Pain is complex, especially persistent pain. So here are some things you need to know about your brain so you can overcome your pain. 

*Credit for most of the content of this post: Adriaan LouwDr. Joe TattaShelly Prosko, and Carolyn Vandyken (all really awesome physical therapists that know a lot about the neuroscience of pain)

Quiz time. No anxiety with this simple quiz. All you have to do is answer YES or NO to each question, without overanalyzing.
  1. Does pain always indicate tissue damage?
  2. Does chronic or persistent pain mean an injury has not healed correctly?
  3. Does pain always indicate there is a physical injury?
  4. My body tells me when I am in pain?
Pretty easy quiz, right? Some of you may be surprised by the answers, however.
Let’s move on and talk about pain and your brain to provide answers to those questions.

What is pain?

 According to the International Association of the Study of Pain , pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
Now let’s unpack that.

Fact #1: Pain is not always an issue with the tissues

Did you know there are no pain nerves or fibers in your body? Your body does not send messages to your brain that there is pain. The understanding of pain has definitely changed and evolved, and the most current knowledge is that pain fibers do not exist.
However, there are different types of nerve fibers in your body, and they do transmit “danger” signals. Your nerve fibers sense three things: chemical, thermal, and mechanical input/changes. These nerve fibers then transmit danger signals to your brain when there is too much or not enough chemical, thermal, and mechanical input.
Your brain is slated with the task of interpreting the sense data coming in…it is always processing A LOT of input— consciously and (mostly) subconsciously.
For example, your brain is always receiving input from things like hormones, immune system, respiration, heart rate, cognition, thoughts, beliefs, emotions, and memories of past experiences….to name a few.
That’s a lot of work. I would get tired if I was a brain. 😉

Fact #2: Persistent pain does not mean that something has not healed properly.

Did you know that all tissues in the body heal within 6 months? Most tissues heal by 12 weeks. The body is amazing, and it will heal (unless there is an underlying disease or genetic condition that prevents normal healing).
Carolyn Vandyken, PT, explains it well. Long after the body has healed, the pain system is still firing. Persistent pain is highly connected to sensitivity in the central nervous system, but the tissues may be tight and weak as well.
Think of pain as an alarm system. Acute pain is an alarm you need. It is good and necessary.
Chronic or persistent pain is the opposite–it is the alarm system out of control.

Fact #3: Pain is an OUTPUT of the brain, not an INPUT to the brain.


Do you think your body tells you that you are in pain? (I know your brain is a part of your body, but in this case I am referring to all body parts and organs other than the brain)

Pain is actually an output of the brain, and it is produced by the brain based on the actual or perceived presence of threat or harm.
Simply put, your nerves send information to your brain, then your brain creates the pain experience. This does not mean pain is all in your head and you can just believe or think your way out of pain.
In order for you to change your experience of pain (the output), you have have to change the input. This may include taking a long, hard look at your thoughts, beliefs, past experience, and your movement habits and patterns in relation to your pain.
*An important point to not here is the concept of SAFETY. Safety is critical in your journey with persistent pain. If you don’t feel safe (in more ways than just physically safe), then this can be a driver in your pain experience.
For example, people with a diagnosis of PTSD may not feel safe in their bodies, and also have issues with persistent pain. If you do not address the SAFETY issue, it will be difficult to resolve the pain.

Fact #4: Chronic or persistent pain is a pain SYSTEM problem.

There is a lot involved with the pain experience. Like I said above, you cannot just think your way out of pain most of the time. Chronic or persistent pain is a multi-system experience, so it requires a multi-system treatment approach to overcome it.
Did you know there is no pain center in your brain? There are many areas in your brain that contribute to the pain experience.
Research has found that there are about nine different areas of the brain–all with “primary jobs” of something other than pain management. 
 When there is chronic or persistent pain present, any of these areas go into a “pain meeting” as Adriaan Louw coins it. Because they are occupied in the pain meeting, they fall short of performing their primary jobs well.
These areas of the brain have been found to be involved in the pain experience. Their “primary jobs” are listed.
  1. premotor/motor cortex: organize and prepare movements
  2. cingulate cortex: concentration and focus
  3. prefrontal cortex
  4. amygdala: fear, fear conditioning, addiction
  5. sensory cortex: sensory discrimination
  6. hypothalamus/thalamus: stress response, autonomic regulation, motivation
  7. cerebellum: movement and cognition
  8. hippocampus: memory, spatial recognition, fear conditioning
  9. spinal cord: gating from the periphery
Have you ever noticed when pain is present, it is difficult to focus, problem solve, fear may be amplified, your muscles are tight, your memory is not up to par? That is because they are in a “pain meeting.” Pain overrides these areas.

Fact #5: Pain is a response to a threat. It is based on the perception of actual or potential harm or damage.

See how complex this can be? If you perceive that the sudden onset of pain in your low back is a “slipped disc” and you won’t be able to work and you may need to go on disability. 
All of this, whether you have a disc issue or not, will impact and drive your pain experience.

Fact # 6: Pain is protective.

Pain can help you from injuring something further. Even emotional pain can protect you, but I am not going to unpack that here. 
The point is simple: pain serves a purpose. If we did not have pain, we wouldn’t survive. It protects us from doing really dumb things.

Fact #7: Your pain is REAL.

I will end with this for today. Your pain is real. Don’t let someone tell you it is all in your head. In  truth, yes, all of our pain experiences involve our “head” or brain.
Pain is pain. Pain is real, but you don’t have to live in pain. As Adriaan Louw says, you can flirt with pain, but don’t get in a long-term relationship with it.
Emily Warren

Dr. Emily Warren

Dr. Emily is a Doctor of Physical Therapy and Integrative Spine Specialist. She is the owner of Emily Warren Physical Therapy in Salt Lake City, Utah. She lives with her husband, 2 girls, 1 pup and enjoys anything outdoors. She wants people with back and neck pain to feel empowered and hopeful, and get back to the active lives they want. She has helped many people resolve their pain through physical therapy and online coaching. Check out her website HERE for more information on how she can help you.