The first step on your journey.

Without learning about the science of pain, the advice on the best way forward often makes no sense at all!

If you live with pain, this information might make you less fearful of pain flare-ups. Less fear is always a good thing, and it could also make your subconscious brain feel safer, reducing the amount of pain it produces.

Understanding the science of pain can also help you create a plan that works. Things like improving your sleep, stress levels, or amount of movement might not make sense without understanding this stuff: but actually, the clinical guidelines all say these can help.

If someone you know lives with pain, this information might help you better understand what it’s like when they’re struggling. It can also help you give the best advice (if asked!) and encourage them to keep going with the things that are proven to work.

If you work with people living with pain, feeling confident in the science can help you achieve better outcomes together. Whether you support people with pain every day or just once in a while, this information could help you in your role.

Acute pain is the kind of pain you get short-term: like a sprained ankle, a broken bone, or a cut. It usually lasts less than three months. More often than not, it has a clear cause: some sort of tissue damage (‘tissues’ being the groups of cells that make up body parts and organs). But not always: things like head or stomach aches don’t involve physical damage, but the pain is still very real and intense.

In most cases, this kind of pain is helpful and protective: it encourages us to rest, heal and avoid making things worse. It usually gets better with time and tends to respond well to things like painkillers.

Persistent pain is different. It lasts longer than three months, and by that time, the original injury or illness (if there was one) has usually healed. That can be really confusing. The pain is still very real, but it’s not necessarily caused by new damage.

In fact, persistent pain can be a bit like an alarm that keeps going off, even when there’s no danger anymore. It’s no longer helpful and can stop us from doing the things we love. Our usual go-to treatments like painkillers don’t tend to work as well for persistent pain.

If acute and persistent pain are different, it makes sense that we’d need different ways to treat them. The good news is there are different things that can help when it comes to persistent pain.

There’s no difference between ‘chronic’, ‘persistent’ and ‘long-term’ pain: they’re all words that describe the same thing.

Flippin’ Pain uses the term ‘persistent pain’ most of all because we feel it is the most accurate and helpful way to describe it. We avoid ‘chronic’ as much as we can, because we think it sounds like pain is a lifelong sentence, and it doesn’t have to be: recovery is possible.

Both types of persistent pain last for more than three months. The difference is in the cause:  

• Primary persistent pain has no clear medical explanation or underlying cause, like fibromyalgia or non-specific low back pain.  

• Secondary persistent pain is linked to another condition, such as rheumatoid arthritis or pain from multiple sclerosis.

If you have primary or secondary pain, the information on this website will be useful to you.

Before we start on the definitions, it’s worth mentioning that all pain is created by the brain: so the information on this website is appropriate to everyone, no matter which type of pain you have.

Neuropathic pain is caused by an injury or disease affecting the body’s nerves. Some examples of neuropathic pain are sciatica, carpal tunnel syndrome, diabetic neuropathy and trigeminal neuralgia.

For neuropathic pain, medication, injections and surgery (e.g. nerve decompression) can sometimes help, but less so the longer someone has had symptoms.

Nociceptive pain is caused by an injury, inflammation or tissue changes. These activate danger receptors in the skin or body tissue (called nociceptors). Some examples of nociceptive pain are a sprained ankle, arthritis, tendon pain and spondylosis.

People with nociceptive pain often describe it as movement related and localised to one body area. It may be helped by conventional treatments, such as medication, injections and surgery (e.g. Joint replacement) if there are significant tissue changes present. But it’s not a guarantee that this will help the pain.

Nociplastic pain, or primary persistent pain, is pain that happens without a clear injury or nerve issue. Some examples of nociplastic pain are chronic widespread pain, fibromyalgia, non-specific lower back pain and chronic primary headache.

It’s extremely common for scans to not show any cause for this type of pain, but that doesn’t mean the pain isn’t real. For nociplastic pain, medication has little to no benefit and the pain cannot be reduced by surgery. But there are many other options!

The good news is that everyone can be helped by looking at the psychological and social factors that might be affecting your pain levels, as well as any biological factors. Many people have a mixture of these pain types, so it’s always worth looking at your personal situation: how can you reduce the things in life that make you feel danger, and increase the things in life that make you feel safe?

Yes! This information is backed by organisations such as the NHS and NICE, as well as the British Pain Society and the European Pain Federation.

We get funding from Cora Health, the public sector and not-for-profit groups to provide this information for free. This is because we all agree people need to know this information and it can really help.

We don’t want you to part with your money, and we don’t just share a ‘one-size-fits-all’ solution. We just want to encourage you to be your own ‘pain detective’, exploring all of the biological, psychological and social factors that might help.

First things first: get yourself thoroughly checked out by a qualified health professional. They will know the right questions to ask and tests to do to make sure you have not got an additional condition. Having an additional condition doesn’t mean that information from Flippin’ Pain doesn’t apply, it just means you have to do other things as well to treat the condition.

If you have had pain for more than a few months, then your pain system will be more efficient at producing pain. This is what happens over time: your system becomes more sensitive. Nerve cells in your spinal cord and brain change to be more responsive.

You will know your pain system is becoming overprotective when:

• Your body starts to feel more sensitive than it did.

• Activities that used to cause a little bit of pain now cause a lot of pain.

• Activities that were usually not painful start to become painful.

These things are common in acute pain too, but if they don’t go away after 3 months, it might be a sign of an overprotective pain system. It can feel like your injury is getting worse, but that is actually very unlikely.

Other signs your pain system is becoming overprotective include:

• Your pain might spread, move to different sides/locations in the body, or new spots become sore.

• You might find some movements become more difficult. You might feel stiff.

• You might have muscle spasms. They can be really frightening, particularly if you don’t understand them or know what caused them, but they are another way your body protects a painful area. They are almost never a sign that you have damaged something.

• You might even find you become more sensitive to things that don’t seem related to your body: loud noises, unusual smells, annoying people!

All of these things show that your system is ‘on alert’. Pain can actually be turned up and down by your thoughts, feelings and other things going on in your life: things that actually have nothing to do with the painful body part!

One thing that we know for certain is that an overprotective pain system is not a sign you have a weak personality or a weak mind. It does not mean you are going crazy, and it does not mean your injury is getting worse or your body is falling apart.

It just means your body is doing too good of a job of protecting itself.

Absolutely not: it might be a sensation created by the brain, but that doesn't mean you're making it up!

Pain is always 100% real: we believe you, and we hear you.

There are many ways to retrain your pain system, but they all begin with understanding your pain. Understanding that pain is much more complex than just nerve signals and damaged body tissue is one of the best things you can do to start your recovery.

Many people say that their pain began to reduce as soon as they understood it better. But we can also work to retrain the pain system, so it only produces pain when you’re actually at risk of danger.

• Start by understanding your pain system: the Flippin’ Pain Formula can help with this.

• When you understand the pain system, you’ll know that pain can be turned up or down by a huge range of biological, psychological and social factors. You can explore how to reduce the things in life that make you feel danger and increase the things in life that make you feel safe. Remember: the trick is not to avoid all life’s challenges, but to retrain your system to cope with them.

• Moving more has been proven to be one of the best ways to improve feelings of safety. The key is to find your ‘sweet zone’: doing just enough to push yourself, but not making yourself too uncomfortable. You can find more advice in the movement FAQ below.

• Find a good coach: this could be anyone who understands pain science well, such as a physiotherapist, occupational therapist, GP or nurse. A good coach will help you understand your pain and identify the things that make your pain worse/better. They will teach you how to plan your recovery, one week at a time, and encourage you to persevere and ‘train smart’.

• Unfortunately, it might take patience: sometimes retraining is slow going and you can have setbacks. But remember pain is protecting you, not telling you that you have damaged yourself.

• Being creative in managing your journey is likely to help. Our brains love to get new information, or to be reminded of situations or activities that are full of safety messages. Some people have seen this as a ‘prescription to have fun’ and try new things.

• You might have to teach your nearest and dearest about pain too – they might not realise it, but the way other people understand your pain, can affect your pain.

Sounds challenging, right? Well, it is, but it might not be as challenging as you think. And it might take a long time, but it might not take as long as you think.

We’re here to help you take the first step.

Movement is the most important tool for recovery and it is almost always safe to move.

Too much rest and avoiding movement tends to make an overprotective pain system even more protective. The chance of ongoing pain is higher if you stop moving, as your body adapts to being stationary.

You can get a health professional to check you over and give you the ‘OK’ to move. They’ll be able to tell you if you are the very rare case for whom it is not safe to move.

If they understand modern pain science, they can talk you through why it is safe for you to move. They can tell you how much you can push it and how you can ‘read the signs’ that you are getting close to triggering your pain system.

Start with something slightly more intense than you currently do. If you are like many people with persistent pain, it is usually best to start gently with a simple movement such as walking.

The most common reasons that people don’t get better is that they avoid everything that hurts or they do everything regardless of how much it hurts, until they give up because it is too horrible. The first is called the ‘avoidance pathway’. The second is called the ‘boom-bust cycle’.

The third way is the best. Understand your pain. Get a plan to slowly increase what you are doing and stick to it. Be patient. Be persistent. This is the best thing you can do to recover.

Some people with persistent pain already do a massive amount of exercise (some are Olympians!): if this is you, it can be a case of mixing exercise with other factors that might be affecting your pain.

No one can completely eliminate all risk of injury: we can’t control everything. But unless you’re very unlucky, then your chances of injuring the painful body part are very low.

Remember: even if you do get an injury, your body is perfectly capable of healing and re-adapting again. Think of sportspeople who have multiple injuries and re-injuries, and yet in most cases keep going back to their sport.

As you begin to challenge yourself and move more, you might feel a bit more pain. But it is important to realise that that an increase in pain does not mean an increase in injury. Remind yourself that pain is trying to protect you: it’s not a sign of damage.

If a flare-up lasts longer than usual, or you have had a significant accident and you are concerned, ask your health professional to give you the ‘all clear’.

Exercise and movement are the best way to reduce your pain. It’ll make your brain feel safer, reducing the amount of pain it produces. You’ll also become stronger, and your stronger body will be more resilient to injury.

We know some professionals might not have heard this new pain science. This is because a lot of professionals don’t get enough training on persistent pain when they’re qualifying. Flippin’ Pain is working to try and change this!

To find out whether your health professional understands modern pain science, you can ask:

• Do you understand and believe the biopsychosocial model of pain?

• Can you help me understand my own pain system?

• Can you teach me how to manage my own recovery?

• Can you give me skills to master my situation?

They should say yes to each one!

Feel free to show them this website as part of your conversations.

Over the past 40 years, researchers have made a lot of discoveries about pain. But very little of this information has filtered down to the average person on the street (and even to some professionals). This is why Flippin’ Pain exists: to share this information.

You can watch Cormac and Libby talking about why this information hasn’t trickled down on YouTube.

Pain is the body’s alarm system: it helps us protect ourselves from harm. But if we do get hurt, it can also help with the healing process.

When we have an injury, within seconds all the danger receptors in the injured body part suddenly become hyper-alert and very sensitive. This stops us from going anywhere near or doing anything with that injured tissue, helping it to heal.

As injuries heal, these danger receptors should gradually reduce their sensitivity until things go back to normal. But for some people, unfortunately the pain doesn’t go away.

Though the injury has healed, the pain has turned into persistent pain, which is controlled by our brain and nervous system and is no longer linked to the injury.