Understanding pain
With Professor Paul Cameron
Paul is Director of Allied Health at NHS Forth Valley and Honorary Clinical Professor at the University of Stirling. He is an advisor to Pain Concern.
This information was last updated in June 2025. It is due for a review in June 2028.
One of the most important steps in managing pain is understanding it. This can reduce concern and increase confidence in activity.
Pain from tissues
We can experience pain from our muscles, tendons, joints and on if we overdo activities or are not quite prepared for that type or level of activity.
This kind of pain is normal. It reflects muscles working hard (sometimes harder than normal) and needing some time to recover. However, regular use will allow time for the muscles to adjust, and the pain experienced from this activity will lessen as you become fitter.
When pain behaves in this way, coming at or just after a period of activity and settling down after a few days, an exercise programme can be planned and built up. The messages from the tissues at the time help you decide a sensible level, and should you overdo it the pain will settle quickly when you stop.
Pain from a ‘sensitised’ pain system
Not everyone experiences pain in this way. For some, an activity may produce very little discomfort from the tissues at the time but later, even the next day, the pain flares up. This increased pain can often last for days and a rest, warm bath or tablets may make things more bearable, but the pain takes its own time to settle down and in many cases does not settle completely. Getting no warning signals from the body at the time of activity means it is difficult to set a level that can be kept going and increased over time.
Why does the system become sensitised?
We know from pain scientists that this kind of pain is happening because of changes at many points along the pathways carrying signals to and from the brain. These changes result in the warning signals remaining switched on hours or days after stopping the activity, with the brain continuing to respond with pain.
What can be done?
While some pain cannot be treated, it can be managed. Healthcare professionals working in pain management have observed that people making lifestyle changes experience reductions in their flare-ups, while those who make few or no changes, simply enduring the pain, remain in ongoing distress.
Whether a person makes these changes or not often seems related to their ability to negotiate with their pain. The pain beats those who see the relationship as a constant battle that they are always trying to win. Those who negotiate and reach an ‘I win, you win’ situation with their pain are better able to manage it and improve the quality of their lives.
Learning to negotiate
Some people have found it helpful to think about their pain in the same way as a diabetic would consider their diabetes. Diabetics have to see their diet as an important part of managing their disease. If they eat the right kinds of foods at the right times of day, their diabetes is kept under control. Foods such as chocolate cake might be avoided in favour of a piece of fruit. In time many diabetics would not even consider chocolate cake as an option and would not miss it. Can you imagine trying to eat the cake to ‘beat’ the diabetes? Much more can be gained by negotiating with the condition we have to live with.
A good negotiating strategy is to establish tolerance levels for activities. For instance, you might slow down your walking pace or divide gardening activities into fifteen-minute chunks of time. This reduces the chance of flare-ups and, with time and practice, leads to a sense of control over the pain. This results in a better quality of life.
If you need help to negotiate with your pain and want to know which strategies would be best for you, you could ask your doctor to consider referring you to a pain management programme where staff would help you to improve these skills.
