Our Words Affect Pain

Picture from Coregymball

It may be just words you think. Perhaps not. Recently published fascinating research suggest that how healthcare providers describe an injury can have a direct impact on a patient's pain. 

Not only were the patients blinded (a technique used to minimise bias), the patients also did not know they were part of a study.

Picture from article

50 recreational runners with Achilles tedinopathy took part in the radomized trial (pictured above). They ran 3 times a week. Runners in the experimental group received diagnostic information of tendon pain that highlighted reversible changes in muscle function as their primary problem. They did not hear any reference to tendon pathology.

The control group received an explanation of tendon pain that prioritised irreversible structural tendon pathology as the cause of pain.

The primary outcome measure was how much pain the runners had during a standardised hopping task measured on a scale of 0-100. Secondary outcomes were how stiff the lower limbs were hopping and time in seconds for pain to ease after completing the hopping task.

The diagnostic information immediately affected pain intensity during the hopping task. The average pain score was 25.4 in the experimental group versus 36.7 in the control group.

Time to ease (no pain) after hopping was near identical in both groups. Lower limb stiffness was higher in the experimental group. Note that higher leg stiffness is better for leg hopping because increased leg stiffness allows for greater force production and more efficient energy transfer. This leads to higher jump heights and faster movement.

This is a really intriguing area of research. We now have data showing that information from healthcare providers during the first visit has an immediate effect on pain. The language we use during clinical interactions can be powerful, shaping our perceptions and pain responses. This knowledge should change how we interact with our patients. 

However, we need to also be able to do this in our clinics without compromising the accuracy and necessary medical information.

Reference

Travers NJ, Travers MJ, Gibson W et al (2025). The Content Of Diagnostic Information Has An Immediate Effect On Pain With Loading In People With Morportion Achilles Tendinopathy: A Randomized Clinical Experiment. Bra J PT. 29(5). DOI: 10.1016/j.bjbt.2025.101244

Physical Activity And Pain Tolerance

Picture from Science News

Almost all of my patients tell me they have a high tolerance for pain. That seems to be the most common reason why they sometimes do not come in early for treatment, thinking that they can tolerate the pain until it somehow goes away on its own. Some patients do have a higher tolerance for pain compared to others. Consuming too much sugar can be a contributing factor, I've written on that before. The following article may give further clues on why.

Since there are limited information on the association between lifestyle factors and pain severity in older adults, a group of researchers decided to investigate if unhealthy lifestyle variables were linked to feeling more pain.

Subjects who were above 50 years living in 27 European countries and Israel were sampled and their data retrieved. Association between lifestyle actors (smoking, sleep, diet and physical inactivity) and how they tolerated pain (mild, moderate or severe) were assessed. Age, sex, geographic region, education, history of chronic disease were all mutually adjusted for each lifestyle.

A total of 27,528 cases were included. The average age was 73 years and 63.3 percent of the cohort were female. A significant association was observed between those who hardly ever or never engaged in activities that required a moderate level of energy and severe pain (pictured above).

In addition, sleep problems, smoking and an inadequate diet were also significantly associated with severe pain, although with lower odds. 

The authors concluded that older adults that were physically inactive were more likely to experience severe pain. Sleeping poorly, smoking and an inadequate diet were less associated with experiencing severe pain. 

Since the above mentioned lifestyle factors are modifiable, they suggested that they may be useful as preventative measures to reduce pain and ensure healthy living.

Previously, I wrote about how strength training helps prevent frailty, especially when you grow older. Well, that's another very good reason to be active.

Reference

Numez-Cortez R, Cruz-Montecinos C, Lopez-Bueno R et al (2025). Physical Activity Is The Most Important Unhealthy Lifestyle Factor For Pain Severity In Older Adults With Pain. A SHARE-based Analysis Of 27,528 Cases From 28 Countries. Musc Sci Pract. DOI: 10.1016/j.mskp.2025.103270

Triathletes Feel Less Pain Than Others

Me at the 2005 SEA Games on the left

We know triathletes can handle a lot of pain, especially since they need to push through pain barriers to complete their races. A new study published recently shed some light on how good triathletes are at handling pain.

Researchers at Tel Aviv University in Israel studied a group of Ironman triathlon (swim 3.8km, bike 180km and run 42.195km--yes they go through a lot of pain) triathletes and another group (who swam, ran and did other sports but do not compete in races).

Both groups of participants went through a battery of tests including one that involved applying a heating device to one arm while the other arm was submerged in cold water. In addition the participants also had to answer a questionnaire on pain perception, stress perception and fear of pain.

Compared to the other group, the triathletes displayed greater pain tolerance during the tests. They rated lower pain intensity on the pain scale and tolerated pain longer allowing the researchers concluding that triathletes can perform at high levels because they feel less pain compared to casual exercisers. What the researchers cannot decide is whether triathletes compete in triathlons because they feel less pain or they feel less pain because they train for and compete in triathlons.

My personal experience suggests the latter. Cumulative effects of hard workouts does blunt the body and mind to pain. It makes you more willing to put up with pain and tough it out until you cross the finish line.

Reference
Geva N and Defrin R (2013). Enhanced Pain Modulation Among Triathletes: A Possible Explanation For Their Exceptional Capabilities. J Int Assoc for study of Pain. doi : 10.1016/j.pain.2013.06.031