Pain Doesn’t Equal Damage

You can have pain without injury. And you can have injury without pain. That’s not broken biology — that’s brilliant protection.

The Myth That Won’t Die

Most people (and sadly, many clinicians) still believe the old myth:

“If it hurts, something must be damaged.”

It makes intuitive sense. But it’s often completely wrong.

Pain and tissue damage do not correlate as neatly as we think. In fact, some of the most powerful pain experiences occur when there’s no visible injury at all (Melzack & Katz, 2013).

Exhibit A: Asymptomatic Findings

• Studies show people with no pain often have:

• Herniated discs

• Rotator cuff tears

• Arthritis

• Degenerative changes on MRI (Brinjikji et al., 2015)

So if those same findings are seen in people without pain… how can we say the pain must be coming from those tissues?

The issue isn’t the tissue.

It’s the interpretation.

Exhibit B: Severe Pain, No Damage

• Phantom limb pain: People feel intense pain in limbs that no longer exist.

• Complex regional pain syndrome: A minor injury can spiral into disproportionate, ongoing pain.

• Tension headaches and emotional trauma: No tissue damage needed—just perceived threat.

Your body doesn’t need damage to hurt.

It just needs a reason to protect.

Protection, Not Precision

Pain is protective, not precise.

It’s like a smoke detector. It might go off for:

• Steam from the shower

• Burnt toast

• A real fire

All three trigger the same alarm. The alarm doesn’t know what’s real—it just reacts to potential danger (Moseley, 2007).

So What’s the Clinical Takeaway?

• Don’t panic when imaging finds “something wrong.”

• Don’t assume that more pain = more damage.

• Don’t avoid movement because it hurts—unless there’s clear, acute injury.

• Don’t let outdated beliefs shrink your life.

Instead:

Reframe pain as a sensitivity issue, not a structural one.

Treat the whole system, not just the symptom.

Shift from fixing damage to reducing threat.

Final Thought

Pain doesn’t mean you’re broken.

It means your body cares.

Sometimes it overreacts.

Sometimes it’s too loud.

But underneath the volume is an important truth:

You’re not weak—you’re wired for protection.

Let’s help that system calm down.

References

1. Brinjikji, W., Luetmer, P. H., Comstock, B., et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol, 36(4), 811–816.

2. Melzack, R., & Katz, J. (2013). Pain. Wiley Interdisciplinary Reviews: Cognitive Science, 4(1), 1–15.

3. Moseley, G. L. (2007). Reconciling pain and tissue damage: a modern view. Physical Therapy in Sport, 8(3), 105–113.