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Advances in medicine and pain science mean that we now know there is far more to pain than tissue and structure. Despite what you read, watch online or hear from 'so called' medical experts pain is far more complex than muscles, tendons, ligaments and joints.

On our 'How It Works' page we discussed how the pain you experience is controlled by your nervous system. This is why pain is complex and why it is a very subjective, individual experience because your nervous system is affected by any number of different factors.

Old School


  • We used to assume that pain was purely due to physical factors, structure and tissue damage.


  • Factors such as a broken bone, a nerve irritation, a torn muscle and changes to the cartilage in your joint were solely attributed to the pain you experience. There is no doubt that these things can cause pain, however, we also know that you can have these findings with and without pain and that pain can continue long after the tissue healing process has finished.


Your nervous system does react to physical factors but we also know that it reacts to psychological factors and environmental factors as well:

Psychological factors:

  • Stress

  • Mood

  • Thoughts

  • Feelings 

  • Emotions

  • Attitudes to pain

  • Catasrophisation

  • Frustration

  • Anger

  • Fear avoidance or fear of movement

  • Anxiety & depression

  • Other mental health issues

Environmental factors:

  • Sleep (amount & quality)

  • Nutrition

  • Exercise

  • Work

  • Finances

  • Culture

  • Relationships

  • Health care treatment

  • Social isolation/loneliness

  • Family bereavement

  • Health literacy

  • Smoking & alcohol

These factors can work positively or negatively for you, for example, in the same way that getting enough good quality sleep is likely to decrease your chances of experiencing persistent pain, having consistently poor sleep is a risk factor for experiencing persistent pain. Whilst at the same time, having some of these factors going on in your life doesn't mean you are destined to get pain

Persistent Pain_Complicated
Persistent Pain_Volume


Firstly, society consistently tells us that pain is purely linked to tissue and structure which for many people in pain, increases worry, fear, stress and anxiety, which in turn makes pain worse. Taking some reassurance from the fact that your pain could be driven by some more psychosocial factors can help to reduce anxiety and concern, helping to 'turn down the volume' in your nervous system and subsequently your pain.

Secondly, if there are psychosocial factors potentially driving some of your symptoms and your treatment purely focuses on physical factors, like scans, injections and passive treatments, then it could be that you are not addressing a large percentage of the problem. If this is the case, you are less likely to see a positive outcome in your pain and function.

Empowering and educating yourself about how pain works and the different factors that affect it means, that you can think more accurately about some of the factors that could be contributing to your symptoms and focus on those.


You are much more likely to see an overall improvement in your persistent pain and your level of function by trying to make a few small changes to a number of things, for example, stress, sleep and nutrition, than attributing all of your symptoms to one physical factor, for example, getting stronger, and hoping that will help.

There is no doubt this is often
easier said than done so if you do feel that this is something that you need support with then try to get in touch with a health care professional that understands pain and can help you with yours.

You can also find lots of useful information and education on the Persistent Pain Resources page.


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