In the biomedical model tissue damage is required to cause pain. Thankfully replaced by the biopsychosocial model which acknowledges a pain experience as independent of physical damage.
The biopsychosocial model takes into account the life experience of the person. In experience lies meaning and in meaning is sickness and health. Pain is a sensory emotional experience. The interactions in our life, the concepts we hold, the narratives we grow up into, the friends, family and colleagues who influence our inner monologue all affect the activation or inhibition of pain pathways independent of tissue damage. There are many ways pain can be fully experienced other than muscle, joint, ligament or inter-vertebral disc damage.