Understanding Pain: The fragility of the link between pain and trauma

Pain and trauma

It’s a commonly held view that pain and trauma are strongly linked. In other words the greater the injury the bigger the pain response. From a medical perspective it makes sense. The more tissue damage the greater the activation of different pain pathways (nociception). Resulting in greater sensitisation of the nervous system, therefore producing a larger pain response. However it appears that this theory does not always hold true.

Contradictory evidence

For some people the pain response persist even after the tissues have healed.  It appears for a small group of individuals there is a heightened response. The pain can effectively become a condition in its own right. So it is important to be aware that pain can exist without trauma or pathology – but also pathology can be present without pain. Therefore the link between pain, trauma and pathology appears increasingly more fragile.  Especially in regard to persistent pain.

Fight or flight

Individuals in a enhanced state of fight and flight may have an absence of pain with trauma.  One report on casualties of war revealed out of 215 soldiers with severe trauma (including loss of limb) a third had no pain.  Furthermore only a quarter reported severe pain.

However heightened fear or perceived threat can also increase the pain response. The classic example is the published article by an A&E consultant on a builder.  The unfortunate chap was in  severe pain after jumping down onto a nail. The nail passed through the sole of his boot and out the other side. Ouch! However when the boot was actually taken off – they found the nail had missed his foot and passed between his toes. There was no tissue damage.

Personal experience

Pain it appears is therefore a very personal experience. Biological factors, such as age and sex, will influence it. Body composition and status also has a role to play.  Psychological factors including anxiety and depression can all heighten the pain response. Even social factors such as culture, faith and economic status will all have a bearing. The pain response can even vary with the same individual with similar types of injuries.


By understanding the different factors that can influence our pain we are more likely to be able to change it. Influence it in a positive manner.  As a physiotherapist I often see people who have suffered with long term pain manage to get themselves better. It can take time but with the right guidance it is possible to break out of the self perpetuating cycle of pain.

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