We oftentimes hear the phrase “pain is in your head” used to motivate others around us while suffering
through a physically intense endeavor. I frequently heard this or similar renditions while in the Army
during training events like our semi-annual fitness tests, long unit runs, and grueling ruck marches. The
meaning of statements like this is to reinforce the power of the mind over the body, to mentally fight
through the physical discomfort. However, it turns out that pain is actually experienced in our heads and
NOT actually where pain is felt. Pain truly is in our heads. Now bear with me as I elaborate.
You see, the painful body part is too “dumb” and not equipped to produce pain. Let’s use tweaking the
low back while lifting something heavy, for example. Within the tissues of the low back are special
receptors and nerves that simply detect whatever might be a threat to the body. This includes local
chemical responses from inflammation, exposure to high forces of pressure, and extreme heat or cold.
These nerves detect this stimulus but do not know how to utilize this information; however, they know
who does…. the brain! So, these low back nerves that detected a potential threat send a signal away
from the local area to the spinal cord which then relays the message up to the brain for further
processing. Once received, the brain makes note of where the message is coming from, what type of
message was received (a potential threat!), and the current situation (bending over picking up
something heavy). It quickly processes the message to produce the output of pain.
Believe it or not, pain is a blessing protecting us from further harm. If it wasn’t for pain, I wouldn’t be
able to detect the sharp rusty nail I am stepping on and quickly pull my foot away from it, preventing
getting tetanus. Without pain, I wouldn’t know if my appendix was about to rupture, potentially causing
a fatal event. Pain forces me to the doctor to get the appropriate treatment. Pain prevents us from
running on a sprained ankle, causing further harm to sensitive tissue. Without pain to protect us and
guide us, we wouldn’t have survived long as a species!
Not only can the brain receive and process information from pain receptors and nerves, it is also the
body’s headquarters for processing any and all information related to our senses, movement, internal
health, cognitive processing, emotional state, and overall well-being. The brain will use other information
to fine tune the output and can amplify, distort, or weaken the output based on this other data. It can
also suppress the pain output in a life or death situation. For example, a Soldier being shot in the arm in
combat may not realize it until after the firefight is over. During this scenario, the arm’s pain receptors
and nerves detected the threat and relayed the information to the brain for processing. However, the
brain quickly “decided” the arm is less threatening than the potentially fatal situation it was facing, so it
dampened the pain output to deal with it later, when not in a life and death situation.
Because the pain is processed in our heads as well as EVERYTHING else, there can be some crosstalk
between different processes simultaneously occurring that can greatly impact the pain output. For
example, a person with both chronic back pain and depression may experience more back pain if their
depression worsens. What is it about being more depressed that causes more back pathology? Nothing!
But because both the depression and the back pain are processed in the brain, they can oftentimes
negatively impact each other. The opposite is true, too. Feeling more hopeful and optimistic can have a positive effect on chronic pain. This is why managing chronic pain should include a holistic approach (a
topic certainly worth its own article).
Of course, the physiology of experiencing pain is much more complex than explained here, but hopefully
this simple description helps identify the complexity of pain and how it’s not necessarily all about the
painful body part. It’s important to remember this while going through the rehabilitation and recovery
process, especially when there is a lack of progress, worsening of symptoms, or when dealing with other
health issues simultaneously (physical, mental, spiritual, etc.).
So, in summary, the pain you and I feel is actually in our heads. No, we are not all crazy, and the pain
experienced is actual legit pain. We just need to remember this as we recover and heal as there can be
many other factors that can influence the rehab process and pain symptoms. By understanding and
acknowledging this, we are able to identify non-pathological reasons why pain may worsen, and this
gives us a little more control over what often seems to be an uncontrollable situation.
For more information, check out this 5-minute animated video: