Thinking Of Pain As A Warning Signal.
About a week ago, I had a conversation with my 10-year-old that stuck with me. We were talking about my week at work and somehow landed on how some explanations of pain can inadvertently push patients toward hopelessness, even suicidal thoughts.
She gave me that 10-year-old look - the “WTF?” look. I tried to reassure her that it wasn’t intentional, just a rare outcome. Her reply? “Sure…yeah, but…” and the look didn’t leave her face.
Patients don’t come to us for the unpleasant sensation of pain. They come because pain has stolen their sense of purpose, joy, identity, and self-worth. When we describe pain as a “false alarm” or “misinterpretation,” some patients hear: “It’s all in your head.” And that perception can deepen despair.
I’ve made this mistake myself. It was never intentional, but it was enough to create unacceptable risk for a small number of patients. I wouldn’t make that kind of error with medication. So why do it in the way I explain pain?
Now, I frame pain as a warning signal, a prompt to look for what’s happening.
The “what’s happening” could be:
A cause that may or may not be findable and treatable, depending on knowledge, skill and technology.
Amplifiers such as stress, illness, depression, poor sleep, metabolic dysfunction, etc.
Take my own experience: when I get sick, my left sacroiliac joint and right shoulder flare up. The pain isn’t imaginary, it’s amplified by inflammatory mediators while my body fights the virus. The pain goes away when I recover. Same principle applies to patients with stressors and metabolic amplifiers.
I’m a interventionist so I’m a “find and fix it” doctor, but my process is fluid. When diagnosis or treatment exceeds my current skill, knowledge, or tools, I refer out or pivot to address the amplifiers. I try to own my limitation and never blame the patient.
Over the years, I’ve seen patterns emerge with complex patients, patterns that only become visible when you observe many cases over time. Metabolic factors like insulin resistance, systemic inflammation, and lifestyle all play a significant role in amplifying pain. In some cases, addressing the basics like protein intake, hydration, fibre, gentle movement can dramatically reduce pain, even before pinpointing the exact cause.
Over the years, my patients have taught me to:
Reframe pain as a warning signal, not a misfire.
Validate the patient’s experience; it’s real, and it matters.
Be honest about my limitations: “I don’t know yet, but here’s what we can do together.”
Look for and treat causes AND amplifiers; even small wins matter.
Empower patients with practical steps to regain control of their pain.
Seeing pain as a warning signal rather than injury or false alarm provides a structure to identify the causes and amplifiers of pain while not dismissing its existence or its consequences for the patient.
-Dan