What if there is no tissue damage in chronic pain? Can you accept it?

As an evidence-based chiropractor, I use the latest research to help my clients. Because that is statistically most likely to help you get better. Some people think that clinical studies do not reflect real life, and therefore shouldn’t be taken serious. However, the outstanding results our clients experience suggest otherwise.

The latest article from The Lancet is on chronic pain. If you have been living with pain for a long, long time, and you don’t seem to be getting any better, you may want to listen to the experts.

Your pain has real consequences.

Some people think you can tahan (bear with) pain. Since there is no real problem (besides the discomfort) with living in pain, no treatment is really indeed. Afterall, nobody really dies from pain.*


The truth is chronic pain is the number one cause of disability in the world. You may be surprised, but anything shy of full function can be interpreted as a disability.

If we look at the Oswestry Disability Index, not being able to lift heavy weights without pain is a form of disability. Not being able to walk for one mile (1.6km) without pain is to some degree disability. Not being able to sit on the chair for as long as you like, not being able to sleep well, reduced sex life because of your pain are all forms of disability.

Your pain does affect you.

If you are eyeing a job promotion or an extra fat bonus in the near future, you really don’t want your pain to slow you down.

*Chronic pain is associated with shorter life expectancy. Even after controlling for other diseases and suicide!

Pain is not an indicator of on-going damage.

Culturally, we think of pain as damage. However, that is not true.

If you dig a bit deeper, you can quickly tell why that is the case. For example, foam rolling can hurt a lot in the absence of damage. No?

Not only is pain not a sign of damage, we sometimes actively seek after it. Most of us would agree that a pain-free massage is not shiok (enjoyable).

I am not saying that you can’t have damage and pain at the same time. I am saying that they are not related, and that your chronic pain is extremely unlikely to be due to true tissue damage.

Your brain plays a huge role in why it hurts.

brain mri scan chronic painThere is research to show that chronic pain can lead to structural changes in the brain.

A study published earlier this year was able to show that chronic pain not only result in abnormal movement patterns but also changes in the cortical thickness of your brain. This is why mindfulness practice can potentially help with your pain management.

All of the research is pointing to that long standing pain experiences is often unrelated to physical injury!

You have to consider psychosocial factors.

lancet psychosocial chronic painI am not a psychologist but I do provide weekly coaching calls to help our clients overcome the challenges in their recovery process. I had written about how exercise alone is not enough because behaviour change is crucial to true long-term results. The other aspect to consider is the psychosocial factors.

Because chronic pain is poorly related to tissue injury, most of what needs to address is in the lifestyle. Sure, exercise can make you stronger. Similarly, a good mental and social well-being is equally important.

Do you know most social media posts about low back pain are written with the intent of seeking validation from their social network? This demonstrates the the need for people in pain to express what they are feeling and their desire to be heard. In the study, the two themes were identified in over 700 posts are: (1) “hear my pain” and (2) “I feel for you”.

When we dig deeper, we are able to show that when a patient experiences a flare up, the pain intensity during the flare up is not actually no longer painful than their average-day pain. This is mind blowing right?

We think that we have more pain when we experience a flare up. However, research is showing that 67% of flare ups are not actually more painful. What were associated with flare ups are: poor sleep, fatigue, disability (yep, it’s a big thing), pain catastrophising and fear avoidance behaviour.

What do I do now?

Keeping an open mind is a good start. Especially if you are not getting results from more conventional treatments.

Evidence-based treatments is not intuitive because nobody talks about it. However, it is what people had talked about over a hundred years ago.

The founding father of chiropractic, DD Palmer, said:

“Daily exercise short of fatigue, calmness of mind, intellectual powers, a family life and a merry disposition are aids to longevity.”

He supports a biopsychosocial framework!

Book in for an appointment via the form below to see how an evidence-based chiropractor can transform your life.


Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.