What they don’t tell you
Why modern pain science leaves the old biomedical script in the dust
1. Pain has a brand-new definition – and it’s not just “tissue damage”
In 2020 the International Association for the Study of Pain rewrote its 40-year-old definition to spell out that pain is “an unpleasant sensory and emotional experience” that may occur with or without clear tissue injury. Note the words emotional and without – two quiet bombs under the old “find the damage, fix the damage” worldview. iasp-pain.org
Take-home: if your scans look “normal” yet you still hurt, you’re not broken – you’re typical of millions whose nervous systems have learned to amplify danger signals.
2. The biomedical model is brilliant at bones & bugs … and bad at everything else
Where it shines
Fractures, tumours, infections, ruptures, acute inflammatory cascades – problems with a single biological “culprit”.
Where it stumbles
Persistent low-back or neck pain, fibromyalgia, tension-type headaches, irritable bowel syndrome, complex regional pain syndrome – conditions where nerves can stay sensitised long after tissues heal and where thoughts, sleep, stress, and context modulate the volume dial.
MRI makes the mismatch obvious: disc bulges, arthritis, meniscal frays show up in pain-free people every day. A 2015 systematic review found degenerative spine changes in up to 37% of 20-year-old individuals to 96% of 80-year-old individuals. ajnr.org Which were asymptomatic!
3. Enter the biopsychosocial (BPS) – now upgraded again
Since Engel’s 1977 BPS manifesto, health pros have tried to consider biology + psychology + social context. Yet adoption is patchy, so pain researchers now speak of “keystone mechanism theories” – frameworks that map how these factors interlock to drive or dampen pain. sciencedirect.com
Key mechanisms to know
Peripheral nociception (tissue alarms)
Central sensitisation (spinal & brain amplification)
Cognitive–emotional filters (expectations, fear, catastrophising)
Behavioural loops (avoidance, over-protection)
Social cues (validation, cultural meaning of pain)
4. Pain Neuroscience Education (PNE) – the evidence keeps stacking
A 2024 scoping review mapped dozens of trials showing that explaining pain’s biology in approachable metaphors – when paired with movement – can reduce pain intensity, catastrophising and disability in chronic musculoskeletal conditions. sciencedirect.com
But researchers also flag barriers: if clinicians still talk “wear and tear” and patients fear damage, PNE falls flat. Building trust, tailoring metaphors and integrating graded movement are critical facilitators. mdpi.com
5. So, what are they not telling you (but should)?
Scans ≠ destiny. Structural “damage” explains only a fraction of persistent pain – and often none at all.
Thoughts & feelings aren’t soft-science add-ons; they’re nerve signals that change spinal cord gain in real time.
Rest rarely rewires a sensitised system. Graduated, confidence-building movement is neuro-medicine.
Language heals or harms. Being told you have a “crumbling spine” can up-regulate pain networks for years.
You can train your nervous system. Sleep hygiene, breath work, exposure to valued activities, and meaning-making practices (yes, even guided conversations or tarot reflection) all de-threaten the system and dial pain down.
6. Quick self-audit: are you stuck in a biomedical echo-chamber?
Question
If you answer “yes”…
Do you chase a perfect scan/label before you’ll move?
Explore graded exposure instead.
Does flare-up automatically mean “more damage”?
Re-frame it as “alarm system rehearsal”.
Do you catastrophise (“my back is ruined”)?
Trial PNE videos or see a physio who speaks BPS fluently.
Is your care plan only pills or passive modalities?
Ask for an active program that targets sleep, stress & strength.
7. Where to from here?
Seek clinicians who integrate pain neuroscience education + progressive loading + lifestyle tuning – not those who only jab, crack or x-ray.
Track wins besides pain score: function, confidence, social re-engagement.
Remember the nervous system is plastic throughout life – and that’s the best kept secret of all.
Bottom line: What they don’t tell you is that persistent pain is less about “fixing a part” and more about teaching a sensitive alarm system to recalibrate. The science is clear; the culture is just catching up. Let’s spread the word.