Exploring the Concept of Pain Free Living: Is Complete Absence of Pain Desirable?

A common question asked in many settings, by doctors, physios, PTs or soft tissue therapists. But if we sit back and think about what this question means and what are we really trying to find out when we are asked it, it doesn’t stack up.

Is it normal to be totally pain free?

The more I hear it, and ask it to clients myself, I start to wonder what I am really trying to find out. Upon reflection maybe we are possibly aspiring to a false gold standard of being “pain free”. Let me explain.

Pain serves a purpose, otherwise we wouldn’t be able to survive.  Pain is a sensation interpreted by the brain from sensory nerve messages picked up from the neurons all over the body. These provide a feedback loop that we learn from. If there is pain, then we adjust our actions and learn e.g. touching a hot pan, it hurts and we don’t touch a hot pan again intentionally. Experience and context also play a large part in what pain we feel e.g. if you have had a previous injury then you are more aware/ sensitive to ANY messages sent to the brain from that area and can sometimes be miss interpreted meaning a 4/10 could feel like 5 or 6 /10 “pain”. Throw into the mix other possibly influential factors such as sleep, stress and emotional state on your processing bias of expecting pain or sensitivity to stimulus coming into the brain, all of which could have significant effects on the level of pain/discomfort felt/interpreted.

So the context is super important and learning how to best understand that, not all pain is bad, pain is normal, not always wanted but we can’t live totally pain free.

How to best rephrase & reconceptualise this is the key in life otherwise it becomes an unhealthy or unnecessarily holly grail of being “pain free”. I like to think that some discomfort / mild pain is ok in some instances. When working with a tendon tendonitis then the appropriate loading in rehab is high, they need to be worked hard and through more discomfort than say a cartilage or meniscus injury which should be much more gradual lower loading protocol. Essentially its still important to use it or use it, and as a result that comes with a bit of discomfort but the difference here is knowledge & confidence in what you are doing & level of discomfort/ pain to expect is normal and helps to interpret the sensations correctly.

Think about the first set of an exercise, sometimes there maybe a bit of discomfort/ pain, but as long as its not unsafely loaded too much or too rapidly then, commonly the second set it improves. This is likely due to the brain having change to take all the info in and reconfigure, recalibrate and compute that there is no lasting damage happening and all is ok. Normally until there is fatigue or too much strain in the system and then discomfort & pain onset increases again as a warning that unwanted damage may occur.  This is normal and means that context, education, experimentation are all vital in re-calibration, of a sometimes oversensitive sensory input into the brain, especially after injury. Once the brain recognises there’s no damage (second set) the Brain reconfigures its interpretation of signals in the brain and the discomfort is less. If pain persists then it’s obviously not good.

Having said this I am not a fan of the phase “no pain, no gain” as its missing a caveat and as bad as aspiring to be pain free all the time. If we don’t approach pain with curiosity and work with it to see if how we load the body and how it responds we could be on a forever declining cycle of increased pain and decreased capacity.  Ultimately this isn’t healthy and a cycle that needs to be broken. If you are in discomfort / pain and want to explore the context within which your physiology, psychology & emotional state effects pain, movement and exercise can be a great way to explore this and understand it better.