One of the most interesting aspects of “pain” is that it doesn’t just hurt, but is motivates us to change our behaviour. Pain related behaviour consists of two broad types: avoidance behaviour, which is seen in everything from reflexive withdrawal of the body from a source of harm, such as a heat source, and; overt expressive behaviour, such as crying, other vocalizations and facial expressions of discomfort. Avoidance behaviours seem to remove the body from further injury. The role of expressive pain behaviours seem to have value primarily as social behaviours. That is, in crying out when hurt, you warn other members of your group of danger and at the same time call for assistance. So pain behaviours can be considered to also have a communications role, as well as a harm reduction role.

These points are very logical for acute pain. But what about chronic pain? While the meaning of acute pain is that harm has occurred, the meaning of chronic pain is ambiguous - it no longer signals danger of harm because the injury has occurred several months or even years previously. It is not surprising, then, to recognize that chronic pain is particularly illustrative of the influence of factors such as cognitions and contexts on pain experience.

We have also to think about the meaning of chronic pain, as this significantly influences the emotional/motivational elements of the pain experience. A benign pain, such as common chronic low back pain is not life threatening. It may be uncomfortable, limiting and frustrating, but it will not kill the sufferer. However, cancer pain, while perhaps no more intense in terms of tissue disruption than a benign pain, is usually experienced as being far more painful. The difference is in what the pain signifies. In benign pain it is a nuisance, but in malignant disease, it signifies the move towards death. This is a much more threatening situation and the emotional response will be very different. So the signaling or symbolic elements of a pain are of key importance in understanding what pain experience is.