mind & body

Chronic pain and the brain

By Valentina Alaimo, LCSW · More notes

If you live with chronic pain, you may have heard some version of "it's all in your head." Let's be very clear: your pain is real. And there's also some genuinely hopeful science about the role the brain plays in it.

Pain is your brain's alarm

Pain is one of the body's most important protective signals. Your brain takes in information from your body, along with your past experiences, your stress level and your sense of safety, and decides how loudly to sound the alarm.

When pain lasts a long time, the alarm system can become extra sensitive. The nervous system learns to keep sending pain signals even after an injury has healed, or when the body isn't actually in danger. Researchers sometimes call this neuroplastic or nociplastic pain.

Why stress turns up the volume

Stress, fear, poor sleep and constantly bracing for pain all tell the brain that you're under threat, so the alarm gets louder. Then the pain creates more stress and fear. Round and round it goes. This is often called the pain-stress cycle.

Feeling safe, gentle movement, good sleep, connection and joy all send the opposite message. They help turn the volume down.

What is pain reprocessing therapy?

Pain reprocessing therapy (PRT) is an approach developed by Alan Gordon that helps people relearn that certain sensations are safe. It's taught to clinicians through the Pain Reprocessing Therapy Center, and one of its core ideas is noticing a sensation with curiosity and calm instead of fear.

In a 2022 clinical trial published in JAMA Psychiatry, 66% of people with chronic back pain who received PRT were pain-free or nearly pain-free afterward, compared with 20% in a placebo group and 10% in a usual-care group. Many kept those gains a year later. It's one study, focused on back pain, but it's a hopeful one.

A gentle mindfulness practice: The next time you notice pain, take a slow breath and get curious about it. Where exactly is it? Is it sharp, dull, warm, buzzing? Does it shift if you watch it? Then remind yourself, gently, "This sensation is uncomfortable, and I'm safe right now."

A few important notes

• Please always check new, changing or severe pain with your doctor. These tools work alongside medical care, not instead of it.
• Not all pain is neuroplastic, which is why a medical evaluation matters.
• Progress usually comes in small steps. Go at your own pace.
• If you're interested in PRT specifically, the Pain Reprocessing Therapy Center keeps a directory of trained providers.