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Rehab Science · Chapter 4

The Factors That Influence Pain

Pain is shaped by far more than tissue: activity level, movement dose, mental health, beliefs, stress, sleep, diet, genetics and history, culture and meaning, social connection, anatomy, posture and touch. Addressing several factors together works best.

CompleteSource: Rehab Science · Ch 4 · PDF pp. 60–79
You will learn to
  • ✓ Distinguish pain perception from pain tolerance
  • ✓ Explain why "dose" matters more than "bad" movements or posture
  • ✓ Describe placebo and nocebo effects, including the impact of imaging reports
  • ✓ List lifestyle factors with evidence of influencing pain
1.

Pain perception vs pain tolerance

📖 Rehab Science

Perception threshold is the moment something starts to hurt; tolerance is how long or how much you can bear after that. People start hurting at similar points, but tolerance can be trained—athletes and martial artists build it, and meaningful events raise it.

Diagram · Pain perception vs pain toleranceOriginal illustration
increasing stimulus intensity (e.g. hand in ice water) →perception threshold“it starts to hurt”tolerance threshold“I can’t take more”trainable →
Perception threshold (when it starts to hurt) is similar between people; tolerance (how much you can bear) is trainable and shaped by meaning. — Based on concepts in Rehab Science Ch 4 (PDF pp. 62–63).
Source: Rehab Science · Ch 4 · PDF pp. 62, 63· 16 original research citationsshow sources ▾
  1. [Ch 4·1] Paller CJ, Campbell CM, Edwards RR, Dobs AS. Sex-based differences in pain perception and treatment. Pain Med. 2009;10(2):289-299. find original ↗
  2. [Ch 4·2] Riley JL 3rd, Robinson ME, Wise EA, Myers CD, Fillingim RB. Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain. 1998;74(2-3):181-187. find original ↗
  3. [Ch 4·3] Assa T, Geva N, Zarkh Y, Defrin R. The type of sport matters: pain perception of endurance athletes versus strength athletes. Eur J Pain. 2019;23(4):686-696. find original ↗
  4. [Ch 4·4] Peterson JA, Schubert DJ, Campbell J, Bemben MG, Black CD. Endogenous pain inhibitory function: endurance-trained athletes vs. active controls. Pain Med. 2019;20(9):1822-1830. find original ↗
  5. [Ch 4·5] Tesarz J, Schuster AK, Hartmann M, Gerhardt A, Eich W. Pain perception in athletes compared to normally active controls: a systematic review with meta-analysis. Pain. 2012;153(6):1253-1262. find original ↗
  6. [Ch 4·6] Geva N, Defrin R. Enhanced pain modulation among triathletes: a possible explanation for their exceptional capabilities. Pain. 2013;154(11):2317-2323. find original ↗
  7. [Ch 4·7] Ohel I, Walfisch A, Shitenberg D, Sheiner E, Hallak M. A rise in pain threshold during labor: a prospective clinical trial. Pain. 2007;132 Suppl 1:S104-S108. find original ↗
  8. [Ch 4·8] Berlit S, Lis S, Häfner K, et al. Changes in birth-related pain perception impact of neurobiological and psycho-social factors. Arch Gynecol Obstet. 2018;297(3):591-599. find original ↗
Also cited by the book on these pages:
  1. [Ch 4·9] Sluka KA, Frey-Law L, Hoeger Bement M. Exercise-induced pain and analgesia? Underlying mechanisms and clinical translation. Pain. 2018;159 Suppl 1(Suppl 1):S91-S97. find original ↗
  2. [Ch 4·11] Landmark T, Romundstad PR, Borchgrevink PC, Kaasa S, Dale O. Longitudinal associations between exercise and pain in the general population—the HUNT pain study. PLoS One. 2013;8(6):e65279. Published 2013 Jun 12. find original ↗
  3. [Ch 4·12] Bobinski F, Ferreira TAA, Córdova MM, et al. Role of brainstem serotonin in analgesia produced by low-intensity exercise on neuropathic pain after sciatic nerve injury in mice. Pain. 2015;156(12):2595-2606. find original ↗
  4. [Ch 4·15] Naugle KM, Riley JL III. Self-reported physical activity predicts pain inhibitory and facilitatory function. Med Sci Sports Exerc. 2014;46(3):622-629. find original ↗
  5. [Ch 4·16] Gong WY, Abdelhamid RE, Carvalho CS, Sluka KA. Resident macrophages in muscle contribute to development of hyperalgesia in a mouse model of noninflammatory muscle pain. J Pain. 2016;17(10):1081-1094. find original ↗
  6. [Ch 4·19] Grace PM, Fabisiak TJ, Green-Fulgham SM, et al. Prior voluntary wheel running attenuates neuropathic pain. Pain. 2016;157(9):2012-2023. find original ↗
  7. [Ch 4·20] Belavy DL, Van Oosterwijck J, Clarkson M, et al. Pain sensitivity is reduced by exercise training: evidence from a systematic review and meta-analysis. Neurosci Biobehav Rev. 2021;120:100-108. find original ↗
  8. [Ch 4·21] Grooten WJA, Boström C, Dedering Å, et al. Summarizing the effects of different exercise types in chronic low back pain—a systematic review of systematic reviews. BMC Musculoskelet Disord. 2022;23(1):801. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

2.

Physical inactivity

📖 Rehab Science

Not moving makes the nervous and immune systems more pain-prone. The type of exercise matters less than doing something you enjoy, at moderate intensity, for 20–30 minutes on most days.

  • 150 min/week moderate aerobic activity + strength training twice weekly
  • Any enjoyable movement helps
Source: Rehab Science · Ch 4 · PDF pp. 63, 64· 17 original research citationsshow sources ▾
  1. [Ch 4·9] Sluka KA, Frey-Law L, Hoeger Bement M. Exercise-induced pain and analgesia? Underlying mechanisms and clinical translation. Pain. 2018;159 Suppl 1(Suppl 1):S91-S97. find original ↗
  2. [Ch 4·10] Landmark T, Romundstad P, Borchgrevink PC, Kaasa S, Dale O. Associations between recreational exercise and chronic pain in the general population: evidence from the HUNT 3 study. Pain. 2011;152(10):2241-2247. find original ↗
  3. [Ch 4·11] Landmark T, Romundstad PR, Borchgrevink PC, Kaasa S, Dale O. Longitudinal associations between exercise and pain in the general population—the HUNT pain study. PLoS One. 2013;8(6):e65279. Published 2013 Jun 12. find original ↗
  4. [Ch 4·12] Bobinski F, Ferreira TAA, Córdova MM, et al. Role of brainstem serotonin in analgesia produced by low-intensity exercise on neuropathic pain after sciatic nerve injury in mice. Pain. 2015;156(12):2595-2606. find original ↗
  5. [Ch 4·13] Brito RG, Rasmussen LA, Sluka KA. Regular physical activity prevents development of chronic muscle pain through modulation of supraspinal opioid and serotonergic mechanisms. Pain Rep. 2017;2(5):e618. Published 2017 Aug 21. find original ↗
  6. [Ch 4·14] Lima LV, DeSantana JM, Rasmussen LA, Sluka KA. Short-duration physical activity prevents the development of activity-induced hyperalgesia through opioid and serotoninergic mechanisms. Pain. 2017;158(9):1697-1710. find original ↗
  7. [Ch 4·15] Naugle KM, Riley JL III. Self-reported physical activity predicts pain inhibitory and facilitatory function. Med Sci Sports Exerc. 2014;46(3):622-629. find original ↗
  8. [Ch 4·16] Gong WY, Abdelhamid RE, Carvalho CS, Sluka KA. Resident macrophages in muscle contribute to development of hyperalgesia in a mouse model of noninflammatory muscle pain. J Pain. 2016;17(10):1081-1094. find original ↗
  9. [Ch 4·17] Leung A, Gregory NS, Allen LH, Sluka KA. Regular physical activity prevents chronic pain by altering resident muscle macrophage phenotype and increasing interleukin-10 in mice. Pain. 2016;157(1):70-79. find original ↗
  10. [Ch 4·18] Bobinski F, Teixeira JM, Sluka KA, Santos ARS. Interleukin-4 mediates the analgesia produced by low-intensity exercise in mice with neuropathic pain. Pain. 2018;159(3):437-450. find original ↗
  11. [Ch 4·19] Grace PM, Fabisiak TJ, Green-Fulgham SM, et al. Prior voluntary wheel running attenuates neuropathic pain. Pain. 2016;157(9):2012-2023. find original ↗
  12. [Ch 4·20] Belavy DL, Van Oosterwijck J, Clarkson M, et al. Pain sensitivity is reduced by exercise training: evidence from a systematic review and meta-analysis. Neurosci Biobehav Rev. 2021;120:100-108. find original ↗
  13. [Ch 4·21] Grooten WJA, Boström C, Dedering Å, et al. Summarizing the effects of different exercise types in chronic low back pain—a systematic review of systematic reviews. BMC Musculoskelet Disord. 2022;23(1):801. find original ↗
Also cited by the book on these pages:
  1. [Ch 4·3] Assa T, Geva N, Zarkh Y, Defrin R. The type of sport matters: pain perception of endurance athletes versus strength athletes. Eur J Pain. 2019;23(4):686-696. find original ↗
  2. [Ch 4·6] Geva N, Defrin R. Enhanced pain modulation among triathletes: a possible explanation for their exceptional capabilities. Pain. 2013;154(11):2317-2323. find original ↗
  3. [Ch 4·7] Ohel I, Walfisch A, Shitenberg D, Sheiner E, Hallak M. A rise in pain threshold during labor: a prospective clinical trial. Pain. 2007;132 Suppl 1:S104-S108. find original ↗
  4. [Ch 4·8] Berlit S, Lis S, Häfner K, et al. Changes in birth-related pain perception impact of neurobiological and psycho-social factors. Arch Gynecol Obstet. 2018;297(3):591-599. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

3.

Movement, biomechanics and the idea of "dose"

📖 Rehab Science

There are no "bad" movements—only movements your body is not ready for yet, or doses that are too much, too soon, or for too long. With a fresh injury, technique and load matter more. With long-standing pain, the goal is to move the area in non-threatening ways to calm the system.

  • Movement has a dosage, like medication
  • Sensitive ≠ damaged
Diagram · Load vs capacity — movement has a doseOriginal illustration
capacity (grows with training)spike: too much, too soon → injury/flaregraded load stays under capacityweeksload / capacity
Injury and flare-ups happen when load exceeds what tissues are conditioned for—too much, too soon or too long. Progressive, graded loading raises capacity over time. — Based on concepts in Rehab Science Ch 4 (PDF p. 65) & Ch 9 (PDF pp. 163–165).
Source: Rehab Science · Ch 4 · PDF pp. 64–67· 3 original research citationsshow sources ▾
  1. [Ch 4·21] Grooten WJA, Boström C, Dedering Å, et al. Summarizing the effects of different exercise types in chronic low back pain—a systematic review of systematic reviews. BMC Musculoskelet Disord. 2022;23(1):801. find original ↗
Also cited by the book on these pages:
  1. [Ch 4·22] Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163(20):2433-2445. find original ↗
  2. [Ch 4·25] Doan L, Manders T, Wang J. Neuroplasticity underlying the comorbidity of pain and depression. Neural Plast. 2015;2015:504691. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

4.

Mental health

📖 Rehab Science

Depression and anxiety are strongly linked to long-lasting pain. If you are struggling, talking to a mental health professional can make a real difference to your pain.

Source: Rehab Science · Ch 4 · PDF pp. 67, 68· 9 original research citationsshow sources ▾
  1. [Ch 4·22] Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163(20):2433-2445. find original ↗
  2. [Ch 4·23] IsHak WW, Wen RY, Naghdechi L, et al. Pain and depression: a systematic review. Harv Rev Psychiatry. 2018;26(6):352-363. find original ↗
  3. [Ch 4·24] Lewis GN, Rice DA, McNair PJ, Kluger M. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth. 2015;114(4):551-561. find original ↗
  4. [Ch 4·25] Doan L, Manders T, Wang J. Neuroplasticity underlying the comorbidity of pain and depression. Neural Plast. 2015;2015:504691. find original ↗
Also cited by the book on these pages:
  1. [Ch 4·21] Grooten WJA, Boström C, Dedering Å, et al. Summarizing the effects of different exercise types in chronic low back pain—a systematic review of systematic reviews. BMC Musculoskelet Disord. 2022;23(1):801. find original ↗
  2. [Ch 4·26] Kroslak M, Murrell GAC. Surgical treatment of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. Am J Sports Med. 2018;46(5):1106-1113. find original ↗
  3. [Ch 4·28] Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361(6):557-568. find original ↗
  4. [Ch 4·29] Blasini M, Corsi N, Klinger R, Colloca L. Nocebo and pain: an overview of the psychoneurobiological mechanisms. Pain Rep. 2017;2(2):e585. find original ↗
  5. [Ch 4·32] Hohenschurz-Schmidt D, Thomson OP, Rossettini G, et al. Avoiding nocebo and other undesirable effects in chiropractic, osteopathy and physiotherapy: an invitation to reflect. Musculoskelet Sci Pract. 2022;62:102677. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

5.

Thoughts, beliefs, placebo and nocebo

📖 Rehab Science

Believing a treatment will help can make it help (placebo). Scary messages—"you have the spine of a 70-year-old"—can make pain worse (nocebo). Many scan findings are normal ageing. Ask questions, and get a second opinion before anything invasive.

Source: Rehab Science · Ch 4 · PDF pp. 68, 69· 9 original research citationsshow sources ▾
  1. [Ch 4·26] Kroslak M, Murrell GAC. Surgical treatment of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. Am J Sports Med. 2018;46(5):1106-1113. find original ↗
  2. [Ch 4·27] Moseley JB, O’Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347(2):81-88. find original ↗
  3. [Ch 4·28] Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361(6):557-568. find original ↗
  4. [Ch 4·29] Blasini M, Corsi N, Klinger R, Colloca L. Nocebo and pain: an overview of the psychoneurobiological mechanisms. Pain Rep. 2017;2(2):e585. find original ↗
  5. [Ch 4·30] Manaï M, van Middendorp H, Veldhuijzen DS, Huizinga TWJ, Evers AWM. How to prevent, minimize, or extinguish nocebo effects in pain: a narrative review on mechanisms, predictors, and interventions. Pain Rep. 2019;4(3):e699. Published 2019 Jun 7. find original ↗
  6. [Ch 4·31] Petersen GL, Finnerup NB, Colloca L, et al. The magnitude of nocebo effects in pain: a meta-analysis. Pain. 2014;155(8):1426-1434. find original ↗
  7. [Ch 4·32] Hohenschurz-Schmidt D, Thomson OP, Rossettini G, et al. Avoiding nocebo and other undesirable effects in chiropractic, osteopathy and physiotherapy: an invitation to reflect. Musculoskelet Sci Pract. 2022;62:102677. find original ↗
  8. [Ch 4·33] Hasenbring MI, Chehadi O, Titze C, Kreddig N. Fear and anxiety in the transition from acute to chronic pain: there is evidence for endurance besides avoidance. Pain Manag. 2014;4(5):363-374. find original ↗
  9. [Ch 4·34] Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30(1):77-94. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

6.

Stress

📖 Rehab Science

Short bursts of stress are normal. Stress that never switches off makes the body more sensitive to pain. Identify your triggers, improve sleep, food, exercise and relationships, and use breathing or meditation.

Source: Rehab Science · Ch 4 · PDF pp. 69, 70· 6 original research citationsshow sources ▾
  1. [Ch 4·35] Miller GE, Cohen S, Ritchey AK. Chronic psychological stress and the regulation of pro-inflammatory cytokines: a glucocorticoid-resistance model. Health Psychol. 2002;21(6):531-541. find original ↗
  2. [Ch 4·36] Thacker MA, Clark AK, Marchand F, McMahon SB. Pathophysiology of peripheral neuropathic pain: immune cells and molecules. Anesth Analg. 2007;105(3):838-847. find original ↗
  3. [Ch 4·37] Togo F, Natelson BH, Adler GK, et al. Plasma cytokine fluctuations over time in healthy controls and patients with fibromyalgia. Exp Biol Med (Maywood). 2009;234(2):232-240. find original ↗
Also cited by the book on these pages:
  1. [Ch 4·33] Hasenbring MI, Chehadi O, Titze C, Kreddig N. Fear and anxiety in the transition from acute to chronic pain: there is evidence for endurance besides avoidance. Pain Manag. 2014;4(5):363-374. find original ↗
  2. [Ch 4·34] Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30(1):77-94. find original ↗
  3. [Ch 4·38] Van Looveren E, Bilterys T, Munneke W, et al. The association between sleep and chronic spinal pain: a systematic review from the last decade. J Clin Med. 2021;10(17):3836. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

7.

Sleep

📖 Rehab Science

Poor sleep and pain feed each other. Most adults need 7–9 hours. A wind-down routine, a dark and cool room, no phone, and gentle stretching can help.

Source: Rehab Science · Ch 4 · PDF pp. 70, 71· 7 original research citationsshow sources ▾
  1. [Ch 4·38] Van Looveren E, Bilterys T, Munneke W, et al. The association between sleep and chronic spinal pain: a systematic review from the last decade. J Clin Med. 2021;10(17):3836. find original ↗
  2. [Ch 4·39] Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s updated sleep duration recommendations: final report. Sleep Health. 2015;1(4):233-243. find original ↗
  3. [Ch 4·40] Short sleep duration among US adults. National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. Centers for Disease Control and Prevention. Updated September 12, 2022. Accessed December 31, 2022. https://www.cdc.gov/sleep/data_statistics.html. find original ↗
Also cited by the book on these pages:
  1. [Ch 4·35] Miller GE, Cohen S, Ritchey AK. Chronic psychological stress and the regulation of pro-inflammatory cytokines: a glucocorticoid-resistance model. Health Psychol. 2002;21(6):531-541. find original ↗
  2. [Ch 4·37] Togo F, Natelson BH, Adler GK, et al. Plasma cytokine fluctuations over time in healthy controls and patients with fibromyalgia. Exp Biol Med (Maywood). 2009;234(2):232-240. find original ↗
  3. [Ch 4·41] Dragan S, Șerban MC, Damian G, Buleu F, Valcovici M, Christodorescu R. Dietary patterns and interventions to alleviate chronic pain. Nutrients. 2020;12(9):2510. find original ↗
  4. [Ch 4·44] Comee L, Taylor CA, Nahikian-Nelms M, Ganesan LP, Krok-Schoen JL. Dietary patterns and nutrient intake of individuals with rheumatoid arthritis and osteoarthritis in the United States. Nutrition. 2019;67-68:110533. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

8.

Diet

📖 Rehab Science

Heavily processed foods high in refined carbs, trans fats and sugar may make nerves more sensitive. A whole-food diet and healthy weight are sensible; a dietitian can personalise it.

Source: Rehab Science · Ch 4 · PDF p. 71· 6 original research citationsshow sources ▾
  1. [Ch 4·41] Dragan S, Șerban MC, Damian G, Buleu F, Valcovici M, Christodorescu R. Dietary patterns and interventions to alleviate chronic pain. Nutrients. 2020;12(9):2510. find original ↗
  2. [Ch 4·42] Bjørklund G, Aaseth J, Doşa MD, et al. Does diet play a role in reducing nociception related to inflammation and chronic pain? Nutrition. 2019;66:153-165. find original ↗
  3. [Ch 4·43] Correa-Rodríguez M, Casas-Barragán A, González-Jiménez E, Schmidt-RioValle J, Molina F, Aguilar-Ferrándiz ME. Dietary inflammatory index scores are associated with pressure pain hypersensitivity in women with fibromyalgia. Pain Med. 2020;21(3):586-594. find original ↗
  4. [Ch 4·44] Comee L, Taylor CA, Nahikian-Nelms M, Ganesan LP, Krok-Schoen JL. Dietary patterns and nutrient intake of individuals with rheumatoid arthritis and osteoarthritis in the United States. Nutrition. 2019;67-68:110533. find original ↗
Also cited by the book on this page:
  1. [Ch 4·39] Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s updated sleep duration recommendations: final report. Sleep Health. 2015;1(4):233-243. find original ↗
  2. [Ch 4·40] Short sleep duration among US adults. National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. Centers for Disease Control and Prevention. Updated September 12, 2022. Accessed December 31, 2022. https://www.cdc.gov/sleep/data_statistics.html. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

9.

Genetics, environment and history (trauma)

📖 Rehab Science

Only some people who suffer the same injury develop chronic pain—for whiplash, roughly a third to a half. Genes and upbringing play a part, but you can change your environment and build resilience gradually. Past physical or psychological trauma may need professional support.

Source: Rehab Science · Ch 4 · PDF pp. 73, 74· 8 original research citationsshow sources ▾
  1. [Ch 4·45] Atherton K, Wiles NJ, Lecky FE, et al. Predictors of persistent neck pain after whiplash injury. Emerg Med J. 2006;23(3):195-201. find original ↗
  2. [Ch 4·46] Ritchie C, Ehrlich C, Sterling M. Living with ongoing whiplash associated disorders: a qualitative study of individual perceptions and experiences. BMC Musculoskelet Disord. 2017;18(1):531. find original ↗
  3. [Ch 4·47] Buskila D. Genetics of chronic pain states. Best Pract Res Clin Rheumatol. 2007;21(3):535-547. find original ↗
  4. [Ch 4·48] Clementi MA, Faraji P, Poppert Cordts K, et al. Parent factors are associated with pain and activity limitations in youth with acute musculoskeletal pain: a cohort study. Clin J Pain. 2019;35(3):222-228. find original ↗
  5. [Ch 4·49] Walker SM. Long-term effects of neonatal pain. Semin Fetal Neonatal Med. 2019;24(4):101005. find original ↗
Also cited by the book on these pages:
  1. [Ch 4·50] Bates MS, Edwards TW, Anderson KO. Ethnocultural influences on variation in chronic pain perception. Pain. 1993;52(1):101-112. find original ↗
  2. [Ch 4·51] Xygalatas D, Mitkidis P, Fischer R, et al. Extreme rituals promote prosociality. Psychol Sci. 2013;24(8):1602-1605. find original ↗
  3. [Ch 4·52] Fischer R, Xygalatas D, Mitkidis P, et al. The fire-walker’s high: affect and physiological responses in an extreme collective ritual. PLoS One. 2014;9(2):e88355. Published 2014 Feb 20. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

10.

Culture and meaning

📖 Rehab Science

Painful things that carry meaning often hurt less. Doing small, growing doses of an activity you value can make your system more resilient. Pain is not weakness, and ignoring it can lead to injury.

Source: Rehab Science · Ch 4 · PDF pp. 74, 75· 4 original research citationsshow sources ▾
  1. [Ch 4·50] Bates MS, Edwards TW, Anderson KO. Ethnocultural influences on variation in chronic pain perception. Pain. 1993;52(1):101-112. find original ↗
  2. [Ch 4·51] Xygalatas D, Mitkidis P, Fischer R, et al. Extreme rituals promote prosociality. Psychol Sci. 2013;24(8):1602-1605. find original ↗
  3. [Ch 4·52] Fischer R, Xygalatas D, Mitkidis P, et al. The fire-walker’s high: affect and physiological responses in an extreme collective ritual. PLoS One. 2014;9(2):e88355. Published 2014 Feb 20. find original ↗
Also cited by the book on these pages:
  1. [Ch 4·53] Rabin BS. Stress, Immune Function and Health: The Connection. New York: Wiley Liss; 1999. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

11.

Social interaction and humour

📖 Rehab Science

People in pain often withdraw, become lonely and feel worse. Seek supportive people, limit contact with those who make you feel dismissed, and find reasons to laugh.

Source: Rehab Science · Ch 4 · PDF p. 75· 1 original research citationshow sources ▾
  1. [Ch 4·53] Rabin BS. Stress, Immune Function and Health: The Connection. New York: Wiley Liss; 1999. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

12.

Anatomy

📖 Rehab Science

Some body shapes—very flexible joints, or a hip socket shaped a certain way—raise the risk of certain problems, but bodies adapt remarkably. If anatomy matters for you, adjust how you move (for example, a wider squat stance) rather than stopping.

Source: Rehab Science · Ch 4 · PDF p. 76show sources ▾

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

13.

Posture

📖 Rehab Science

Posture matters less than most people think. Any position held too long becomes uncomfortable. Your next posture is your best posture—keep moving.

Source: Rehab Science · Ch 4 · PDF pp. 77, 78· 4 original research citationsshow sources ▾
  1. [Ch 4·54] Lewis JS, Green A, Wright C. Subacromial impingement syndrome: the role of posture and muscle imbalance. J Shoulder Elbow Surg. 2005;14(4):385-392. find original ↗
  2. [Ch 4·55] Lewis JS, Wright C, Green A. Subacromial impingement syndrome: the effect of changing posture on shoulder range of movement. J Orthop Sports Phys Ther. 2005;35(2):72-87. find original ↗
  3. [Ch 4·56] Edmondston SJ, Chan HY, Ngai GC, et al. Postural neck pain: an investigation of habitual sitting posture, perception of “good” posture and cervicothoracic kinaesthesia. Man Ther. 2007;12(4):363-371. find original ↗
Also cited by the book on these pages:
  1. [Ch 4·57] Uvnas-Moberg K, Petersson M. Oxytocin, a mediator of anti-stress, well-being, social interaction, growth and healing. Z Psychosom Med Psychother. 2005;51(1):57-80. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

14.

Touch

📖 Rehab Science

Being touched can ease pain by releasing oxytocin and building trust. Some people become over-sensitive to touch, but careful, gradual touch can help them too.

Source: Rehab Science · Ch 4 · PDF p. 78· 1 original research citationshow sources ▾
  1. [Ch 4·57] Uvnas-Moberg K, Petersson M. Oxytocin, a mediator of anti-stress, well-being, social interaction, growth and healing. Z Psychosom Med Psychother. 2005;51(1):57-80. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

15.

Breaking the loop

📖 Rehab Science

The best pain centres treat the whole person. Tackle as many factors as you can.

Source: Rehab Science · Ch 4 · PDF pp. 78, 79· 1 original research citationshow sources ▾
Also cited by the book on these pages:
  1. [Ch 4·57] Uvnas-Moberg K, Petersson M. Oxytocin, a mediator of anti-stress, well-being, social interaction, growth and healing. Z Psychosom Med Psychother. 2005;51(1):57-80. find original ↗

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Check your understanding

1. Which threshold can be trained upward?
2. Being told "you have the spine of a 70-year-old" after a scan is an example of…
3. According to the book, what usually makes a position painful?