Pain isn't simply proportional to tissue damage. It goes up and down based on what your nervous system perceives as threatening or safe. The Protectometer is a framework that makes this visible — and gives you something to actually work with.
“Pain goes up when the brain perceives more danger than safety — and you can influence both sides of that equation.”
DIMs and SIMs: the two sides of the ledger
Lorimer Moseley and David Butler developed the Protectometer concept in Explain Pain Supercharged. The central idea: your brain is constantly running a subconscious calculation — how much danger are you in?
On one side of the ledger are DIMs — Danger In Me signals. These are any inputs the brain reads as evidence of threat: tissue damage, but also worrying thoughts, stress, a job where nobody believes you're hurting, and a healthcare system that keeps telling you something is badly wrong.
On the other side are SIMs — Safety In Me signals. These tell the brain the body is okay: understanding what's happening, feeling supported, moving successfully without disaster, being well-rested, feeling in control.
The balance determines your pain
Pain increases when DIMs outweigh SIMs. It decreases when SIMs outweigh DIMs. This isn't metaphorical — it reflects what we know about how the brain processes threat.
Here's a practical example. You have shoulder pain sitting at a 4/10. Then you get a scan report saying "significant degeneration" — even if that finding is completely normal for your age (more on this in the scans article). Suddenly your pain is a 7/10. The tissue hasn't changed. The perceived threat has.
Common DIMs in daily life
DIMs come in many forms that patients don't always connect to their pain. Poor sleep. An argument at work. Financial worry. Being told to avoid a certain movement forever. Even the words a clinician uses carry enormous DIM or SIM weight — "your spine looks like that of a 70-year-old" is a DIM-loading statement that can alter pain for weeks.
I see this a lot in clinic: patients whose pain reliably spikes during stressful periods at work or in their relationships, and settles when things calm down. That's the Protectometer in action.
Adding SIMs is active treatment
Understanding your pain is a SIM. Moving with confidence is a SIM. Good sleep, social connection, a supportive workplace, exercise, and having a clear plan for recovery — all SIMs.
This means treatment isn't only about removing DIMs (fixing the tissue problem). It's also about actively adding SIMs. In my practice, pain education itself is a SIM: when someone understands that their pain is a protective response rather than evidence of damage, the threat level drops — and often the pain drops too, sometimes immediately.
References
- 1.Moseley GL & Butler DS. (2017). Explain Pain Supercharged. Noigroup Publications, Adelaide.
- 2.Moseley GL & Butler DS. (2015). Fifteen years of explaining pain: the past, present, and future. The Journal of Pain, 16(9), 807–813. PMID: 26051220.
- 3.Moseley GL. (2003). A pain neuromatrix approach to patients with chronic pain. Manual Therapy, 8(3), 130–140. PMID: 12909433.