Pain isn’t a damage report. It’s a complex experience generated by the brain, a response to perceived threat, not necessarily tissue harm. One of the biggest game changers in how we understand this was Patrick Wall, co-creator of the Gate Control Theory and founding editor of PAIN journal. He helped shift our view of pain from a mechanical problem in […]
Pain isn’t a damage report. It’s a complex experience generated by the brain, a response to perceived threat, not necessarily tissue harm. One of the biggest game changers in how we understand this was Patrick Wall, co-creator of the Gate Control Theory and founding editor of PAIN journal. He helped shift our view of pain from a mechanical problem in the body to a dynamic perception shaped by the brain, the nervous system, and the world around us.
As manual therapists, it’s vital we understand where these ideas came from, why old models were abandoned, and how we can support people better with evidence-informed touch and communication. Because once we realise pain doesn’t live in the body, our whole approach changes — for the better.
In 1664, René Descartes published a now-famous drawing of a boy with his foot in a fire, showing a direct line from the injury to the brain. This simple, linear model became the foundation of how pain was understood for centuries, the idea that if there’s pain, there must be injury, and that pain lives in the body.
But this ‘pull-the-rope, ring-the-bell’ view has carried it’s criticisms encouraging a search for damaged structures even when none were responsible for the pain. This may have played a role in unnecessary surgeries, over diagnosis, and clients feeling dismissed when no cause was found.
Pat Wall used Descartes’ diagram not to support it, but to mock its limitations. He argued that pain is not a direct signal from tissue to brain, but a constructed experience based on many factors, and often, not about injury at all.
The Gate Control Theory brought in two big ideas:
This changed everything. It helped explain why people in pain clinics often didn’t fit textbook patterns. Why two people with the same injury can have totally different experiences. Why reassurance, safety, and context matter.
Modern neuroscience now sees pain not as a sensation but as a perception — a brain-generated experience based on prediction, not just reaction.
Some researchers, like Lisa Feldman Barrett, even argue that pain is an emotion constructed by the brain in the same way it builds anger, sadness or joy. This means pain is shaped by our past experiences, emotional state, social environment, and what our brain thinks is going on.
The brain is constantly making educated guesses based on incoming sensory data, but also expectations, memories, and beliefs. So pain becomes less about what’s happening to the body, and more about what the brain thinks is happening a process called predictive processing.
This helps us understand why:
Once you know pain is built by the brain, not caused by tissue alone, your role becomes even more valuable. You’re not fixing tissues, you’re helping people feel safe, seen, and supported, which influences their pain experience.
Here’s what this looks like in practice:
Pat Wall didn’t just change theories. He helped us understand what people in pain have known all along — that pain is personal, unpredictable, and sometimes unexplained by injury alone. He replaced old dogma with real-world science and gave therapists permission to ask better questions, listen more carefully, and let go of outdated fix-it models.
His message for us? Stop chasing broken bits. Start supporting whole people.
Devor, Marshall. Experiencing pain: perspectives of Patrick D. Wall—founding editor of the journal PAIN. PAIN 166(1):p 11-19, January 2025. | DOI: 10.1097/j.pain.0000000000003480
Established in 1992 and officially recognised by the Scottish Government, the Scottish Manual Therapists Organisation (SMTO) is the foremost and longest-standing association for soft tissue, massage, and manual therapy practitioners in Scotland.
