Where is the Pain?
Evans, David Williama,b,*; Liew, Bernard Xian Weic; Andersen, Johan Hviidd; Mose, Sørene,f. Where is the pain? Spatial patterns of pain co-occurrence in a population-based study of 4833 pain drawings incorporating network analysis. PAIN 166(9):p 2116-2127, September 2025. | DOI: 10.1097/j.pain.0000000000003551
A recent Danish study looked at how pain shows up across the body — not just where people hurt, but how those pain regions relate to one another. Researchers wanted to understand two main things:
Which parts of the body are most often painful, and
Whether pain in one area tends to connect with or influence pain somewhere else.
Over 5,000 adults between the ages of 17 and 64 completed detailed pain drawings, marking every area that had hurt in the past four weeks. Most were employed, around 45 years old, and more than half had been living with pain for at least three months.
The most common pain areas were the lower back, thorax (mid-back), head and face, and neck — with pain slightly more common on the right side. But the real insight came from how pain patterns overlapped:
About two-thirds of people reported pain somewhere along the spine or neck.
Roughly half experienced lower limb pain, and 43% had pain in the upper limbs.
Interestingly, over one-third had bilateral pain — pain mirrored on both sides of the body — and in most of those cases, it was almost perfectly symmetrical.
In fact, 93% of those with pain on both sides reported that it was mirrored, like a reflection in the body’s midline. For the lower limbs, that number was still over 90%.
This is surprising — because symmetrical, bilateral pain is often associated with specific conditions like rheumatoid arthritis or fibromyalgia. Yet these conditions only explain a small fraction of what was seen in the population. This suggests something deeper: the human nervous system itself may be wired to mirror or spread pain patterns in ways we don’t yet fully understand.
When the researchers mapped these relationships, they discovered three main mechanisms shaping how pain spreads or stays contained:
Mirrored facilitation: Pain on one side of the body can encourage pain to appear in the same region on the opposite side — like the left shoulder and right shoulder becoming linked.
Neighbour facilitation: Pain in one area can spread to nearby regions on the same side — for example, from the shoulder into the upper arm.
Contralateral inhibition: Pain in one area may actually reduce the chance of pain showing up in the opposite side — unless the mirrored facilitation is stronger, which often seems to be the case.
So what does this mean for us, as massage therapists and movement practitioners?
It reminds us that pain is rarely local — it’s part of a conversation happening across the whole body. If one side hurts, the other side is listening. And sometimes, activating or moving the non-painful side may be what helps the painful side find relief.
This study invites us to think beyond tissue and technique. Perhaps part of our role is to help the body remember its balance — to reawaken its capacity for symmetry without suffering.
In practice, that might mean:
Begin by addressing the painful area, to calm local irritation and restore movement.
Then, bring attention to the opposite side — engage it, move it, strengthen it.
This dual approach could tap into the nervous system’s natural inhibitory pathways, helping the body reorganize its perception of pain.
Pain, in this sense, becomes not just a symptom to chase, but a map — one that reveals how deeply connected our bodies are across space and sensation.
