Chronic Pain and Your Brain

Annie Miller TherapyBlog

In my practice, I find that many of the people I work with may not be completely aware of how powerful the mind can be. Particularly when we experience any physical pain, our first thought is often what medication to take or what can a doctor do to fix this quickly. 

Pain-killers or injections tend to be the first stop for those dealing with pain, but even things like massage, physical therapy and chiropractic work are also often part of the process for many patients. While these treatments can be helpful for many, pain often persists for some patients. And pain becomes chronic when it lasts for months or even years.

How Pain Works

How does pain work exactly? When we are injured, nerve cells in the injured area send distress signals to the brain and the amygdala and limbic system alert us that there is danger present. Once the brain’s danger signals activate, our brain registers pain. This all happens very quickly. And in fact, we can have an injury and have no pain at all. An example of this is when you cut yourself and don’t feel it until you actually see blood. You may not realize you have a cut until the sight of the wound visually registers in your brain. That is when your brain understands that something dangerous has happened. 

It also works the other way where we can have excruciating pain with no physical injury, as in the case of phantom limb pain. Phantom limb pain occurs when someone has pain in an amputated or missing limb. Merely the suggestion or fear of pain can create pain signals in the body. We rely on the brain to evaluate danger messages, thus we feel what our brain allows us to feel. So, if an injury can occur without pain and pain can occur without injury, then our emotional response can play a prominent role in how pain affects us.

Emotional stress activates the same areas of the brain that physical injury does. The brain constructs pain as a protective response and then pain becomes a neural pathway that is learned and repeated. The more this pattern is learned, the more our brain remembers it and is conditioned to respond with pain. This is how chronic pain develops over time with no apparent physical injury. 

Mind-Body Pain

Differentiating between pain that has a clear structural source and pain that originates in your brain can be complicated. Let’s look at some statistics. 

According to Howard Schubiner, a specialist in TMS/mind-body pain syndrome and board-certified internal medicine physician, “A study published in 2014 by Waleed Brinjikji from the Mayo Clinic showed that 50 percent of pain-free 30-year-olds have evidence of disc degeneration on MRIs, and 40 percent have evidence of a bulging disc. Those numbers are 80 and 60 percent, respectively, for pain-free 50-year-olds, and they rise from there. A study published in 2009 evaluated more than 1,100 people with acute back pain and followed them for one year after the pain started—only 1 percent of them were found to have a significant structural abnormality in their back.” What this shows is that many people who have normal MRIs experience pain and those with structural abnormalities can recover quickly. There is undoubtedly a role of emotions and neurology in the way we develop pain.   

New Concept of Pain

It is important that we focus on chronic pain being both a medical condition, as well as something that our brain can create without any injury. Many patients would highly object to the idea of pain being at all psychological or even feel offended if a provider told them that the “pain is in their head.” The idea that severe pain is not due to some type of physical damage can feel impossible to grasp. But chronic pain is a learned response from the brain and if we can start to accept the idea that the brain is involved, then we can start to make progress in overcoming it. 

Let me explain further – this is different than thinking of pain as purely psychosomatic. We do not create pain or choose to have it. Pain is a response that the brain gets used to having and the cycle is then perpetuated. It becomes accustomed to pain signals. For example, let’s say you break your foot and experience pain due to the injury. Once the injury heals properly, sometimes the pain persists. Your brain has learned this pain pathway and every time you put pressure on your foot, for instance, you are remembering that this hurts, thus recreating pain signals in your brain. 

The thoughts that we have about pain can also exacerbate it. Stress, anxiety, catastrophic thinking, negative predictions and focus on pain, can all make pain worse. And pain affects many aspects of our life such as relationships, career, sleep and health among other things. We are more likely to isolate ourselves when we’re in pain, thus making the entire cycle worse.

Other Conditions

This concept of the brain’s role in pain can also be applied to other conditions with symptoms that are not simply pain-related. The brain may serve an important role in pain syndromes like fibromyalgia, as well as chronic fatigue syndrome, irritable bowel syndrome, chronic headaches and other disorders without a clear etiology. 

Changing your Brain

The good news about this model is that there is hope for those dealing with chronic pain. If you’re coping with pain, learning about the brain’s role will benefit you greatly. If you can change your brain, you can change your pain. Just as your brain learns the pain response, it can also unlearn it. Psychological techniques like meditation, mindfulness, CBT and working on re-wiring your thoughts around the pain can be very beneficial. Working on your emotional health will have positive impacts on pain and your overall health. And finding a therapist who is well-versed in this model and the psychology of pain is an essential step in the process of treating chronic pain.