When Pain Doesn’t Make Sense: A Physiotherapist’s Take on the Different Faces of Pain

Patient X: A Story Many Know Too Well

Let’s call her Patient X. A student nurse, busy and high-achieving.
She injured her lower back doing a heavy squat, likely poor form, too much weight, too soon. Sharp pain, leg symptoms. The works.
She shrugged it off. No proper physio, just rest and hope. Eventually, she had a discectomy.

Recovery went well, until it didn’t.
Eight months later, the pain came back. No injury. No scan findings. But the same fear, same sensations.
She noticed the pain was worse under stress. She had stopped exercising. She was afraid to move, afraid to trust her back.

Now she was considering surgery again. But there was nothing to operate on.
This wasn’t tissue damage anymore. It was a learned pain pattern. Her brain had filed it under “danger” - and kept pressing play.

Pain Isn’t Always What It Seems

Pain can come from many places. Understanding the type matters.

Acute Pain

This is pain with a purpose. It shows up when there’s actual tissue damage — think sprains, fractures, or muscle tears. It’s the body saying, “Hey, pay attention.”

It tends to follow a predictable pattern: sharp at first, then fades with healing and time. Most people recover well with basic physio, rest, and smart movement.

Chronic Pain

Chronic pain stays beyond the typical healing window — usually past 12 weeks — but often long after tissues have recovered.

It’s not about ongoing injury. It’s about a nervous system that’s become hypersensitive. Pain signals get stuck in the “on” position.

It’s often linked with stress, poor sleep, anxiety, trauma, or fear of movement. It can feel unpredictable, exhausting, and deeply misunderstood.

This is what Patient X was living through — not broken tissue, but a brain and body locked in protection mode.

Cancer-Related Pain

Pain from cancer is complex. It can be due to the tumour itself pressing on nerves or organs, or a side effect of treatment like chemotherapy, radiation, or surgery.

Sometimes it’s constant, sometimes it flares. It can show up in strange places and is often mixed with fear, grief, or fatigue.

Cancer-related pain needs an approach that’s respectful, adaptive, and trauma-aware — with careful movement, comfort-focused physio, and nervous system support.

The Nervous System Doesn’t Forget

Nociplastic Pain

This is a newer but important category. Nociplastic pain is when the brain perceives pain even though there’s no clear tissue damage or inflammation.

Think fibromyalgia, irritable bowel syndrome, or long-standing neck and back pain without injury.

It’s very real — the body feels it — but it doesn’t show up on scans. These pain experiences are influenced by the brain’s processing of danger, stress, and sensory input.

Neurogenic or Nerve Pain

This is pain caused by nerve irritation or injury. Think sciatica, carpal tunnel, or post-surgical nerve pain.

It often feels like burning, shooting, pins and needles, or numbness.

Because nerves are the body’s electrical system, when they get cranky, the pain tends to travel and feel intense — even when the source is small.

The Nervous System Doesn’t Forget

If pain came during trauma, stress, or fear, the brain remembers
It builds a shortcut, a loop that fires even when nothing’s wrong.
Add in hyper-awareness, poor sleep, fear of movement - and that loop strengthens.
That was Patient X. She didn’t need more scans. She needed to feel safe in her body again.

How We Broke the Loop

We used breathwork, movement, and nervous system regulation techniques.
We talked about mindset, perspective and psychology of pain.
We talked about the bigger picture in life. Values. Purpose. Thoughts being just thoughts.
We explored her pain with movement. Re-training the brain to feel safe in “unsafe” movement patterns.
She learned how to observe pain without reacting to it.
She started moving again, with curiosity instead of fear.
The pain didn’t vanish overnight - but her relationship with it changed.

What If Pain Is Asking for Something Different?

Not pills. Not surgery. Not to be ignored.
What if your pain is asking for safety, connection, and a slower pace?

At Obsidian Physiotherapy, this is the work we do — helping people unlearn pain and rebuild trust in their bodies.

You don’t need to be stuck. You don’t need to be dismissed.

Move always & all ways.
Kai x