But what about the muscles and joints?

Thankyou for your emails about “words that hurt”. A continuing discussion and a source of angst for some readers is the role of body tissues in a chronic pain state. The discussion on “words that hurt” may suggest that we think 'its all in the brain'. This is not true. Many chronic pain states (eg rheumatoid arthritis, severe trauma) are constructed with very significant contributions from body structures such as joints and muscles. However the key thing is that bodily damage or changes do not necessarily have to contribute to pain production. The ‘degeneration' reported on the X-ray simply does not have to hurt.

In cases of chronic pain where tests such as imaging, blood tests, and physical examination finds little to report, yet pain persists, it is quite possible that a process of central sensitisation exists – a very real, physical and increasingly understood process based on synaptic activity in the spinal cord and brain. It is the representation of the structures in the brain, rather than the actual tissues which are at fault.

However, in this state, while the tissues have been through an appropriate healing time, they can still contribute in the following ways:

• by being unhealthy, unfit, weak, unused and sensitive. But remember they have been through their healing stage of inflammation, cell proliferations, remodeling and repair, thus they can’t heal again, but they can get healthier and 'fitter'.

• by being the recipients of the brain’s attempts to help out what it perceives are the problem areas by increased levels of stress chemicals, tight muscles and inflammation.

Every human pain state is constructed by varying contributions of the body tissues, the representation of the tissues in the brain and the stress systems called upon to defend the injured tissues or the brain’s perception of the injury.