Busting Myths and Misconceptions About Pain

I'm sure there is more debunking to be done, but for now, we'll wrap up this series on misconceptions by covering the topic of pain.

The origins of pain as a science—rather than afflictions from gods or evil spirits—date back nearly 350 years, when the philosopher Descartes illustrated how a flame touching the toe sends a signal up the spinal cord to the brain to say, "Ouch."

This original view saw pain as a direct response to tissue damage, with the intensity of pain believed to be directly proportional to the severity of the injury.

And to some extent, this is still how we view pain today.

It’s not a total myth. The body does indeed send danger signals to the brain called nociception.

However, modern pain science emphasizes the role of the brain in shaping pain perception, highlighting the importance of context—previous experiences, emotions, environment, social influences, and cognition.

So, what does it actually mean when something hurts—and what does that mean for recovery?

Misconception #1: Pain Equals Tissue Damage

One of the most common misconceptions is that pain is always a direct result of tissue damage. But research shows this is not necessarily true.

A well-known case published in the British Medical Journal describes a man who jumped onto a nail that appeared to pass through his foot and out the top of his shoe.

He was in so much pain that he required sedation just to examine the injury.

But once sedated, clinicians discovered the nail had actually passed between his toes—there was no tissue damage at all.

Another classic example is phantom limb pain. Individuals who have undergone amputation can continue to feel pain in a limb that no longer exists—again, without any tissue to damage.

These examples highlight a key point: pain is an output of the brain, not a direct measurement of tissue damage.

Misconception #2: Imaging Always Reflects the Problem

Medical imaging—X-rays, CT scans, MRIs—is often treated as the gold standard for diagnosing injury.

But the research tells a more complicated story.

A 1994 study in the New England Journal of Medicine found that nearly two-thirds of people with no history of back pain still showed significant abnormalities on spinal imaging.

Similarly, a 2012 study in the British Medical Journal found that almost 90% of individuals had knee abnormalities regardless of whether they had pain.

On the flip side, many people with chronic pain show little to no structural issues on imaging.

This doesn’t make imaging useless—but it does mean it’s just one piece of the puzzle, not the entire picture.

Misconception #3: The Point of Therapy

Rehabilitation often focuses heavily on the physical side of injury—based on the idea that something is “broken” and needs fixing.

This leads people to search for the one exercise that will solve everything.

Strength and range of motion matter, but they are only part of the equation.

The brain is constantly evaluating signals from the body and deciding whether a situation is dangerous. Pain is the output of that decision.

Even after tissues heal, the brain can continue to produce pain as a protective mechanism.

This is where graded exposure becomes critical.

By introducing small, tolerable, pain-free (or low-pain) movements, we can help the brain recalibrate what it perceives as threatening.

This is a key part of the value behind Crossover Symmetry.

The system builds strength and improves range of motion—but just as importantly, it allows for scaling movements based on tolerance, creating a gradual progression back to full function.

In Your Head?

If pain is influenced by the brain, it’s easy to jump to the conclusion that it’s “all in your head.”

But that’s not quite right.

Pain is real—it’s just more complex than we once thought.

By understanding that pain isn’t always tied directly to tissue damage, we can take a more complete approach to recovery and improve outcomes for both acute injuries and chronic pain.