Pain is more than just a physical experience—it’s shaped by the way it is understood and communicated. While joint pain originates in the body, the information provided by healthcare professionals plays a crucial role in how patients perceive and manage their condition.
Pain is in the Joint, but the Messengers Are in the Brain
Pain might be felt in the joint, but its interpretation happens in the brain. Neurotransmitters act as messengers, transmitting pain signals and modulating their intensity. The nervous system is responsible for processing this information, determining how pain is perceived.
For instance, studies on chronic pain have shown a decrease in dopamine levels in key areas of the brain. This change affects not only pain perception but also mood and motivation, reinforcing the idea that pain is not just about tissue damage—it is an experience shaped by the nervous system. (1)
The Role of Medical Information: Good vs. Bad Communication
The way medical information is delivered can directly impact a patient’s perception of their condition. A diagnosis should be based on facts, but the way it is explained can either reassure or distress the patient.
Poorly communicated medical information can lead to excessive caution, fear, or uncertainty about the future. Beyond diagnosis, prognosis is equally important. A patient who understands what to expect in terms of recovery time and outcomes is more likely to remain optimistic. This confidence influences the nervous system and, in turn, their pain experience.
The Nocebo Effect: When Words Worsen Pain
Just as positive explanations can improve a patient’s outlook, negative or misleading statements can worsen their condition. This is the nocebo effect—where a medical explanation, perceived as alarming or catastrophic, amplifies pain and disability.
For example, I’ve had patients return from radiology exams where the radiologist told them they had “the spine of a 90-year-old”—even though they were only 40. Such statements can cause unnecessary fear, excessive precautions, and a sense of hopelessness, leading to long-term disability, not because of the physical condition itself, but because of the psychological impact of the message.
Keeping Medical Knowledge Up to Date
The nocebo effect can occur at any stage of a patient’s medical journey. This is not about blaming healthcare professionals—staying updated with evolving scientific knowledge is challenging. (2)
On average, it takes 18 years for new scientific evidence to be fully integrated into clinical practice. This means that outdated explanations about musculoskeletal pain are still widely used. Keeping up with new research is essential—not only for clinicians but also for patients who want to understand their condition accurately.
Understanding pain is as important as receiving hands-on treatment or following an exercise program.
References:
Martikainen IK, Nuechterlein EB, Peciña M, Love TM, Cummiford CM, Green CR, Stohler CS, Zubieta JK. Chronic Back Pain Is Associated with Alterations in Dopamine Neurotransmission in the Ventral Striatum. J Neurosci. 2015 Jul 8;35(27):9957-65. doi: 10.1523/JNEUROSCI.4605-14.2015. PMID: 26156996; PMCID: PMC4495244.
Colloca L. The Nocebo Effect. Annu Rev Pharmacol Toxicol. 2024 Jan 23;64:171-190. doi: 10.1146/annurev-pharmtox-022723-112425. Epub 2023 Aug 16. PMID: 37585661; PMCID: PMC10868531.
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