This week we welcome our guest blog written by Sarah Cosway. Thank you Sarah for sharing some really useful insights and tips to help manage pain. Read more about Sarah at the end of the blog.
Exploring the brain’s role in pain
Do you feel like you have done every test your doctor has to offer, and yet they still can’t tell you why you’re in pain?
It’s hard to explain pain that doesn’t show up in a scan, and perhaps you might start to wonder if people will start to think you’re making it up.
Even if those around you were sympathetic and supportive in the beginning, you can end up worrying that their patience will run out and they’ll get sick of hearing about your pain whenever they ask how you’re doing.
Does it feel like you’ve reached the end of the road in terms of what they can offer you in pain relief?
We’re going to explore why pain can still persist even when the doctors can’t identify an obvious physical cause.
Why Does Chronic Pain Feel Like It Never Ends?
When we initially experience an injury, whether it’s as innocuous as stubbing a toe or as serious as a broken bone or post-surgical wound, we will experience acute pain.
It is immediate and designed to tell us that we need to pay attention to that part of our body so that we can sort out whatever the problem is.
But there is also the kind of pain that is ongoing, that grinds away at us and wears us down; this is chronic pain.
Sometimes, there is a clear explanation for why we’re experiencing chronic pain, for example, when you need a hip replacement because degeneration in the joint has made movement painful.
Once it has been replaced and you have recovered from the surgery, the pain is no longer there because the issue has been fixed.
But sometimes, long after the original problem has been resolved, the pain persists.
And sometimes, the pain came originally with no obvious underlying reason, and no one has been able to explain why it is there.
Without a ‘why’, it can be difficult to foresee a ‘when’ for the pain to stop, reinforcing the relentlessness of the experience.
But just because no apparent cause can be found, your pain is real.
It’s not in your head, it’s in your nervous system.
It turns out that more than just injury can cause pain: our nervous system and our brain are involved, which means it’s a whole lot more complicated than just injury = pain.
How the Brain and Body Create Pain: The Science Behind Pain Perception
So pain isn’t just a warning signal; it’s a full-body and full-brain experience.
In 1965, researchers proposed the Gate Control Theory of Pain [1], which views the spinal cord as a kind of gateway to the brain that controls how pain signals are received.
Think of it like a volume dial; the spinal cord can turn pain signals up (intense pain), down (no pain), or somewhere in between (dull pain).
In this theory, several things control how open the gate is, not just a physical injury.
For example, if you are stung by a stinging nettle, the gate will open, but then the action of rubbing a dock leaf on the sting can partially close the gate.
I remember that when I was a child, if I complained to my mum that something hurt, she would offer to stamp on my toe because that would help the original pain to stop hurting – parenting in the 70’s ehh?!
What she intuitively knew, though, was that some event going on in another part of my body could effectively ‘drown out’ the original pain.
Pain Gate Theory explains that things such as applying pressure (e.g., rubbing) can close, or at least partially close, the gate, but psychological factors can influence it too.
You might have noticed that when you’re stressed, your pain seems to intensify, but when you’re completely focused on a difficult task, it’s like the volume has turned down a little.
Later, this understanding evolved. In the 1990s, Melzack [2] expanded the theory to shift the emphasis more onto what the brain’s role is in the experience of pain.
This update is called the Neuromatrix Theory and shows that pain isn’t always about injury; it’s about the brain’s interpretation.
Your brain produces the pain you feel, based on input from your body, emotions, and past experiences
Because physical injury is only one part of this network, it is possible to experience pain without physical damage; the pain experience is a product of the brain’s network patterns.
This can explain why different people have different experiences of pain, because we all have different historical experiences and process emotions in our own way; these are influential factors.
I want to be clear, this doesn’t mean that I am saying pain is “all in your head”, but it does mean that the brain is central in shaping it.
And the good news is that this gives us options!
Perhaps a helpful way of understanding what’s going on is to use a metaphor.
How Pain Works: A Concert Metaphor for Understanding Pain Perception
Imagine the experience of pain being like experiencing a concert production; full of moving parts, each playing a role in how you feel the final experience.
In this metaphor, pain flows like music, from the instrument to the mixer, through the DJ, and out through the speakers to you:
- The Instruments = Your Body
Just like a guitar sending out a raw sound signal, your body sends out raw pain signals when something’s wrong (like injury, inflammation, or pressure). Stub your toe? That’s your big toe strumming a painful chord. - The Sound Mixer = Your Spinal Cord (Pain Gate Theory)
Before the signal reaches your brain, it passes through a kind of “volume mixer” in your spinal cord. This is where the Pain Gate Theory comes in.- Feeling stressed or anxious? The volume gets turned up.
- Distracted or rubbing the area? The volume gets turned down.
Your nervous system isn’t just cabling to the brain, it’s already editing the track.
- The DJ = Your Brain (Neuromatrix Theory)
Now comes the real producer: your brain. According to the Neuromatrix Theory of Pain, your brain adds layers to the track based on memories, emotions, and context.- Past trauma? It cranks the volume up.
- Feeling safe and supported? It eases the sound.
Sometimes, the brain even creates pain without any new input (like in phantom limb pain or chronic pain with no clear injury); it’s like the DJ playing a remix no one asked for.
- The Speakers = Your Experience of Pain
What you actually end up feeling, i.e., the pain itself, is the final track. It’s the result of everything: the body, the spinal cord filters, and the brain’s remixing.
So What Does This Mean for You?
Although the feeling of pain may seem quite straightforward, it’s there or it’s not; it’s actually quite a complex feeling.
Pain isn’t just a broken body part shouting for attention.
It’s a full and complex production involving your brain, nervous system, emotions, and environment. And that means, just like a soundboard, there are knobs you can turn.
This metaphor shows that pain is changeable and, in many cases, manageable.
Understanding how pain works is the first step to turning down the volume.
How to Use Mindfulness to Lower Pain Perception
When we feel pain, it commands our attention. That’s by design.
It’s part and parcel of our brain’s built-in alarm system, but constant focus can actually increase pain intensity.
That’s why attention plays a big role in how we experience chronic pain.
The brain perceives pain as a form of threat, which makes sense from an evolutionary standpoint.
Anyone receiving an injury and not paying attention to it probably wouldn’t have survived long enough to pass their genes on to the next generation.
But as I mentioned above, the more attention we pay to our pain, the stronger and more distressing the pain can feel.
According to Pain Gate Theory, our attention is one of the ‘gates’ that we can influence.
A helpful technique is a CBT-based pain management technique called Mindful Attention Shifting.
Research suggests it can help people manage pain more effectively.
This technique helps you to consciously shift your focus away from the pain, a simple strategy to help lower pain perception, but (very importantly) without pretending it’s not there.
You’re simply offering your brain an alternative thing to focus on, which can soften the distress.
The aim of the technique is to reduce the brain’s threat response, which can lower pain intensity and emotional distress.
Simple Steps for Practising Mindful Attention Shifting
- Gently acknowledge the pain: no judgement, no resistance. You’re not ignoring it, just giving your brain a new focus
- Choose a soothing or grounding thing to anchor your attention (e.g., your breath, the sound of the ticking clock, a pleasant sensation).
- Redirect your focus to the anchor; think of it as being like changing the radio station.
- Your mind will wander, and your brain will want to shift your attention back to the pain. This is totally normal, it doesn’t mean you are doing this wrong! Simply re-anchor yourself every time you notice that your attention has drifted back to the pain.
- Practice…lots. You’re building a new skill for managing pain. In the beginning, it might feel like it’s not doing anything for you. But just as you wouldn’t be a concert pianist after a few piano lessons, you’re not going to crack this on the first few goes.
This is one tool in your pain management toolbox; there are many others, and building pain management skills takes time.
Pain relief isn’t one-size-fits-all. Just as each square builds a patchwork quilt, each strategy adds to your overall pain management toolkit
Pain Is a Brain–Body Experience, and That Gives You Options
Pain is real, complex, and valid, even when it doesn’t have a clear physical cause.
What it isn’t is a sign of weakness or something you’re imagining.
When you learn how pain is produced in the brain and body, it gives you new ways to respond and more options for developing coping skills.
Unfortunately, there is no quick fix or magic reset button.
Change can be slow, but it is possible but even when subtle, they can reduce the intensity of the pain and the hold it has over your life.
Evidence-based therapies such as Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Mindfulness have been shown to be highly effective in helping people manage chronic pain.
If you’re struggling, working with a therapist trained in chronic pain approaches can make a real difference.
You deserve support!
[1] Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965 Nov 19;150(3699):971-9.
[2] Melzack R. From the gate to the neuromatrix. Pain. 1999 Aug;Suppl 6:S121-S126. doi: 10.1016/S0304-3959(99)00145-1. PMID: 10491980.
Sarah Cosway is a BABCP accredited Cognitive Behavioural Psychotherapist with over a decade of experience in mental health, both within the NHS and in private practice. She offers tailored CBT in a compassionate, collaborative environment, empowering clients to build resilience and manage their mental well-being with confidence.
