How the brain—and your emotions—may hold the key to curing chronic pain

Pain is in your head—but that doesn’t mean it’s not real.

Pain is the result of a series of complex bodily processes that have evolved over time. We might feel it in a certain part of our body, but pain is a brain activity—one that detects injury or danger and translates it into a painful sensation.

It is, in part, designed to spark action. It’s what teaches us not to jump off buildings, touch a burning stove, or bash your head into that tree. Usually you can trust your pain. If your hand feels like it has been stabbed with a pointed object, it probably has been. But sometimes the brain messes up and gets things wrong, sending a person painful sensations even when the body itself has recovered.

A famous example of such brain misfires is phantom pain—the phenomenon of an amputee experiencing pain that feels like it’s coming from an appendage that is missing. A much more common brain miscue causes many forms of chronic pain—the recurrence of painful symptoms months or years after an injury has occurred and healed.

Traditional treatments for chronic pain are often ineffective, in large part because there is often no physical cause—no immediate impact on muscles and tissue. But in recent years, scientists have created a new way to understand chronic pain—one that looks much more closely not at the place that hurts, but at the place that processes pain signals: the brain.

As they do so, scientists like the University of the Fraser Valley’s Dr. Cynthia Thomson are using their understanding of the brain to find new ways to treat forms of chronic pain. And patients themselves are increasingly being put in the driver seat, in part because of evidence showing that just knowing how pain works can help reduce it.

Fear, pain and the brain

Thomson knows what it’s like to be in pain. A Kinesiology professor at UFV, Thomson spent years looking for the solution to the chronic pain in her back and shoulders.

The pursuit would change her life—then her career.

What she found was a new scientific paradigm, in which experts were rethinking fundamental assumptions about the causes of pain and finding new and seemingly effective ways to help patients.

Pain is linked closely to the feeling of fear. Both exist because they are, in general, helpful sensations that allow us to process the world and take evasive action to avoid harm.

“We very much need pain in our lives to keep us safe,” Thomson said.

But the brain isn’t perfect. It can develop habits that make it more or less likely to detect threats and trigger a pain sensation. It is also subject to a huge number of stimuli, all of which it subconsciously parses and evaluates before sending us signals like “I’m hungry” or “I’m in pain.”

The fundamental idea transforming pain science is both radical and simple: if the brain creates the sensation of pain by translating stimuli into the feeling of pain, then anything that affects that translation process can affect the resulting pain messages.

This framework—called the “biopsychosocial model of pain”—sounds obvious in the abstract. But its finer details can prompt some skepticism. Because what the model means is that chronic pain can be significantly influenced not just by a person’s physical wellbeing, but by things like their thoughts, emotions, and relationships and other experiences and brain functions that affect how we interpret stimuli.

Pain can even be a self-fulfilling prophecy: the expectation of pain can actually help trigger pain.

“When [pain] persists, it’s maladaptive,” Thomson said “The idea is that the whole system has become hypersensitive. It is misinterpreting signals that are actually safe and ok but [the system] is interpreting them as being threatening.”

Pain literature talks about this as a “false alarm.”

This doesn’t mean the pain feels less real, or is fake, Thomson is careful to note. Pain is a signal from the brain, and when it feels real, it is real. But often chronic pain is the result of the brain sending those signals out when it doesn’t need to.

This understanding is pivotal and provides reason to hope for many chronic pain sufferers. Because as scientists learn more about the factors that cause brains to unnecessarily send out those signals, they’re also developing effective new treatments.

“When you can construct these pathways of pain, you can also deconstruct them,” Thomson said.

A patient’s perspective

Thomson’s personal experience has informed her thinking on the subject (even as it has posed challenges and required her to be careful to make sure it doesn’t bias her research).

“As a patient in pain, you’re kind of told that you just have to cope and deal with [pain],” she said. “It’s not necessarily going to go away ever. And it’s unfortunate how much that message is perpetuated.”

Patients have commonly heard those messages from doctors. As Nathaniel Frank wrote in the Washington Post in 2021, “The medical community has traditionally regarded chronic pain in one of two ways. Doctors either consider it a structural problem caused by tissue damage — muscle strain, ruptured discs, an inflamed or torn tendon; or they shrug, saying they can’t find anything wrong and suggesting painkillers, physical therapy, rest, or a different diet or lifestyle.”

But it’s possible that patients don’t just have to accept that they’ll have to live with back pain (the most common form of chronic pain) forever.

Because if a person’s brain can subconsciously develop bad habits that cause it to erroneously detect certain stimuli as pain, it also stands to reason that, with training, the person can do the reverse. In doing so, a person may be able to “learn to not fear those sensations and not interpret them as being painful.”

Before learning how that process works as a scientist, Thomson learned it as a patient.

The treatment is called “pain reprocessing therapy.” It involves psychological training to help train patients’ brains that pain signals do not necessarily mean that the body itself is injured or being harmed. Patients learn meditation techniques, as well as the science behind pain. They can also learn to recognize some of the triggers for their own painful sensations.

In Thomson’s case, that was recognizing the role that stress and other emotions play in her pain.

Today, Thomson says she is free of her chronic pain, though it occasionally does flare up. But Thomson now has the tools to notice that when her pain does flare, it’s usually concurrent with times of stress in her life.

“I don’t fear it,” she said.

A pain science revolution

The new models’ understanding of the role of emotions and personal history in pain might be one of the most revolutionary—and the most likely to prompt deep skepticism. Frank notes that centreing pain in the brain has historically been “largely dismissed as New Age hooey.”

But in 2021, a landmark study was published in pain reprocessing therapy. It compared PRT’s efficacy on chronic back pain patients to both placebos and to usual care techniques. The pain reprocessing therapy significantly outperformed the other treatment techniques.

“For a long time, we have thought that chronic pain is due primarily to problems in the body, and most treatments to date have targeted that,” the lead doctor was quoted as saying. “This treatment is based on the premise that the brain can generate pain in the absence of injury or after an injury has healed, and that people can unlearn that pain. Our study shows it works.”

There are huge secondary implications of pain reprocessing therapy—one of the funders of the 2021 study was the American National Institute of Health’s National Institute on Drug Abuse, which speaks to the fact that pain reprocessing could reduce the need for medications like opioids. In addition to its governmental funding, the research was published in the Journal of the American Medical Association—not a traditional bastion of New Age hooey.

That credibility is important because accepting that pain is focused in the brain can lead one to some pretty far-out discoveries.

Because a patient’s personality, upbringing, and relationships all seem to influence how a person experiences pain, they impact the brain and its development, Thomson said.

“If you are raised in an environment where you're always taught to fear everything, then your nervous system is going to be set to detect and watch out for fear all the time, or watch for threats all the time,” Thomson. “So you're already hypersensitive. So that then can predispose you to experiencing chronic pain.”

Another pillar of pain reprocessing therapy is education: teaching people how their brain processes pain signals. Just the knowledge that one’s pain can be rooted not by physiological cause but by things like stress or emotions can allow people to learn to outwit their subconscious pain systems.

But it can be hard getting people to open their minds to an understanding of pain that flies in the face of what they have learned, assumed, and sometimes felt.

So Thomson has turned her mind on that challenge. To do so, she and two colleagues are creating a study to investigate ways to teach pain patients about the biopsychosocial model of pain. To do so, they are recruiting volunteers with chronic pain for their study who would participate in focus groups and inform language that could help introduce the ideas to those who stand to benefit from learning more.

You can find out more here. Those wishing to participate in the study can email [email protected]. Questions can be directed to Thomson at [email protected]. Because the study is aimed at finding ways to connect to new and potentially skeptical patients, participants from a wide range of backgrounds are desired.

Thomson said there are limited pain reprocessing therapy experts based in Canada. She said she used an app called Curable to try to overcome her own pain. Other resources can be found at painrevolution.org and painreprocessingtherapy.com.