Although pain is usually due to tissue stimulation activating nociceptors, influenced by the way in which the information is processed by the nervous system. Pain is produced by the brain to protect the body from damage. In contrast, many patients believe that pain is produced in the body to tell the brain about damage.
The brain’s decision to produce pain is influenced by a range of factors including:

  1. Nociceptive information coming up the spinal cord - the result of tissue stimulation, receptor sensitivity and activity, and spinal cord modulation
  2. The context and meaning of the nociceptive information
  3. The person’s thoughts - how they think about and react to the nociceptive information
  4. The person’s feelings or mood

These factors are equally important in the generation of pain. If someone has a small injury in the context of significant stress, the amount of pain they experience will be the same as if they had a larger injury in a less stressful situation.

Pain is different to any other sense because it is vital to be able to adjust the pain experience to the context.

There are many things going on in people’s lives which will influence their pain. Understanding this helps patients to make sense of their experience.


Pain can be viewed as being produced in response to a perceived threat.

The threat will be greater if:

  • back pain has very negative connotations
  • it is assumed that the injury is worsening every time pain is felt
  • someone is already under stress
  • a negative outcome is expected

In circumstances like these the brain will make more pain. This means that their back will feel much worse than it really is.