A primer on pain, inflammation and longevity

Each of us has a different pain threshold. There is pain that is “not that bad,” and then there is acute pain that grabs your attention, like when you bash your toe in the middle of the night. Pain can also come on so gradually and be so insidious that most people don’t notice when it starts. Things change gradually, and then suddenly, BAM! You’ve got this pain and don’t know why. The quicker you get to know your body, learn to recognize early warning signs, and get in to see someone who can fix you, the better. Much of today’s chronic orthopedic and musculoskeletal pain is due to poor mechanics, muscle imbalance, and poor movement resultant from ignoring problems earlier on. Pain lasting more than a few days is not likely to get better on its own, and probably indicates a problem that warrants medical attention.

Why Do Humans Have Pain?

Pain is the body’s alert system; it protects it from yourself and your environment. Under extreme stress, when adrenaline is high, it overrides our pain signals; when it relents, shock sets in, along with excruciating pain. Without pain, we would damage tissues beyond repair. In other words, pain lets you know when you have gone too far – meaning once you have it, tissue injury has already occurred.

Types of Pain

When evaluating a patient with pain, I first obtain a medical history and look to categorize the pain. It is crucial to identify the primary pain generator correctly. Often imaging studies such as MRI may reveal pathology that is not necessarily the actual pain generator. The following is a list of questions I ask my patients.

Chronic vs. Acute: Most joint and soft tissues should heal within 3-6 months. Pain lasting longer than six months is considered chronic. Have you had pain for over three months, a few days, weeks, or perhaps a month?
Global vs. Local: Does the pain involve the entire body or a specific location? Global pain is often a sign of a hypersensitized nervous system, or a systemic issue like fibromyalgia or rheumatoid arthritis, or other autoimmune condition.
Injury-related or Idiopathic: Was this due to an acute injury? Note that damage can occur over time due to repetitive motion, not just a specific event such as a slip-and-fall or a car accident. Idiopathic means we do not know why we have pain.
Constant or Episodic: Does the pain come and go?
Provocative or Stable: Are there movements/activities/positions that worsen the pain, or is the pain constant? Persistent pain is always a red flag that requires further investigation.
Age-dependent: Did the pain start slowly and then progress with age? If so, there’s a high chance it’s a degenerative process.

Next, I categorize the pain. For example, I distinguish between anatomical structures like bone pain, soft tissue pain, and visceral referred pain.

Nociceptive pain originates from bones, muscles, joints, fascia, skin, and visceral organs.
Neuropathic pain is derived from neural structures, such as nerves, nerve irritation, and nerve inflammation. Common examples include nerve pain related to diabetic neuropathy, spinal cord and nerve injury, post-stroke, and pain of central origin, meaning from the brain (think migraines).

Dr. Matt Fontaine

Inflammatory pain is pain that stems from cytokine release. Cytokines are foot soldiers in the inflammatory process. Inflammatory pain can be systemic, involving many-body systems (autoimmune diseases like inflammatory bowel disease and rheumatoid arthritis) or localized (acute appendicitis). Multifactorial pain originates from multiple anatomical sites. This type of pain is often difficult to describe and classify. Common examples include cancer pain, headaches, migraines, fibromyalgia, polymyalgia, rheumatic heart disease, other autoimmune myopathies/arthropathies, and low back and neck pain.

Three Paths to Pain Management

When it comes to pain, there are three paths you can take:

1. Drugs (pharmaceuticals for pain management: NSAIDS, opioids, steroids)

2. Drug-free (chiropractic, physical therapy, acupuncture, nutrition, massage, regenerative medicine/stem cells, and Platelet Rich plasma, aka PRP)

3. Surgery (Cancer (CA) removal, Cardiac, Gastro(GI), Ortho/Neuro)

How Do You Determine the Right Course of Action?

Often, the best outcomes for musculoskeletal pain are directly tied to a collaborative approach, using some acute short-term pain management along with conservative manual therapy. Pain management can manage pain, but ultimately correcting structural misalignment and fully rehabilitating an injury or condition creates long-lasting recovery. Unfortunately, for millions of patients living with pain, the commonly prescribed pain medications are not helping. Moreover, we really don’t understand the long-term effects of these medications and how they interact with other medications.

Structural alignment via manipulative therapies should always be considered essential to managing chronic pain. Healing is motion-dependent. A physician or surgeon has informed many people that they have arthritis and should discontinue physical activities such as running or weightlifting. However, without a prognosis and effective solutions, stopping exercise is likely to make you less healthy in the long run. Move at comfortable levels without fear when the brain is not protecting the body. In other words, get active and moving to help get past the stranglehold of chronic pain and inactivity.

Why Are We So Inflamed?

Nearly all chronic aches, pains, and diseases are, in part, driven by chronic inflammation. The main culprits are high stress levels, imbalanced cortisol and other hormones, insufficient high-quality sleep, insulin resistance, poor blood sugar regulation, inadequate recovery from day-to-day stress and workouts, dehydration, and poor nutrition. What we eat and expose ourselves to can increase or reduce inflammation. Poor dietary choices create inflammation, which leads to disease expression based on your genetic predisposition. In addition, inflammatory foods can trigger systemic inflammation, affecting internal organs, skin, joints, muscles, the heart, and most importantly, your digestive system.

One of the most exciting perspectives on inflammation comes from Dr. David Seaman, who has authored several books, including DeFlame Your Diet. Dr. Seaman deep dives into inflammation and its role in chronic disease. As he explains, the modern Western diet is a critical driver of inflammation. Think white bread, white potatoes, white sugar, processed foods; you get the idea. If it comes in a box, it probably causes inflammation in your body. Poor nutrition, a lack of sleep and exercise, and too much “bad” stress all lead to chronic inflammation, eventually leading to aches, pains, depression, fatigue, general ill health, and chronic disease.

Three Major Drivers of Inflammation

1. Physical Stressors and Poor Recovery: Muscle imbalance, joint dysfunction, and insufficient sleep leading to elevated cortisol.

2. Processed Foods and Nutritional Deficiencies: A lack of whole, nutrient-dense foods and gut health issues like dysbiosis.

3. Omega-6/Omega-3 Imbalance: A dietary ratio heavily skewed towards pro-inflammatory fatty acids.

Physical, mental, and emotional health and well-being are all inextricably linked. This highlights the all-important mind-body connection. A well-thought-out strategy to combat inflammation must consider the physical, chemical, emotional, psychological, and nutritional aspects to formulate practical, actionable solutions for each.

Key Takeaways

We all have different pain thresholds. Pain is a direct perceptual experience. You are the only person who can experience pain in your body.
Pain is a lagging indicator. By the time you have pain, you have an injury.
Injuries and musculoskeletal pain syndromes are impacted by the overall health of the joint and fascial system, your body’s overall ability to move correctly, and your body’s ability to recover from the day-to-day stress of training and life.
An inflammatory diet rots your joints, muscles, tendons, spinal discs, bones, and nervous system creating chronic pain.
Chronic pain lasting longer than 3-6 months can lead to changes that decrease a person’s functional capacity.
If uncontrolled, pain can rewire your brain to become more sensitive to pain long after an initial injury.

Chronic pain has less to do with tissue damage, and more to do with sensitivity of the nervous system. As pain science evolves and our understanding increases, we will better manage chronic pain patients.

Note: Dr. Fontaine’s new book is Only One Body (Adjusted Inkworks, August 19, 2025).