imaging
Scans show structure, not pain. They’re obviously useful, but they often represent the area’s longer history of use, adaptation, and wear over time, and don’t always reflect what’s currently sensitive or how pain is being processed.

It’s also worth knowing that imaging has limits. Different scans are better at showing some tissues than others (for example, X-rays are very bone-focused). Some soft-tissue, nerve, or movement-related drivers of pain may not show clearly — or may be easy to overlook.

​This is why scan findings and pain don’t always match — and why your experience still matters.
What shapes how pain is felt?
Once we understand the different types of pain, the next question is why pain can feel so different from person to person, or change over time. Pain is not a direct read-out from tissues. It’s the brain’s interpretation of incoming signals, shaped by past experiences, expectations, and what similar sensations have meant before. Previous injuries, repeated flare-ups, or difficult medical experiences can leave the system more cautious and protective.
What about arthritis?
Arthritis describes changes in joint tissues that are quite common as we age — a bit like grey hair or wrinkles under the skin. While arthritis can contribute to pain, it doesn’t automatically explain how much pain someone feels, or whether they’ll have pain at all.
Stress also plays a real, physical role. When the system is under pressure, muscles tend to brace, breathing and circulation change, and recovery and tissue tolerance can reduce. The body doesn’t separate emotional stress from physical stress — they add together and influence how pain is processed.
Here are some of the key factors that can influence how pain is felt:
  • What your body is sensing – Signals from tissues (such as pressure, movement, irritation, or inflammation) are constantly being sent toward the nervous system and brain.
  • Past experiences – Previous injuries or pain memories can shape how your system responds now.
  • Emotions – Feeling stressed, low, or anxious can increase pain sensitivity.
  • The situation you're in – If your nervous system senses danger or threat, it may increase pain to protect you. When things feel safer, pain often eases.
  • Beliefs and expectations – Thoughts like “this must mean something is seriously wrong” can unintentionally amplify the pain experience.
Different parts of the brain and spinal cord work together to create the experience of pain:​
  • Sensing (somatosensory cortex, thalamus) — Where is the pain? What does it feel like?
  • Body & emotional response (insula, cingulate cortex) — How intense or important does this feel?
  • Thinking and interpretation (prefrontal cortex) — What do I believe this pain means?
  • Memory & threat learning (amygdala, hippocampus) — Does this match past experiences? Does my system flag this as potentially dangerous?
  • Pain modulation systems (periaqueductal gray, brainstem, spinal cord) — These deeper control systems continuously adjust pain sensitivity up or down depending on context, stress levels, inflammation, and whether the body feels safe.
​Because the brain is constantly receiving updated information from the body, changes in movement, loading, fluid flow, and perceived safety can all influence how pain is experienced.
Movement is Medicine
One of the most effective ways to retrain the nervous system is by slowly reintroducing pain-free movement, allowing the system to learn that it’s safe again. Pain can act not only as a warning, but also as a guide — helping you notice which movements or postures irritate your system and which feel more supportive. By gradually building a repertoire of comfortable movement, you support nervous system recalibration and give any potentially irritated tissues the chance to recover without ongoing stress. Over time and with the right pacing, this process can feel empowering, restoring confidence in movement and helping you move, rest, and recover with more clarity.
Watch this short talk by a prominent researcher in this field, Lorimer Moseley, discussing Why Things Hurt:
Lorimer Moseley DSc PhD FACP is Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy at the University of South Australia. He is Senior Principal Research Fellow at Neuroscience Research Australia and an NHMRC Principal Research Fellow. Video Source
Click here to see the optical illusion for yourself.

Notice how you can’t simply decide to see blocks A & B as the same colour — even once you know they are. Your brain is constantly interpreting information for you, outside of conscious control. Pain works like this too.

Shifting pain patterns takes time and new experiences — not just willpower.
What If Pain Didn’t Exist?
Imagine living in a body that could not feel pain. At first this might sound appealing, but pain is one of the body’s most important protective signals. It warns us when tissues are overloaded, injured, or at risk. Without it, we would miss many of the cues that help us rest, recover, and protect ourselves.
Pain often eases when the system feels safe enough to downshift. Feeling listened to, not rushed, and supported can change how pain is processed — biologically, not just emotionally. With that in mind, a different way to approach pain is to think of it as the body’s way of asking for support, and an opportunity to respond with care.
⚠️ Disclaimer:
This page is here to support—not replace—medical advice. If you're experiencing intense, unusual, or worsening symptoms, it's a good idea to check in with your GP or health care provider.

🩺 For Referrers:
We’re always happy to collaborate with referring providers. Feel free to get in touch to discuss an approach or referral.
Compiled by Joe Liguori
Back to Articles