What’s the difference between the causes of pain and the amplifiers of pain?
Pain is complex. Anyone working with people in pain quickly learns that identifying the source of pain isn’t always straightforward and neither is understanding why some people experience more severe or persistent pain than others.
As clinicians, we often hear patients asking:
What’s causing my pain?
But to truly help them, we need to look beyond the surface and distinguish between what actually causes pain and what amplifies it to become so overwhelming.
Understanding Pain Causes: The "Find and Fix"
When we talk about the cause of pain, we’re referring to the actual tissue, nerve, or body part that is injured or malfunctioning. It could be a joint damaged by arthritis, a nerve compressed by a disc, or an inflamed tendon.
Our clinical goal here is often to identify and, where possible, treat or manage this root cause. This is the classic “find and fix” approach: find the problem area, and fix it.
But here’s where it starts to get complicated. Sometimes, even after addressing the physical injury or pathology, patients still experience pain. Why?
Understanding Pain Amplifiers
Pain amplifiers are factors that amplify, sustain, or worsen the pain experience. They don’t cause the pain in the traditional sense but fuel the nervous system dysfunction that makes pain so persistent and debilitating.
One key concept here is central sensitisation, a condition where the nervous system becomes over-reactive or dysfunctional. It’s like a volume knob on pain that’s been turned up too high. Central sensitisation often involves neuro-inflammation, a subtle but powerful inflammatory process in the nervous system that drives this heightened sensitivity.
What fuels this neuro-inflammation? From my clinical experience, and backed by the literature, there are around 7 main drivers that contribute to persistent pain’s amplification:
Persistent, untreated injury: When an injury doesn’t heal or isn’t properly diagnosed, ongoing tissue damage keeps the pain signal alive.
Inflammatory and autoimmune disorders: Conditions like rheumatoid arthritis, spondyloarthropathies, Crohn’s disease, and others cause chronic inflammation, which can amplify pain.
Metabolic imbalances: Diabetes, hypothyroidism, and other metabolic issues can contribute to nerve irritation and pain amplification.
Pre-existing mental health conditions and psycho social stress: Anxiety and depression can worsen pain perception and the body’s stress response.
Hypermobility: Excessive joint movement can increase strain and pain sensitivity.
Obesity: It’s more than just mechanical load; obesity contributes to systemic inflammation, which can worsen pain.
Multi-mobidity: The accumulation of multiple conditions or diseases (major and minor) that appear to have a dose response effect on pain.
These drivers don’t just operate in isolation. Often, they interact, creating a feedback loop where pain worsens itself.
Difference Between Pain Causes and Pain Amplifiers
Understanding the difference between causes and amplifiers changes how we approach treatment. It shifts our mindset from simply fixing a damaged part to managing a complex system of factors that maintain pain.
For causes, we seek diagnosis and direct treatment.
For amplifiers, we look at holistic management aiming to identify and treat modifiable amplifiers such as under-treated inflammatory and metabolic disease: addressing mental health and social stressors, improving metabolic health, supporting lifestyle changes, and educating patients about how their nervous system works.
This human-centred approach is empowering. It validates the patient’s experience, showing them that their pain isn’t "all in their head," but rather the result of complex body-brain interactions, some treatable, some modifiable.
Moving Forward With Empathy and Clarity
In clinical practice, it’s important to communicate this distinction gently and clearly. Patients often feel frustrated when they can’t pinpoint a single cause. By explaining pain amplifiers, we help them understand why pain can persist and how they can take meaningful steps towards relief.
Pain management is not about blame or mystery. It’s about clarity, compassion, and partnership. As clinicians, embracing this nuanced understanding of pain that does not exclude finding and fixing, or decreasing amplifiers, equips us to lead patients forward with hope and practical strategies.
The goal is not just to treat pain, but to help people reclaim their lives.
To deepen your understanding of pain amplifiers and how they shape chronic pain, listen to Podcast Episode 28 of It’s Not In Your Head - If it’s not in your head, where is it coming from?
https://www.iniyh.com/episodes/ep-28-if-its-not-in-your-head-where-is-it-coming-from