I know this got lengthy, but it is the last 8 years of research on my part for pain consolidated into hopefully an easier and more helpful read. Enjoy!

(Hint: if you only want bullet points you can scroll to the bold headings)
I’m going to use the oldest analogy in the book: Ever have a small rock in your shoe? Hurts every step you take right? And then you take it out of the shoe and no more pain. That all seems simple enough, so why is it we are unable to take the proverbial “rock” out of the area of our bodies that always hurts on some level?  We become accustomed to our areas of “weakness,” we say “oh that’s just my tweaked hamstring, or my bum shoulder, or my common headache,” and consider it our standard of living. In America we can buy the big house, nice car, 100th pair of shoes and live large. To be healthy we can drink green juices, wheat grass shots, whiten our teeth, highlight our hair, run marathons, sculpt our bodies to magnificence….but we can’t say “oh my old hamstring injury? That’s all better now.” Why is that?
I’m going to get Sigmund Freudian on you for just a moment. Did you ever really hurt yourself as a kid? Do you think back and re-live the pain from that injury? My guess is, unless something very atypical happened, the answer is no. I’ll use myself as an example: I broke my arm when I was nine years-old flipping off a horse backward in a lightning storm. That sounds traumatic if anything ever did right? I will look you straight in the eye to this day and swear to you I don’t remember it hurting or ever really bothering me; even though it must have hurt (I bet my mom has a different version of the story). How is it that a broken arm has not really affected me as much as lesser injuries or events that occurred later in life? Let me list the ways:
1) Faith in the system and my body:
I was nine! I had no previous experience with pain or injuries and when the doc put a neon rainbow cast on my arm and said it would be all better in 6-8 weeks, I had the utmost faith in him. Magically, he was right. It never occurred to me he would be wrong. This shows our mind plays a strong component in getting better. If I were a betting person, I would have to say if he had told me my arm would probably never really be the same, it would bother me to this day and be the reason for everything achy in my body. We will circle back to this concept…
2) Lack of previous experience with pain:
Because I had never been injured before, I didn’t have that many pain receptors in the area, and the ones that were there were less responsive. You see, as we continue to injure ourselves our bodies try to keep up and be smarter. It thinks if it responds faster, and more strongly to a pain signal, we will stop doing whatever is hurting us and in the long run this will keep us from further damage: trying to prevent recidivism. Recidivsim is “the act of a person repeating an undesirable behavior after they have experienced negative consequences of that behavior.” If we can, in effect, stop playing that mental game with ourselves where we go back to that old saying “no pain, no gain,” we would be so much better off!
Side note here: If I had hurt my arm every year since, it might take only the slightest bump to cause my brain to interpret pain in my arm because I would have a million pain receptors in the area and they would be damn efficient!
3) Using my brain for other things: 
There was something more traumatic that happened to me the same year I broke my arm: my parents got divorced and I relocated across country. Don’t get sad here- I’m a very happy Cali girl, my point is, if there is something else that happens around the same time as an injury that calls attention to our frontal cortex (thinking part of our brain), there is less space and energy to store memories of the injury. It doesn’t have to be something sad- it can be exciting, inspirational, frightening, (insert here life-changing event).
Let’s talk about what my childhood example has to do with you and your pain:
1) Most important: Don’t get lost in the land of tolerance; get help 
The longer you allow a true injury to exist, the more pain receptors build up and become hyperactive; called primary hyperalgesia. Basically, it will take less and less with each additional injury to create more “suffering,” (our mind-body connection to pain). Also, it will take longer after an insult/injury to decrease the pain, even though the insult might be lesser than the original injury.
If this continues for a longer period of time, the pain can become chronic and centralized (messages in spinal cord to the brain that you are in pain when you no longer should be; called central sensitization). Think of central sensitization this way: Things that used to feel pleasurable, like a deep tissue massage, are now interpreted as painful. Or something like this: you are just sitting at your desk and you randomly get sharp unexplained pain in the knee you had injured several years ago which mostly got better, but not 100%. I’m telling you to seek medical help and see what can be done to heal you sooner rather than later so you don’t end up here.
2) No pain, no gain…no more!
Stop believing things you do in your daily life or exercising are supposed to hurt. This is a MYTH! There are  very few things out there that should hurt and at the same time are working to make you a stronger, healthier person. If you are an exercise addict, allow me to inform you if you are sore for more than 24ish hours after a specific exercise, you have actually WEAKENED your muscles by tearing some muscle fibers within your sore muscles. You CAN’T get them back either. I like to get my butt kicked as much as the next person; but you have to know what is practical and helpful in your body, and also what is harmful.

3) Sexy and you know it….work out! 
There are some hormones released in exercising that decrease your pain naturally and also make you more energetic, stronger, and euphoric (see: our bodies own analgesics):
A) B- endorphins and Enkephalins (natural pain killers): 
These decreases pain signals to our brain: instead we feel euphoric! Also, they can decrease anxiety associated with the pain. You get more of this good stuff with exercising >30 minutes/session, and even more with increased frequency of exercise because our bodies can also get more sensitive to releasing endorphins and enkephalins!
B) Growth Hormone: 
The longer you exercise (within reason), the more of this stuff you get; especially with aerobic exercise (the kind where you get your heart rate up). It helps by promoting growth and strength of our muscles and tendons- which decreases our risk of injury.
C) Estrogen
Among other cool things, estrogen elevates your mood and increases libido (woohoo!) for 1-4 hours after exercise.
D. Thyroxine (T4)
Courtesy of our thyroid gland, this increases the metabolic rate of cells in our body; which helps us feel more energetic. Fun fact: “Blood levels of thyroxine increase by about 30% during exercise and remain elevated for several hours afterward.”
4) And if you need to know…how to take drugs (no, not that kind!) 
Studies have shown if you are badly hurt and in a lot of pain, it’s good to use more than one medication to decrease your pain because they work in different areas of our bodies and in the spinal cord. This is why some medications don’t work on you at all, while others that seem similar work like magic. Take for example Tylenol and ibuprofen (advil). You can alternate every 2 hours. One is better for pain and fevers while the other is better for inflammation and muscle spasms. You can take this to a whole new level with narcotic pain meds. The research shows people actually take less, and find more effective relief from pain, when they take lower doses of 2 or more medications meant to treat the symptoms. Studies also demonstrate a lower level of possible addiction when the medicine you take take for pain is effective at managing your symptoms.
5) Think positive (to a rational degree)
How we feel about our pain modulates how much we suffer from it. Our memory part of the brain and emotional part produce hormones called dynorphins.They “are very potent even in small amounts, and scientific studies suggest that the painkilling effect of a dynorphin is at least six times that of morphine.” If you believe, without fear, and are reinforced by people whose opinions you have come to trust that you will get better; it will probably manifest itself to some level thanks to science! The opposite is also true: “Catastrophizing was more than 7 times more powerful a predictor than any other predictor… with patients in determining the risk of subsequent chronic pain.” Take with you this: when we think positively about something, and also refuse to perseverate on it or worry about it, our brain shifts focus to something else for problem solving and produces good hormones and memories instead.
Are we shifting into pain-free gear yet? Please share any of your own journeys or experiences or questions here!

Contributed by Dr. Katie Addis 

1) Donovan, Skye. Lecture:  Pain and neurophysiology. June 11, 2008. Chapman University Department of Physical Therapy.
2) McCracken LM, Gross RT. Does anxiety affect coping with chronic pain? Clin J Pain. 1993;9:253–259. [PubMed]
3) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2743454/?tool=pubmed
4) http://archinte.jamanetwork.com/article.aspx?articleid=774421
5) http://liftforlife.com/content/bodybuilding-fitness-diet-health-articles/alternative-health/709-hormones-and-exercise
6) http://www.wisegeek.com/what-is-a-dynorphin.htm
7) Ikeda, R. Pain. 2006; 127: 161-72
8) Lai, J et al. Dynorphin A activates bradykinin receptors to maintain neuropathic pain. Nature
Neuro 2006; 9(12): 1534-40 
9) Leaver, A. Refshauge, K., Maher, C. McAuley, J. Journal of Physiotherapy. 2010; 56(2): 73
10) Buckenmaier III, C. Griffith, S. Military Medicine. 2010; 175(7): 7-12


  1. Great article. I like the way you bring science and your personal history/experiences. Keep up the good work. Dr. Katie Addis

  2. Excellent post, I like how you wrote this! For some folks with chronic pain they may have an abnormal response to exercise and have flair ups. This may apply specifically to the region of the body they have pain or to exercise in general. So, always remember to start general and slow, assess response, avoid flare ups, and stray with other body regions if needed!

  3. Agreed! I wrote this mostly inspired by my more active population who seem to let a hamstring strain become a more chronic issue etc. thanks for reading and for adding your helpful tip about patients with chronic pain syndromes.

  4. Nice post! I agree on all points except number 2 (no pain no gain no more) on the matter of exercise and soreness. DOMS typically starts 24h after exercise and is normal. The statement that, if soreness persists after 24h, the muscle is weakened due to fiber tears that can't be repaired - is begging for a reference to some sort of evidence. I thought small amounts of muscle fiber tear or breakdown was a part of all exercise and all physical activity - and that this plays an important role in adaptation to physical stress.


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