Since you’re reading this post, it’s likely you or someone you know lives with chronic pain. You’ve been praying for healing and seeking help, but nothing seems to work. It may even be getting worse.
I’m here to tell you there is still hope. Understanding the neuroscience of pain, how pain develops, and why it can become chronic is key to interrupting the pain cycle. While I’m still on the healing journey myself, I have found relief through the strategies I’m sharing with you, and I am confident you will as well.
When it comes to living with chronic pain or supporting a loved one who is struggling, understanding how neural circuitry works is extremely helpful. One of the biggest game changers for me was recognizing that all pain, regardless of whether it is triggered by tissue damage, is processed in the brain and nervous system. This is incredibly empowering because your thoughts and beliefs around your pain, which you do have control over, impact the intensity of your pain response.
You can see this in the diagram below, where your thoughts and beliefs about pain impact your emotions and behaviors, which directly impact how your body responds.¹
The Pain Cycle
Trigger = Pain
This means that by changing your brain (e.g. the way you think about and respond to your pain), you can actually turn down your pain volume.
This is huge, and while it may sound too good to be true, I have experienced the benefits firsthand after living for five years with chronic pain that was once debilitating. Playing tag with my kids, driving to the grocery store, or sitting for five minutes at the computer used to cause a pain flare. This week, I drove an hour to an indoor sports arena, played soccer and basketball, and drove home with minimal pain!
The road to recovery is not a straight line—there will be good and bad days—but the goal is to move toward increased positive experiences while minimizing the number of setbacks.
Reaping these benefits (e.g. overcoming fear of pain, turning down your body’s pain response) begins by having an open mind and wrapping your brain around the following statement:
To reduce or get rid of the pain—even if there are structural abnormalities—we must address the brain. “Even when physical factors are present they are not the whole story, and in most cases of chronic pain—even the cases that started out with an injury or surgery or some sort of tissue damage—the contribution of the physical component to the overall experience of pain is usually quite small.”²
Let that sink in. There are things you can do to decrease your pain level and improve your quality of life, even if you have tissue damage and conventional medications and treatments aren’t working! It starts with developing a level of understanding, so let’s dive into that now!
Here are five facts about pain you may not have known:
1. Pain is your body’s mechanism of self-protection that it uses to keep you safe. Its goal is to alert you to danger, but sometimes this system goes haywire.
In chronic pain patients, the nervous system becomes hypersensitive, or stuck in an overprotective setting. When this happens, pain can persist even after the tissue has healed due to learned neural pathways. Learned neural pathways are connections in the brain—our brain’s wiring, so to speak—that form over time and become stronger the more they are reinforced. You might think of it as a well-beaten path through a forest. Your brain becomes accustomed to taking that path and will continue to do so automatically until a new pathway is intentionally formed.
Pain can also occur when there’s no physical injury at all (see point #2). There are some ways to tell if your pain is structural, which I’ll discuss later in this post, but even when tissue damage is present, we can implement strategies to calm down the amygdala and decrease our body’s pain response. The amygdala is the part of the brain that processes fearful and threatening stimuli, releases stress hormones, and turns on the fight or flight response. Calming the amygdala through deep breathing, mindfulness meditation, and brain training techniques such as somatic tracking (here’s a great podcast episode on this) can help you process your pain through a lens of safety. (I’ll discuss each of these strategies in more detail in the future, or you can click here to schedule a session with me to explore them further.)
The good news is that the brain and nervous system can always be reprogrammed—they are “plastic.” (You may have heard the term neuroplasticity, which refers to the nervous system’s ability to change in response to experience). By identifying and resolving the factors that originally sent your nervous system into a hypersensitive, overprotective setting, along with implementing strategies that communicate messages of safety to your brain, you can actually decrease the frequency and intensity of your pain response.
2. Emotional pain triggers activation of the same parts of the brain as those activated with a physical injury. Thus, pain is not only caused by physical damage, but also emotional trauma.
Our brain creates pain when it perceives danger, and it responds to all sorts of potential threats, not just physical injuries. Long term stress—whether from work, relationship strain, chronic illness, or major life events (e.g. death of a loved one, change in employment, a traumatic experience)—can also cause our brain to create pain as a protection mechanism. (See this infographic, The Path In and Out of Chronic Pain, which shows the impact of childhood experiences, adult stress, major life events, and even the presence of pain itself on our pain level.)
Healing begins when we communicate messages of safety to our brain so the protection mechanism (pain) can back off. Simultaneously addressing the stressors that caused the problems, or the emotions that have lingered or remained unprocessed, can also help.
If you believe there is an emotional aspect to your pain, ask yourself the following questions:
- Are my pain symptoms inconsistent with a physical problem or injury? For example, do I have 9/10 pain while driving one day and 2/10 pain the next? Are doctors not finding anything structurally wrong? Does the origin of my pain remain a mystery despite blood work, MRI’s and other medical examinations?
- Do my symptoms spread or move around my body? For example, does the left side hurt one day and the right side another? Does the pain seem to move up my back, or spread from my lower to my upper body?
- Does my pain have emotional or psychological triggers? Is it worse with fear or stress? Does it hurt more when I’m overwhelmed at work, after an argument with my spouse, or when I’m anxious?
- Do I have a history of anxiety?
If you answered yes to any of these questions, it is likely some of what you’re experiencing is neuroplastic pain. Contrary to neuroplastic pain, structural pain is consistent with a physical problem or injury, meaning it hurts every time you turn your neck, sit, or walk. It will usually show up in blood work or medical imaging, although medical imaging is better used to rule out serious pathology than it is to predict or treat chronic pain conditions. When I had an abnormal MRI in 2018, doctors assumed my disk herniation was what was causing my pain—we found out almost two years later that wasn’t the case. We can’t assume abnormal blood work, lab tests, or imaging is the source of our pain, but they are worth exploring further, while also investigating the strategies shared in this post.
Prolonged stress and anxiety, over time, lead to a hypervigilant nervous system, which is a prerequisite for neural pathway pain. Ask yourself, What was happening in my life around the time my pain started? Was there anything traumatic? A car accident? An event that resurfaced past wounds or brought unprocessed emotions to the surface?
If anything comes to mind, talking and/or journaling your responses through expressive writing can help you identity whether there’s an emotional aspect to your pain. If the answer is yes, there is no shame in this. In fact, knowing this is empowering because it means there is something you can do to help yourself heal.
3. All pain originates in the brain. This doesn’t mean your pain is not real—it just means your brain receives signals from nociceptors in your body and decides how much pain it needs to produce to protect you from the threat. ²
How much pain is produced is also affected by your anticipation of pain (i.e. if you’re looking for it and constantly wondering when it will start), how you respond to the pain (i.e. if you dread or fear it), how equipped your body is to heal (i.e. based on your lifestyle and current stress level), and the story you’re telling yourself about it.
If you’re telling yourself that your pain is ruining your life, it has stolen your joy, and/or it’s keeping you from doing everything you love, chances are your brain will interpret it as an even greater threat to your well-being and amplify your pain response. This is also why two people with identical injuries can report varying degrees of pain, and why pain can be disproportionate to the traumatic event or injury that initially caused it.
You might be asking, “How can I possibly not see pain as a threat? How can I observe it objectively, without attaching judgment, emotions, or my opinions?”
It’s not easy, but it can be done by training our brain to think about, speak about, and notice our symptoms through a different lens. We can choose not to ruminate on it, we can refrain from constantly complaining about it, and we can learn how to notice it without a sense of fear, frustration, anger, or despair while being in a positive, relaxed emotional state. When we do this, our brain feels safe and will turn down our danger signals. This is the basis of somatic tracking and pain reprocessing therapy.
As someone who was diagnosed with peripheral neuropathy is 2021, I admit I was highly skeptical about these “brain-training” techniques. I knew I had structural damage/nerve fiber deficits, so I assumed these strategies would not work. What I found is that it’s really hard to objectively monitor pain if we believe 100% of it is caused by structural damage. When I let go of this notion and accepted that some part—even if only a small fraction—of my pain could be due to fear, anxiety, or a heightened emotional state, I started to notice a slight change in sensation. The burning would sometimes become a bit more tingly, or it would decrease in certain parts of my body.
Over the long-term, when we begin to address the brain—our thoughts, beliefs, and emotions about pain—we can see a slow fade of our body’s pain response. We can believe we are safe, and we can get our lives back.
4. Pain is multifaceted, and therefore demands a multidisciplinary approach to treat it.
Some psychologists, therapists, and pain specialists refer to what’s called the biopsychosocial model of pain, meaning it’s caused by an interaction between physiological, psychological, and social factors. I would add a spiritual component to this.
A biopsychosocial-spiritual model addresses the whole person—body, mind, and spirit. It recognizes the role of spirituality in the healing process. Since spirituality is central to the lives of so many chronic pain warriors, a multidisciplinary approach to healing goes beyond movement, nutrition, sleep, stress management, mindset, and supportive relationships to also include finding purpose in our suffering, growing in empathy and compassion for others who are hurting, drawing closer to God, and adopting an eternal perspective on our pain. All of these things are key to our healing.
God’s Word is full of promises for those who are weary, burdened, and in pain. Here are a few:
“And after you have suffered a little while, the God of all grace, who has called you to his eternal glory in Christ, will himself restore, confirm, strengthen, and establish you” (1 Peter 5:10 ESV)
“Heal me, O Lord, and I will be healed; save me and I will be saved, for you are the one I praise” (Jeremiah 17:14 NIV).
“He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away” (Revelation 21:4 NIV).
In the words of French philosopher, Simone Weil, “waiting patiently in expectation is the foundation of the spiritual life.” While we focus on the things we are able to do (e.g. eating well, moving our bodies, working on our mindset, implementing relaxation strategies to combat fear and anxiety), we can trust God with the things that are out of our control. We can hold tight to His promise that healing is coming. It’s not a matter of if, but when. Knowing this means we never lose hope.
5. Pain becomes chronic when it continues for more than six months or persists after the injury or illness that caused it has healed or gone away.
Even after an injury or illness has healed or gone away, pain signals can remain active for weeks, months, or years. The brain has a memory for pain pathways, and they can become “learned” over time. “The more often a certain type of pain is triggered the easier it becomes for the brain to replicate that experience, regardless of whether or not there’s a reason to create pain.”²
To find out if your pain is due to structural damage that has not yet healed or learned neural pathways, ask yourself the questions listed above (see point #2).
When pain becomes chronic, meaning it has lasted for at least six months, we become even more sensitized to it. The Curable app explains chronic pain as a fire alarm that used to work perfectly, but now goes off every time you light a candle, reacting to anything that might be a threat until the danger signal threshold is incredibly low. “This hypersensitivity is almost universal in chronic pain sufferers,” but the good news is we can slowly raise this threshold over time.²
The fact that, “the majority of chronic pain is not caused by physical problems in the body but learned neural pathways in the brain” should be freeing, because it means there is hope for healing.² Next week, I’ll share some ways we can unlearn old thinking patterns and rewire our brain to respond to pain differently. As we do this, we’ll develop new neural pathways that can greatly diminish, or even eliminate, our pain so we can move toward improved health and healing.
Call To Action: Which of the facts from today’s post most resonated with you? Leave it in the comments and please share this post if you found it helpful.
References:
1. Zoffness, Rachel, MS, PhD. (2020). The Pain Management Workbook: Powerful CBT and Mindfulness Skills to Take Control of Pain and Reclaim Your Life. Oakland, CA: New Harbinger Publications.
2. Curable Inc. (2023). [Mobile app]. App Store. https://apps.apple.com/us/app/curable/id1325784379.
3 thoughts on “The Neuroscience of Pain (and How it Becomes Chronic)”
Jen, knowing that you have struggled with chronic pain, I was thrilled to see you onstage at the Coffeehouse and again at Art’s funeral, DANCING with the Crossroads team! Was that due to any of the strategies you mentioned above?