Your pain is real, and your brain is part of the story

Pain is the brain's protective alarm

The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." Its notes make two important points: pain and nerve signals from the body are not the same thing, and pain is always shaped by biological, psychological, and social factors.

In other words, pain is your brain's judgment about danger. Most of the time, that judgment is helpful. It makes you pull your hand off a hot stove or rest an injured ankle.

When the alarm gets stuck

With chronic pain, the nervous system can become more sensitive over time. The alarm goes off sooner, louder, and longer, sometimes long after tissues have healed. In 2017, pain researchers recognized a category called "nociplastic pain": pain that comes from changes in how the nervous system processes signals, without clear tissue damage to explain it. Fibromyalgia, irritable bowel syndrome, and many cases of chronic back pain are examples.

Stress, poor sleep, fear of pain, and feeling unsafe can all turn the volume up. Feeling safe, understood, and rested can help turn it down.

Why scans don't tell the whole story

Many people have changes on their scans and no pain at all. In a review of 3,110 people with no back pain, disc bulges showed up in 30% of 20-year-olds and 84% of 80-year-olds. And many people live with real pain that scans can't explain. Scans are important for ruling out serious problems, but how much something hurts depends on more than what an image shows.

What the research says can help

• Learning how pain works. Pain neuroscience education helps people understand pain as a protective signal, which can reduce fear and make other tools easier to use.
• Changing your relationship with pain. Approaches like acceptance and commitment therapy (ACT) help you stop fighting pain and return to what matters to you.
• Retraining the brain's response. In a 2022 clinical trial of pain reprocessing therapy for chronic back pain, 66% of participants were pain-free or nearly pain-free after treatment, compared with 20% in a placebo group and 10% with usual care. Five years later, 55% of that group were still nearly or completely pain-free. This is one trial, focused on back pain, and more research is underway.

Before focusing on the brain's role in pain, it's important to have your pain evaluated by a medical provider. I'm glad to coordinate with your doctors and physical therapists, with your consent.