Author: Stacey Farmer
When a worker experiences pain, whether that be an acute injury or a longer-term condition, their understanding of their pain can powerfully shape their recovery. As physiotherapists, we often focus on the physical side of an injury; however, what a worker believes about their pain is just as important and can influence how quickly they recover. Education about pain is therefore one of the most powerful tools in our physiotherapy toolbox.
Shaping the Story They Tell Themselves About Their Pain
Pain is not simply a signal that there is tissue damage. Contemporary pain science describes pain as a protective response of the nervous system, influenced by a combination of biological, psychological, and social factors (Butler & Moseley, 2013). The brain evaluates perceived threat and produces pain when it believes protection is required. This means that pain can be present even when tissues are healing or when no ongoing damage is occurring.
For people without a background in health or pain science, pain is often interpreted as a sign that something is seriously wrong. As a result, workers may tense up, move less, and become increasingly worried about their symptoms. This can lead to disengagement from activities that are meaningful to them, including work duties. Research shows that fear, worry, and avoidance behaviours can amplify pain and contribute to its persistence over time, often becoming more disabling than the original injury itself (Crombez et al., 2012).
One helpful way to explain this process is through the alarm system analogy. Pain can be described as the body’s alarm system, designed to warn us of potential danger. In some situations, this alarm system can become overly sensitive, meaning it continues to sound even after tissues have healed or when movement is safe. Using clear metaphors such as a ‘faulty’ or ‘over-sensitive’ alarm has been shown to help people reconceptualise pain, reduce threat, and engage more confidently in movement and recovery (Moseley & Butler, 2015).
Importantly, the injury itself may not change, but the story a worker tells themselves about their pain often does. This story can have a significant influence on prognosis, recovery time, and return-to-work outcomes.
Beliefs in the Workplace
A worker’s beliefs about pain are also shaped by the messages they receive in the workplace. For example, a well-meaning supervisor who insists on complete rest may unintentionally reinforce the belief that pain equals damage. In contrast, a supportive supervisor who encourages safe, gradual movement and activity can help reduce fear and build confidence. As physiotherapists working in workplace and onsite settings, we are in a strong position to influence these conversations. Helping both workers and supervisors understand that pain does not always mean harm can support graded re-engagement in normal work and daily activities.
The Role of Education
Education is one of the most effective tools we have as clinicians. Clear, reassuring explanations about pain have been shown to positively influence beliefs, reduce fear, and improve outcomes. In particular, education delivered in primary care settings can increase reassurance and support recovery by helping people feel more in control of their symptoms (Traeger et al., 2015). Simple changes in language—such as describing joints as strong and adaptable rather than ‘worn out’—can meaningfully change how a person understands and responds to their pain.
By promoting accurate, positive, and evidence-informed beliefs about pain in the workplace, physiotherapists can help employees remain active, engaged, and supported throughout their recovery.
References:
Butler, D. S., & Moseley, G. L. (2013). Explain pain (2nd ed.). Noigroup Publications.
Crombez, G., Eccleston, C., Van Damme, S., Vlaeyen, J. W. S., & Karoly, P. (2012). Fear-avoidance model of chronic pain: The next generation. The Clinical Journal of Pain, 28(6), 475–483. https://doi.org/10.1097/AJP.0b013e3182385392
Moseley, G. L., & Butler, D. S. (2015). Fifteen years of explaining pain: The past, present, and future. The Journal of Pain, 16(9), 807–813. https://doi.org/10.1016/j.jpain.2015.05.005
Traeger, A. C., Hübscher, M., Henschke, N., Moseley, G. L., Lee, H., McAuley, J. H., & Maher, C. G. (2015). Effect of primary care–based education on reassurance in patients with acute low back pain: Systematic review and meta-analysis. JAMA, 314(14), 1459–1467. https://doi.org/10.1001/jama.2015.11686