Pain Series Pt 3: Pain Relies on Context

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Pain relies on context and is more about sensitivity than damage

Written by Mitchell Robinson

There are lots of things in your life that can contribute to the pain you experience and make it worse (we call these DIMs – Danger In Me) or better (we call these SIMs – Safety In Me).

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Figure 1. DIMs and SIMs (NOI Group, 2015)

  • * We know that pain is context-dependent. It relies on both your immediate environment and on larger contextual factors in your life. The hospital may be a powerful SIM if you’ve just broken your leg. It may also be a strong DIM if you’ve previously had a surgery go wrong.
  • ** Swelling and inflammation immediately after rolling your ankle can be a DIM for someone who’s unaware of the powerful healing properties in the swelling.

"Pain can persist because you become more sensitised..."

A remarkable example of pain being altered by the immediate context can be seen with soldiers in the heat of battle who are shot but don’t feel pain until much later on and out of the dangerous environment (SIMs at work!). Moreover, an example of pain relying on larger contextual factors is seen when poor sleep, fear, anxiety, work-related pressures and relational stress work to sensitise you and augment your pain experience for the worse (DIMs at work) (Vachon-Presseau, 2013).

While tissue damage and changes in your body aren’t completely irrelevant, there are still a few things to remember:

  • Pain and tissue damage rarely perfectly correlate.
  • You can get out of pain with no changes to your tissue damage.
  • Pain is context-dependent – there may be things in your life that are working to make you either more (DIMs) or less (SIMs) sensitive to pain. 

So, we have two options for addressing pain:

  • Decrease DIMs
  • Increase SIMs

You don’t have to change a muscle tear, a tendinopathy or the normal joint changes in your body. What you should address is anything that might be sensitising you.

Are you ready to break free of your pain?

We're serious about helping you live life without pain. Right now, you can book in for a FREE initial assessment. No hidden funnies, weird pyramid schemes, or quackery. Just a great chance for you to see how physiotherapy can help you move again. In fact, we're so serious, we even offer half-price treatment should you chose to pursue your tailored therapy, right in the very same session. Press the button below to quickly make an online booking. It's no fuss and super-simple, we promise.

Reflection time 

Some questions to ask yourself: 

  • Is your pain worse after a stressful day at work?
  • Is your pain worse when you’re not sleeping well?
  • Is your pain worse when you’re feeling down?
  • Is your pain better when your out socialising with others?
  • Does your pain seem to change with other significant changes in your life?

What you might find is that other factors besides damage or physical load can influence your pain. Meaning, pain can persist because you become more sensitised even when your tissue is actually healing. For more information on this check out David Butler and Lorimer Moseley’s pain book, ‘Explain Pain’.

If you’re struggling with pain and think you would benefit from seeing a physiotherapist for your pain management, talk to your GP. Sycamore Health has a speciality in pain management and non-medicated remedies, and would love to help you take control of your pain!

Next part in this series: What You Need To Know About Pain: Part 4

Butler, D. S., & Moseley, G. L. (2003). Explain pain. Adelaide: Noigroup Publications
Lehman, G. (2017). Recovery Strategies. Retrieved from
Vachon-Presseau, E. et al., (2013). Acute stress contributes to individual differences in pain and pain-related brain activity in healthy and chronic pain patients. Journal of Neuroscience, 33(16), 6826-6833.

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