What role does your brain play in chronic pain? A pretty big one, according to this psychotherapist and pain expert.
We often think of pain as a purely physical experience. If we get injured training for a marathon, we look to doctors to help us heal in the form of surgery, physical therapy, and more. When we have a headache, we take an NSAID or other pain reliever and lie down until it passes.
If you’re dealing with an injury or having another nagging pain-related medical issue, it’s always important to talk to your physician to get to the bottom of the pain and help you come up with a treatment plan. But what if your doctor has pronounced the injury healed and you still have pain? What if you’re dealing with regular chronic pain in your body, but doctors can’t find any medical explanation for it? That’s where the brain may come in, according to Christie Uipi, LCSW, an LA-based psychotherapist who specializes in the treatment of chronic pain, anxiety, and depression.
To be clear, medical gaslighting—especially of women—is absolutely a problem in our culture. Just because a doctor can’t find an explanation for your pain doesn’t mean it isn’t real. If you’re continuously experiencing pain without an explanation, it’s worthwhile to seek several opinions to do your best to find an answer.
But sometimes, your brain does play tricks on you. Whether you’re dealing with nagging pain from an injury or another form of chronic pain, here’s what Uipi wants you to know about the role your brain plays in pain.
The Function of Pain
From an evolutionary perspective, pain actually serves an important function: It lets our bodies know that there’s danger. If you’ve been lifting weights regularly and suddenly feel intense pain in your shoulder, your body is probably telling you to slow down, recover, and get to the source of the pain.
But pain also becomes a habit, Uipi says. “All injuries heal and scars don’t hurt,” she says. “If pain is persisting past six months—for severe injuries, past 12 months—and you’ve completed a course of treatment your doctor has signed off on, you shouldn’t be in pain anymore. Or, if you go long stretches of time without pain and then it comes back, your brain may be recreating pain even after your body has healed.”
Further, she says, studies show that the way we experience pain is strongly controlled by neural mechanisms (i.e. our brains), and research shows that 85 percent of all chronic pain is neuroplastic.
Stress and anxiety play a huge role in how we experience pain, or if we experience it at all. “There was a placebo car crash study done in Europe where they put participants in a car at a slight incline. They made a really loud noise and moved the car forward a little bit at the same time, and they had something behind them that inched forward at that moment as well,” Uipi says. “It was a completely fake collision designed to make participants feel like they were hit. After four weeks, 10 percent of the participants had pain in their neck—whiplash-like symptoms. They had developed chronic pain, and when the researchers looked into it, it was the 10 percent of people who had a lot of stress and a lot going on in their lives.”
Messaging can also play a big role in our pain, explains Uipi. “If people have received messaging throughout their lives that their bodies are weak or injury-prone, if they’ve been told something like, ‘If you hurt yourself in one area you’re more likely to get injured in other areas,’ or if you have a chronic illness, you may start to believe our body is more prone to having problems. This can cause pain to linger long after the actual injury has healed.”
Action Steps to Reprogram Your Brain
If you’re dealing with pain of unexplained origin or are still experiencing pain from an injury that has long healed, it’s important to bring that up to your doctor, physical therapist, or other expert you might be working with. Often, there really is an issue, and it’s worthwhile to get to the bottom of it.
But if you truly need to reprogram your brain from a pain perspective, Uipi says there are a few tactics you can try. “First of all, it’s very important to see a physician who can definitively tell you that this pain isn’t something you need to pay attention to from a medical standpoint,” she says. “And from there, we work to decrease avoidance and fear. Pain is a habit. Your brain plants the habit over and over again, and you have all these habits in place to make sure you don’t trigger the pain.”
People with back pain don’t sit for long periods of time, for example, people with foot pain don’t walk for too long, and people with migraines don’t look at screens for long periods of time. “You limit what your body can do and your vigilance increases over time,” she says. “It’s a good idea to make a plan to challenge that avoidance and cognitively reframe the meaning of the sensation.”
Another suggestion Uipi has—but says people have to be careful with—is distraction. “There’s a time and a place for distraction,” she says. “Distraction can help us realize that our pain went down because we’re thinking about something else and don’t feel it. Distraction can also bring fear down. For example, if someone is afraid of spiders, you don’t just throw ten spiders at them. You have them look at a few spiders and then distract them.
If you distract yourself every time you feel pain, though, you’re affirming to yourself that the pain is a threat. So it’s ideal to practice distraction in moderation.
Finally, finding a way to experience joy in your body again can go a long way. “Apart from anything specific you’re doing for your pain recovery, having something else that helps you use your body in a way that brings you joy—even something as small as walking outside to get the mail—can help remind you that your body can feel good.”