Five Questions About Pain: That You Might Not Have Thought to Ask

Caroline J Davies

Answers to these questions could help you to understand what might be behind your acute or chronic pain

_{Figure 1 Group Pain Reprocessing Therapy Session: Copyright Caroline J Davies Reprocess Your Pain}

In this article, we will be discussing the well-founded, but still slightly shocking idea, that pain is generated in our brains rather than our bodies. This is completely different to saying “your pain is all in your head”: just to be clear, everyone’s pain is generated in their brains, and everyone’s pain is real.

1. What is Pain For? 

Pain is an alarm, a warning, a shout for help or attention. Depending on the circumstances, it can also be an essential way our collective conscious and subconscious brains can get our attention. Yelling or screaming in pain when we are hurt, might save our lives and those of others. Pain plays a vital role in our survival, in fact, people who are genetically unable to feel pain are less likely to live through to older adulthood.[1] However, having pain in your body day in and day out doesn’t feel like a way to survive, it feels like you need to find a way to survive the pain.

To understand the many purposes of pain, let’s take a common example that we all might have felt at some point in our lives, waking up with pain in our backs. What, typically, goes through our heads when this happens? We try to work out what we did the day before that might have caused the pain, and then we worry about what we have “done to our backs.” If we just helped our cousin move the day before, then it’s easy to understand what the pain is for, to protect us from further damage and remind us of which movements, like bending over, we should avoid while our body heals.

What if we wake up in pain but we had not done anything differently the day before? Or, what if we did clearly hurt our backs months or even years earlier but we are still in pain? What is pain for, in these situations?

 Let’s take the first example, we can’t think of any obvious reason for our pain. Might we consider that our pain is not necessarily caused by a physical threat but more of an emotional one? Could something stressful in our lives be the potential cause or trigger for our pain?

In between helping people who have had pain for many months or years, I see people whose pain has just come on in recent weeks or months. In approximately half of the cases, there wasn’t an obvious physical cause for their pain, they had not changed their routines, started a new activity or injured themselves. Yes, they spent too many hours at a desk, didn’t have enough time to exercise, or have the best posture, but nothing was new or different about this. When we dug a bit deeper, what we discovered was recent and significant stress, and potentially, the real reasons they had pain: back-stabbing from work colleagues, a recent death of a parent, a personal health scare separate from the area that hurt, intense performance pressure for a past or upcoming event, a sudden divorce or just a succession of difficult experiences

_{Figure 2 Copyright Caroline J Davies Reprocess Your Pain}

Why would their brains have sounded the alarm in these situations? Well, quite simply, they were under threat in some way, a threat to their livelihoods, personal feelings of emotional safety, financial support, or health. Pain, in these situations, is a measure of the seriousness of what is going on and the potential risks to those individuals. Pain is perhaps a way to get us to appreciate the stress we are under and even to do something about it.

What about the second example, where we had sustained a real injury by lifting something heavy or maybe we had been in an accident, but months or years had gone by, and we were still in pain? What is our pain for then and how is it useful? Could it be that this accident or injury led to other threats? To our income, standing in life, relationships, ability to do the things that we loved or that kept us sane? Pain in these instances is clearly very tedious and not at all helpful. The fault lies not with us, but with the over-protective nature of pain and the poorly developed approach we have for dealing with it.

A recent groundbreaking study looked at people, with a history of six months of back and neck pain, that went to see a doctor for help; it estimated that 88% of them had pain that was more likely to be caused by life stressors than structural damage in their bodies.[2] Obviously, much more research is needed.

 To summarize, our brains use pain to protect us, against anything that threatens us. Whether it is actual damage to our bodies, potential damage we might fear happening, or indeed anything and everything that might stop us from succeeding in providing for and protecting ourselves, and the people and things we care about. We are just starting to grasp the larger protective role pain plays in our lives.

 The picture below illustrates how our traditional view of potential threats (and causes of pain) is pretty narrow, and restricted mostly to what happens within the body, while our brains’ view of potential threats is much wider. There is no limit to what our brains can see as threats, perceived or real.

_{Figure 3 Copyright Caroline J Davies Reprocess Your Pain}

Please note that the brain’s viewpoint will always include what is going on in the body, it just includes a lot of other things as well. Pain can be caused just by bodily damage, just by stress, and by damage and stress combined.

Questions for You:

• Did you injure yourself at a time when other difficult things were going on, and this is what made your pain worse?
• Is it possible your pain came on at a difficult time in your life, and this stress could even be the main cause of it?
• Could your recovery from a real injury have been hampered by the worries about the injury itself and what you might not be able to do again?

2. Where is Pain ‘Created’ in Our Brains? 

If you are wondering where exactly in the brain pain is produced- the locations of this are still emerging. One area of the brain that is being considered as a “key region in pain processing” (or pain production) is the insula, the fifth or “hidden lobe” of the brain.[3][4]

The insula is buried under the other lobes, and hasn’t, until recently, been given a lot of attention, probably somewhat because of its location. Interestingly, pretty much everything is connected to the insula, like a central station, all the inputs and outputs from our bodies and the other parts of our brains connect with it. Makes some sense, doesn’t it, that the part of our brain responsible for our pain would want to have all the “facts” at their fingertips?

_{Figure 4 Copyright Caroline J Davies Reprocess Your Pain}

If the area of your brain that is most busy with deciding whether to “pull the pain alarm” or not, is connected to everything else in the body, and your brain, this should widen our thinking about what else might bring your pain on.

Pain is the result of a vast network of information the brain gathers from other parts of the brain, about what is going on around you, what has happened to you in the past and what it is anticipating or predicting is about to happen to you next, as well as what is going on in your body. This leads us to our next question about pain…

Questions for You:

• Have you noticed that your pain sometimes comes on without any rhyme or reason, or pattern? This could be because we are not privy to all the different things our brains are tracking.
• Next time your pain comes on without any obvious cause, see if you can notice other things that might be happening when your pain increases, such as something someone said to you, a worry you have been thinking about, stress in general, tiredness, sickness coming on, or even hunger, or thirst.

3. How Do Our Brains Make the Decision to “Pull the Pain Alarm”?

This is another question that we are still exploring the answers to, and, importantly, the answers will be different for everyone. In a somewhat simplistic way, we could consider that if the insula is a key region in pain production, all the information going into and out of the insula could be used to help the brain make this decision.

The following list is a summary of some of this information, which our brains might use to decide whether to pull the pain alarm or not, based also on whether pain is useful in that moment to our immediate and longer-term survival.

• “Memories” of anything that hurt or caused us pain before, and anything that our brains predict might hurt or cause us pain again.
• What is coming in from our senses – what we might touch, hear, see, smell or taste that could indicate a problem or remind us of a past one?
• Who is around us, do we have people that make us feel safe or not?
• Where our bodies are in space and our relative position to everything- this is useful information for our protection
• What our skin and tissue sensors tell us is happening at every layer, from our skin to our bones, like pressure, pinching, temperature changes, chemical hazards etc.
• What our internal body receptors (Interoceptors) have to say about how well we are managing our organs and vital processes, such as, how much oxygen we have circulating, available energy levels, nutrition status and immune responses

This is an unfinished list because this understanding of pain is still emerging.

It is important to remember that everything difficult, painful, challenging, emotional or dangerous that happened to us, since we were old enough to process these experiences, is logged somewhere in there, including things we might not remember clearly. Our brains, never forget these key moments or experiences; and, from them, anticipate or predict as much as possible, everything that is likely to happen next. This, in itself, is likely to be one of the main reasons we have chronic pain and also the key to how pain reprocessing works.

So, you have to be patient with your over-protective brain. No wonder pain is complex and individual! Read more about prediction and predicted pain: “Part 1: How Our Helicopter Brains Learn to Predict Everything We Feel and Do”

Incidentally, I know it is difficult to let go of the idea that there are no pain receptors in your skin, think of them now, as damage receptors, instead. They do pass this damage information to the brain when you hurt yourself, but it is the brain that makes the final decision on whether pain, in that moment, is useful or potentially distracting to a more pressing or urgent need, which brings us to our next point.

Questions for You:

• Is it possible your brain remembered something that was painful or hurt you in the past, and that your current pain is more of a preventative strategy your brain is using, than a new injury?

4. Why are Our Brains “In Charge of Pain?”

In any given moment, being in pain might be counterproductive to your other goals or even your survival. My own experience of this was when I was involved in a rollover car accident, many years ago. I broke my finger as I clung onto the roof of the car as it tipped over, but it wasn’t until the next day that I finally noticed some pain; thanks to my brain being in charge, I had been able to hang on in the moment, then help others in the situation who were worse off— without the distraction of a painful finger

My brain, without my knowledge, had made this decision for me.

We might like to think “we” oversee everything in our lives and are aware of what is going on, minute by minute, but on an everyday basis, we have no idea of how much our brains are tracking for us and the complexities of our decision-making. Our brains do have our best interests at heart, even if their methods include inflicting pain, or deciding it isn’t helpful in the moment as mine did for me at the time of that accident.

Pain will get our attention to something we might otherwise miss, that could save our lives, and it could also be drawing our attention to something else we continue to ignore, year in and year out, that might eventually do us in.

Questions for you?

• Can you think of a time when you were in an emergency or intense work, sporting, or other activity, when you hurt yourself, but your pain did not start until after you were safe, or the workday or game ended?
• Do you think your brain has been trying to get your attention to something in your life that you might have been trying to ignore?
• Do you find it difficult to express emotions? Becoming aware of or expressing our emotions can help to both avoid and relieve pain. (see Emotions and Pain Article coming soon)

5. Why We Should Never Ignore Pain 

_{Figure 6 Copyright Caroline J Davies Reprocess Your Pain}

We must always seek medical advice for any new or lingering pain; we would never want to get to the point of dismissing or ignoring pain. Pain can mean we have developed a problem, but pain does not always mean harm to our bodies. 

What if, when you do go to the doctor, they tell you that your back or neck pain is caused by a slipped disc, degenerative changes, or a trapped nerve? This might be true, but it also might not be – multiple studies have shown that many people have scary-looking X-rays and scans, but only some of these people are in pain; many experience no pain at all.[5] These radiographic changes are part of normal aging, surprisingly, from your twenties onwards, and so, are not necessarily the cause of your pain. However, despite this knowledge being understood and recognized by the medical establishment, it is not widely integrated into our medical encounters about pain. 

Summary

Admittedly, pain is very unpleasant in the moment you are having it, but it does force us to notice there is a problem, or retreat and take stock of our situation. Sometimes, with pressing or long-standing threats to our way of life, happiness, or success, we bury our feelings and miss important emotional cues. What else can our brains do then to get our attention? Pull the pain alarm, of course.

So, now we have a better understanding of pain, shouldn’t the fact that our brain has the ultimate authority on pain, factor into how we treat pain? That is, in a nutshell, what Pain Reprocessing Therapy does, it goes straight to the source of our pain, “rewiring” our brains, and therefore, our pain.

 See the next article on Pain Reprocessing Therapy

 Questions For You:

• Have you been to see a medical professional for your pain? If not, please do so. If they either have not found anything, or what they have found has been inconclusive, then Pain Reprocessing Therapy might be for you.
• Even if you have significant damage from a past injury or ongoing condition, you still have the potential to change your brain’s decision-making on pain.

---

[1] https://www.bbc.co.uk/future/article/20170426-the-people-who-never-feel-any-pain

[2] Schubiner H, Lowry WJ, Heule M, Ashar YK, Lim M, Mekaru S, Kitts T, Lumley MA. Application of a Clinical Approach to Diagnosing Primary Pain: Prevalence and Correlates of Primary Back and Neck Pain in a Community Physiatry Clinic. J Pain. 2023 Sep 28:S1526-5900(23)00544-8. doi: 10.1016/j.jpain.2023.09.019. Epub ahead of print. PMID: 37777033.

[3] Horing B, Büchel C. The human insula processes both modality-independent and pain-selective learning signals. PLoS Biol. 2022 May 6;20(5):e3001540. doi: 10.1371/journal.pbio.3001540. PMID: 35522696; PMCID: PMC9116652.

[4] McBenedict B, Petrus D, Pires MP, Pogodina A, Arrey Agbor DB, Ahmed YA, Castro Ceron JI, Balaji A, Abrahão A, Lima Pessôa B. The Role of the Insula in Chronic Pain and Associated Structural Changes: An Integrative Review. Cureus. 2024 Apr 18;16(4):e58511. doi: 10.7759/cureus.58511. PMID: 38770492; PMCID: PMC11103916.

[5] Brinjikji, W. et al. American Journal of Neuroradiology Apr 2015, Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations