Pain Does Not Always Mean Damage: A Real-World Example
Understanding Pain Through the Lens of Modern Pain Neuroscience
Earlier this week, I shared an important truth that often gets overlooked in healthcare: pain does not always reflect tissue damage. Instead, pain is the brain’s response to actual or perceived threat.
A recent patient encounter illustrates this perfectly.
A patient came in with left shoulder pain. Before seeing me, another provider had suggested it was “probably a rotator cuff tear.” That single sentence set off a familiar chain reaction—panic, late-night Google searches, fear of permanent damage, and a noticeable increase in pain.
This response makes sense. The brain’s primary job is protection. When it perceives threat—especially when reinforced by fear-based language—it turns up the alarm. Pain increases not because the tissue is worsening, but because the nervous system is on high alert.
During our session, I shared an important piece of context:
Two out of three people his age who have no shoulder pain at all show rotator cuff tears on imaging. Structural findings are common—and often unrelated to symptoms.
After a thorough assessment, we focused on three things:
Education about how pain works
Simple, non-threatening movement
Rebuilding trust in his shoulder and his body
Within one week, his pain had significantly improved.
Then the MRI results came back.
Painful shoulder: completely normal
Pain-free shoulder: full-thickness rotator cuff tear
He laughed and said, “So… you were right.”
One week later, he was pain-free and back to doing what he loves.
Why This Matters
This case highlights why pain education is not optional—it is essential.
When pain is framed purely as tissue damage, fear increases, movement decreases, and recovery often stalls. When pain is understood through a neuroscience-informed lens, the nervous system calms, confidence returns, and function improves.
This does not mean injuries are imaginary. It means pain is complex—and treating it effectively requires more than imaging results or structural labels.
Working with a provider who understands pain neuroscience can be the difference between chronic limitation and confident recovery.
