Pain is often confusing. Over the years, I’ve worked with many clients who have experienced a wide range of injuries, yet the intensity of their pain doesn’t always match the severity of the injury. I once met a man who had broken nearly every bone in his body yet reported less pain than another individual who experienced whiplash without any tissue damage.
Chronic pain can be especially distressing, significantly impacting a person’s ability to function and live a meaningful life. The lack of understanding surrounding chronic pain, along with the absence of clear physical findings on scans, can leave clients feeling helpless. Many also feel their pain is minimized within a medical system that often has limited treatment options.
About five years ago, I had the opportunity to meet Daniela a clinical trainer for Pain Reprocessing Therapy, based in California. She joined a podcast I was part of, the Mental Health Bootcamp Podcast, and discussed compelling research, including the Boulder Back Pain Study, which found that approximately 66% of participants were pain-free following treatment, while up to 90% experienced meaningful reductions in pain.
Intrigued, I decided to explore this emerging field more deeply. I completed formal training in Pain Reprocessing Therapy, engaged in ongoing consultations, and pursued additional training with renowned pain physician Dr. Howard Schubiner, along with immersing myself in the broader literature on pain psychology.
Here are some helpful reflections to broaden your understanding of pain:
- Pain is not “all in your head,” but all pain is generated in the brain.
Suggesting that chronic pain is somehow less “real” than structurally based pain is both dismissive and inaccurate. All pain is created in the brain-whether the source is a stubbed toe, arthritis, or another injury. A rare exception is a genetic condition called Congenital Insensitivity to Pain with Anhidrosis (CIPA), in which individuals cannot feel pain because sensory signals do not reach the brain. - Pain is always a subjective experience influenced by biological, psychological and social factors.
“Bottom-up” pain processing begins when signals travel from the body to the thalamus, the brain’s relay center. From there, signals are sent to regions involved in sensation, emotion, and evaluation. The brain the integrates this information with context and past experiences to determine the location, intensity, and meaning of pain. - The brain can generate pain even in the absence of ongoing tissue damage.
“Central sensitization” occurs when the central nervous system becomes hypersensitive to pain signals. Neural pathways can become overactive, amplifying pain even without injury. Pain driven primarily by these learned neural patterns is often referred to as “neuroplastic pain,” and plays a significant role in many chronic pain conditions. - Recovery often involves retraining the brain, not just fixing the body.
Healing from chronic pain often begins by helping the brain feel safe again. Practices like: tracking the sensations more objectively, recognizing patterns, and decreasing stress can help the brain reinterpret sensations as safe rather than threatening. - Pain Reprocessing Therapy (PRT) integrates these principles.
PRT combines education and guided exercises to help individuals respond differently to sensations and reduce fear-based patterns that reinforce pain.
Implementing these strategies has been helpful for many clients. To learn more, consider reading The Way Out by Alan Gordon, Unlearn Your Pain by Howard Schubiner, or Back in Control by David Hanscom. There is hope, and it begins the moment we start to understand pain differently.
