#15 March Edition - All About Pain: It’s Real, Changeable, and Not Just About Damage

One day, I was walking to work, coffee in hand, listening to The Intelligence podcast—my usual morning routine. I had slept well, and my first patient wasn’t until 9 AM. Everything felt normal. Then, I heard it.

The unmistakable crunch of two cars colliding.

For anyone who has experienced a car accident, you know the sound. It’s visceral, sharp, and distinct. I turned to look—it was a rear-ender. And to my surprise, the car that had hit the other was a police car. The driver of the front vehicle was furious, throwing their hands up in frustration. But there was nothing I could do, so I just kept walking.

A few minutes later, something strange happened.

My back started to seize up. My muscles tightened. By 9:30 AM, I was in pain.

What had I done? I hadn’t lifted anything, twisted awkwardly, or done anything physically stressful. Yet, there I was—tense, aching, and confused.

In my case, for example. Was my nervous system trying to protect me because it remembered my past car accident? Was my body reacting as if I were the one who had been hit?

Pain Is Real—But It’s Not Just About Damage

Let’s be clear: Pain is always real. It is never “just in your head.” It is a complex experience shaped by multiple factors, including tissue injury, nervous system sensitivity, and even your overall health and well-being.

Take my back, for example. Nothing was actually damaged, but I was experiencing pain. My nervous system reacted to the sound of the crash as if I were in danger. My muscles tensed up, my back locked, and by mid-morning, I was struggling to move. I had to take muscle relaxants, keep moving despite the discomfort, and apply heat to help calm things down. (wildly the pain lasted 2 weeks).

This wasn’t imaginary—it was a real physiological response. My brain had perceived a threat, and my body reacted accordingly. This is how pain can persist, even when there’s no injury.

✅ In the early stages of an injury, pain serves a clear purpose—it stops you from doing further harm.

✅ Once the injury has healed, pain can persist—not because of ongoing damage, but because the nervous system stays on high alert.

A common example I see in clinic: If you sprain your ankle, you expect it to hurt while the ligaments heal. But if months go by and your pain remains just as intense, something else is happening. The tissue has healed, but the pain system hasn’t adjusted.

Why Pain Can Stick Around After Healing

If pain lingers long after an injury should have healed, it’s often due to an overactive alarm system rather than ongoing tissue damage. This heightened sensitivity can be influenced by:

🔹 “Learning” Pain – Just like you can get better at playing an instrument, your nervous system can get better at producing pain. Repeated pain signals can strengthen pain pathways, making them easier to trigger—even when there’s no real threat.

🔹 Fear and Avoidance – If you’re afraid to move in case you “reinjure” yourself, your body may start treating movement itself as a threat. This can make normal activities painful, even when they’re safe.

🔹 Stress, Sleep, and Lifestyle Factors – Poor sleep, high stress, and low physical activity can amplify pain signals—not because you’re imagining pain, but because these factors affect how sensitive your system is.

🔹 The “Full Cup” Effect ☕ – Pain is like a cup filling up with different stressors: lack of sleep, work stress, past injuries, and movement avoidance. If the cup overflows, pain can spike. The goal isn’t just to reduce pain, but to increase your ability to tolerate daily life.

How to Take Control of Pain

The best part about pain being adaptable? It means you can change it.

✅ Trust That Your Body Is Resilient

Your body is not weak or fragile. It is designed to heal and adapt. Many people are told their pain is due to “poor posture” or “structural issues,” but research shows these factors rarely correlate with pain levels.

Take my back, for example. There was nothing structurally wrong with it that morning—yet the pain felt just as real as if I had pulled a muscle.

✅ Move, Even If It Feels Uncomfortable

Avoiding movement can make pain worse by reinforcing fear and stiffness. Start small, move gently, and rebuild confidence in your body’s ability to handle activity.

When my back started to seize up that morning, my first instinct was to sit still—but the best thing I could have done was move. Movement helps desensitize an overactive pain system.

✅ Increase Your Body’s Resilience

Pain can feel overwhelming, but one of the best ways to regain control is to increase your body’s ability to handle stress and load.

🔹 Strength training and varied movement can help “retrain” your system, reinforcing that movement is safe and not a threat.

🔹 Exposing your body to different types of movement—lifting, stretching, twisting, running—keeps your nervous system adaptable and prevents your “alarm system” from becoming overly sensitive.

🔹 A stronger body can handle more demands without setting off unnecessary pain responses. Just like a well-trained athlete can absorb impact better, a body that is gradually exposed to progressive loads becomes more resilient.

Building strength doesn’t mean lifting heavy weights right away. It can start with small, controlled movements that remind your body what it can do.

✅ Manage Sensitivity, Not Just Symptoms

Since pain is influenced by many factors, working on sleep, stress management, and overall health can help lower pain sensitivity.

I didn’t injure my back that day, but my stress response made the pain feel real. If I had been sleep-deprived, dehydrated, or already stressed, my pain would likely have been worse.

✅ Don’t Wait for Pain to Disappear Before Living Your Life

Many people postpone activities they love until they are “pain-free.” But often, the key to recovery is re-engaging with life despite some discomfort, rather than waiting for pain to vanish first.

The Bottom Line: Pain Can Change, and So Can You

Pain that lasts beyond normal healing time is not a sign of ongoing damage—it’s a sign that the nervous system is still in protection mode. The good news? The system can be retrained.

Your pain is real.

Your body is strong.

Recovery is possible.

💡 If this resonates with you, share this newsletter with someone who needs to hear it. Knowledge is power in the journey to recovery. I have attached a great resource by a colleague - perfect for anyone who wants to understand pain more.

Until next time, have a physically active month.

Kosta Ikonomou