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Hurt Vs. Harm & Car Alarms: Interpreting Chronic Pain

Updated: Nov 5, 2023

While there are a few people born with a rare disorder that leaves them unable to feel pain called CIP (Congenital Insensitivity to Pain), most of us have experienced pain throughout our lives. For many people, pain is intermittent, and short lived. For others, pain becomes persistent, and when it lasts longer than 3 months, doctors classify it as chronic pain. For some people, the pain has persisted for so long, that they don't remember what a pain free day feels like.

While it can be difficult to acknowledge that pain can actually be a good thing, there is a reason for it. Our bodies need pain to tell us about danger. While having CIP might sound great at first, consider what it would be like to raise a child with this condition. The child might fall down and break a bone, but continue to walk on it because they can't feel it. They may put their hand on a hot stove, and instead of crying out in pain and pulling it away, they may leave their hand there for several minutes, causing extensive burns. As a parent, you would have a hard job in trying to decide when your child needs to go to the doctor. Unless there were visible signs of injury, your child wouldn't let you know that anything is wrong.

On the opposite extreme, raising a child who has chronic pain can be challenging too. It is difficult to know when your child is injured and needs to see a doctor. Your child might complain of pain in their knees, but taking them to the doctor can seem fruitless. The doctor may tell you that the x-rays are negative, the MRIs are clean, and your child is simply experiencing "growing pains", or they are "attention seeking" and "whiney" and need to toughen up. As a parent, you can leave feeling like you spent a whole lot of money not to get any answers that help your child to feel better. A small voice in the back of your head asks "Don't all kids grow? Why does my child hurt, and some other kids don't?" and "Is my child being whiney, or are the doctors actually missing something serious?" (See Raising Kids With Chronic Pain - When To See A Doctor)

If this isn't challenging enough as a parent, who is an outside observer, it is even more difficult when the person experiencing the chronic pain is you. Whether you are a child or an adult, being able to interpret pain responses is difficult. Pain is supposed to tell you about danger, so your body takes it seriously. Intense pain can sometimes make it hard to think straight, or to focus on anything else because your brain inherently sees it as a top priority.

In a typical healthy body, pain equals danger. It is a warning signal that something harmful has happened that requires your attention. Pain is kind of like the body's internal alarm system to tell you when an injury has occurred. In a body that experiences chronic pain however, the alarm system can sometimes become dysfunctional.

A car alarm is supposed to tell you when a burglar is breaking into your car. Sometimes however, car alarms are too sensitive, and also go off when the thunder booms. If you were to call the police for the car alarm that sounded due to the thunder boom, the police would arrive and find your car sitting undisturbed with no burglars in sight. Similar to a doctor, they may fine you for their time even when they come out to find nothing wrong.


Your body's pain alarm system works similar to a car. Even false alarms still make a sound. The pain is real and it does hurt, but the alarm confuses police (doctors) because there is no burglar (injury/tissue damage) to be found.
Hurt Vs. Harm in a Car Alarm

Chronic pain patients live with alarm systems that sound a warning for burglars and for thunder booms. The problem is, the car only has one sound. A car doesn't have a "This is my real alarm for a burglar" sound, and "This is my false alarm for thunder" sound. It's important to recognize that whether the alarm sounds for the burglar, or the thunder boom, the sound is just as real. Likewise, the pain that chronic pain patients experience is very real, even if their doctors cannot see it on their tests. (See, The Invisible Illness: Why can't my doctor see my pain?).

It can be hard to interpret when something that hurts is actually harming you (hurt vs. harm). While the pain is real, your body's alarm system may not be telling you what it is supposed to tell you. Some patients tell their doctor that they feel like when they sit in a chair they have the stabbing pain of a knife in their back, but in a literal sense, there is not a knife sticking out of their back. This patient is experiencing pain that hurts, but may not actually be harming them. Sitting in a chair isn't a dangerous activity in and of itself for most people. Therefore, further evaluation of the patient's back is needed to determine why this is occurring.

Psychologists call this "Hurt vs. Harm". Pain psychologists and physical therapists work with patients as part of a team to help their brains distinguish between the two. While psychologists are experts in the mind, physical therapists have a unique opportunity to work with patients on Hurt vs. Harm in real time. As your body performs a movement during therapy and you experience a pain sensation, the therapist is there to help assess if there is any orthopedic reason that the movement would have damaged any of your tissues and provoked a pain response. If the pain you experienced is not consistent with some kind of tissue damage, it may be a misfiring of your alarm system.

This is an important skill for people with chronic pain to learn because it helps you to know when to go to the doctor. There is a delicate balance to strike. You don't want to go to the doctor and waste your energy, time, and money on something that was a hurt pain, to be told they can't help you. On the other hand, still knowing when to go to the doctor for something that is legitimately harming you and may be dangerous to your health can save your life.

For example, just because a patient with chronic pain in their left arm has pain in their arm every day, doesn't mean that they can't also have a heart attack which makes their left arm hurt worse. In this case, knowing the difference between the chronic pain in the left arm that hurts, and the harm pain of a heart attack can save a person's life.

Beyond protecting your safety and well being, learning about hurt vs. harm can actually help you to re-program your body's alarm system and help you calibrate how your body perceives pain responses so that you can actually have less pain over time. (See Hurt Vs. Harm: Re-programming The Pain Alarm)

The information above is intended for educational purposes and is not a replacement for individual medical advice. If you are interested in a personal evaluation, click on Book Online at the top of your screen to schedule a consultation with a physical therapist to evaluate your case.



Additional disclaimer: We acknowledge that there are some individuals who feign pain or injury in order to obtain some type of social, financial, or other gain. The intent of this article is not to comment on this, or the validity of conversion disorder as a medical diagnosis in individual cases. This article is intended to recognize that there are also millions of people with chronic pain that are earnestly seeking to address their pain. These individuals should not be instantly discredited because of an assumption that they are insincere or dishonest in their pain complaints. Due to the complexity of biological, psychological, sociological and spiritual factors that contribute to pain processing, each case should be evaluated individually by qualified medical professionals.

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