One of the most important developments in pain medicine has been our understanding that pain is not simply a measure of tissue damage.

Pain is an experience created by the nervous system. It is influenced by our previous experiences, our emotions, our environment, our sense of safety and threat, and by changes within the nervous system itself.

For many people living with persistent pain, understanding this can be enormously liberating.

But there is another group of people for whom this explanation can sometimes feel uncomfortable.

They know their nervous system is involved. They understand that pain can become amplified and that a sensitised nervous system can continue to produce pain long after an injury should have healed.

But they also know something else.

Their body still has reasons to hurt.

The body still matters

Imagine someone with hypermobile Ehlers-Danlos syndrome or symptomatic joint hypermobility.

Their shoulder may repeatedly sublux. Their ankle may give way. Their muscles may work extraordinarily hard to stabilise joints that other people barely have to think about. They may sustain repeated soft-tissue injuries or develop areas of mechanical pain from the way their body moves.

Their nervous system may become sensitised as a consequence of years of pain.

But that does not mean that every subsequent episode of pain is simply the nervous system making a mistake.

Sometimes a painful shoulder is painful because the shoulder has been injured.

Sometimes an unstable joint needs protecting.

Sometimes pain following surgery reflects an identifiable physical problem.

Sometimes a new pain deserves investigation.

And sometimes resting, adapting an activity or treating the painful structure is exactly the right thing to do.

When a helpful idea becomes unhelpful

There is increasing interest in approaches that help people understand the role of the brain and nervous system in persistent pain.

Pain neuroscience education, pain reprocessing approaches and other psychologically informed treatments can be extremely valuable.

They can help people become less frightened of pain, regain confidence in movement and reduce the enormous burden that comes from constantly monitoring the body for danger.

But no explanation of pain should require someone to stop trusting their body altogether.

For some people, being repeatedly encouraged to reinterpret pain as a false alarm can become confusing.

They may start wondering whether they should ignore pain that previously would have prompted them to rest.

They may worry that seeking medical advice represents a failure to manage their pain correctly.

Or they may feel that they are somehow responsible for continuing to hurt because they haven't yet managed to convince their nervous system that they are safe.

That isn't what good pain care should do.

Pain can be more than one thing

One of the difficulties with persistent pain is our desire to find a single explanation for it.

In reality, pain is often mixed.

There may be an ongoing physical source of pain.

There may also be increased sensitivity within the nervous system.

Previous experiences of pain may influence how threatening a new sensation feels.

Poor sleep, stress, illness and exhaustion may turn the volume up further.

Fear of another injury may understandably change the way someone moves.

All of these things can be true at the same time.

Recognising one does not invalidate the others.

You don't have to choose between your body and your nervous system

For someone with persistent pain, the most useful question is often not:

“Is this pain physical or neuroplastic?”

It is:

“What might be contributing to this pain, and what does my body need from me today?”

Sometimes the answer might be reassurance and movement.

Sometimes it might be pacing.

Sometimes it might be rehabilitation and gradually rebuilding confidence.

Sometimes it might be treating an identifiable source of pain.

And occasionally it might mean recognising that something has changed and seeking another medical assessment.

Learning that pain is influenced by the nervous system should expand the options available to you.

It should never mean that you are expected to ignore your body.

Finding the middle ground

At Wye Sanctuary, I don't think we need to choose between traditional medicine and modern pain science.

A scan cannot tell us everything about someone's pain.

Neither can a model of nervous-system sensitisation.

Good pain medicine requires us to remain curious about both.

We can acknowledge the extraordinary ability of the nervous system to amplify, learn and sometimes perpetuate pain while still recognising injury, inflammation, instability, mechanical loading and disease when they are present.

For many people, the most compassionate and useful approach lies somewhere in that middle ground.

Your pain is an experience of your nervous system.

But your nervous system lives in a body.

And the body still matters.