وَأَنَّ كُلَّ الْمُمْكِنَاتِ مُسْتَنِدَةٌ إِلَيْهِ بِلَا وَاسِطَةٍ
All contingent things depend directly on Allah for their existence.
In the Sunni account presented here, pain, fracture, and every other originated contingent state are created by Allah. The observable connection to a human act is acknowledged, but the human cause is not treated as an independent creator.
Direct dependence concerns bringing something into existence, not denying ordinary causal sequences. Saying that pain follows a blow is compatible with saying that its existence depends upon divine creation. A cause in experience and an independent creator are not the same thing.