Mind Your Body Podcast
Inspiration: Episode 11: Metacognition in Motion: My Pain, My Path of the Mind Your Body podcast with Dr. Nevo.
I spent years teaching patients how to reframe their pain. I explained the neuroscience, demonstrated the techniques, and watched them transform their relationship with suffering.
Then my spine gave out.
The flare-up came hard and fast. Within days, I went from treating patients to sitting in an emergency department, waiting to be triaged while I struggled to mask unrelenting pain. This was my second herniated disc in four years. The first time taught me everything I now teach my patients. I learned the neuroscience, developed the metacognitive tools, transformed my relationship with pain. I built an entire practice around those lessons. Now I had to see if any of it actually worked when tested again. The irony cut deeper this time—here I was, a physician who specializes in pain rehabilitation, facing the same raw intensity I’d conquered before. In some ways, this ordeal felt worse. I knew what was coming. I remembered every stage of the first recovery. And I had to engage every tool and resource I’d developed to see if I could beat this again.
That experience taught me something I could never have learned from the other side of the exam table.
In the emergency room, waiting,
I wrote these lines:
“Pain is a language my body speaks
that my mind struggles to translate.”
The Gap Between Knowing and Experiencing
I know the statistics. Over 51 million Americans live with chronic pain [1]. I understand that 24.3% of adults experience it, and that the incidence of new cases exceeds even diabetes and depression [1]. I’ve studied how metacognition—the awareness of your own thought processes—can reduce pain catastrophizing by 20% [2].
But knowing these facts means nothing when your nervous system screams danger.
During my worst moments, I practiced what I preach.
The second time around, I thought I’d be better prepared. I had the playbook. I knew the strategies. I’d successfully navigated this exact situation four years earlier.
But pain doesn’t care about your credentials or your previous victories.
I acknowledged my body’s protective responses. I tried to reappraise the intense sensations. I engaged the prefrontal cortex to override automatic pain reactions. Some of it worked. Much of it didn’t.
The pain was real. Uncomfortable. Undeniable.
And that realization mattered more than any technique.
Stripping Away the Professional Identity
I didn’t want to be Dr. Nevo during those weeks. I didn’t want colleagues to treat me differently because I understood the medical terminology. I didn’t want the burden of maintaining professional composure while my body fought itself.
I wanted what every patient wants—to be cared for as a human in pain.
This vulnerability opened something unexpected. My patients, the ones I’d been treating, extended compassion and understanding during my recovery. They saw me struggling and recognized themselves in my experience. The professional distance dissolved, replaced by genuine connection.
We were all just people trying to make sense of our bodies.
Pain as Information, Not Enemy
Here’s what shifted for me: I stopped trying to eliminate the pain and started listening to what it revealed.
Your nervous system doesn’t create pain to torture you. It generates signals to protect you. Sometimes those signals become overactive, stuck in patterns that no longer serve their original purpose. But the intention remains protective.
During my recovery, I noticed how my nervous system contracted muscles around the injury site. I observed the emotional meaning I attached to each sensation. I watched uncertainty amplify my distress more than the physical sensations themselves [3].
The pain itself was just sensation. The suffering came from what I made it mean.
This distinction matters. You can’t always control the sensation, but you can change your relationship with it. Metacognition allows you to pause between the signal and your response. It creates space for choice.
The Paradox of Healing
Research shows that metacognitive therapy reduces pain catastrophizing and improves quality of life [4]. The approach focuses on how you relate to your thoughts rather than trying to change the thoughts themselves.
I experienced this firsthand. When I stopped resisting the pain and started observing it with detached awareness—like a stenographer documenting facts without judgment—something shifted. The intensity didn’t always decrease, but my suffering did.
Your brain has remarkable neuroplasticity [5]. It can learn pain patterns, and it can unlearn them. But this process requires patience with yourself. The nervous system sometimes fights back against change. You might experience what researchers call an extinction burst—a temporary increase in symptoms as old patterns resist new ones [6].
Facing my second herniated disc tested everything I’d learned the first time. The tools I’d developed weren’t magic shields against pain. They were practices that required constant engagement, even when—especially when—I’d already been through the fire once before.
That’s okay. Missing a day of practice is okay. Struggling is okay.
Self-compassion matters more than perfect execution.
What Physicians Need to Remember
Chronic pain care providers experience burnout rates of 62.3%, significantly higher than other medical subspecialties [7]. We lie awake worrying about our patients. We feel the weight of their trauma histories. We struggle with the tension between providing relief and avoiding harm.
My experience reminded me why this work drains us—and why it matters.
Patients don’t need us to have all the answers. They need us to see them as whole people, to validate that their pain is real, and to walk alongside them as they find their own path to healing. Trauma-informed care establishes safety, trustworthiness, choice, collaboration, and empowerment [8].
These principles apply whether you’re treating someone or being treated yourself.
The Ancient Wisdom Holds True
Aeschylus wrote that we suffer into truth. My spine surgery forced me into a truth I’d been teaching but hadn’t fully embodied: healing happens when you stop fighting your experience and start working with it.
Your body speaks a different language than your rational mind. It communicates through sensation, through tension, through the subtle shifts in your nervous system state. Learning to interpret these signals productively—rather than just reacting to them—gives you back control.
I’m expanding my mind-body rehabilitation services because of what I learned during those difficult weeks. I’m building community among patients because I understand now, more deeply than before, how isolation amplifies suffering.
Even small steps toward healing matter.
What This Means for You
If you’re living with chronic pain, you already know the statistics don’t capture your reality. You know that well-meaning advice often misses the mark. You know that some days, just getting through feels like victory enough.
I can’t promise you a cure. I can’t guarantee that metacognition or nervous system regulation or any other approach will eliminate your pain.
But I can tell you this: your pain is real, and your body is not broken. The signals you’re experiencing made sense at some point, even if they’ve outlived their usefulness. You can learn to interpret them differently. You can build new neural pathways. You can find moments of ease within the difficulty.
The goal isn’t to become indifferent to pain—it’s to stop letting pain define your entire existence.
That shift happens through practice, through patience, through the willingness to observe your experience without immediately trying to fix it. It happens when you treat yourself with the same compassion you’d offer someone you love.
It happens when you remember that healing isn’t linear, and setbacks don’t erase progress.
What You Can Try
If you’re navigating chronic pain right now, here are three practices that helped me during my recovery:
1. The Stenographer Practice
When pain flares, spend 60 seconds observing it like a reporter documenting facts. Where exactly is it? What’s the quality—sharp, dull, burning, aching? Does it pulse or stay constant? This shifts you from reactive suffering to curious observation.
2. Name the Meaning
Ask yourself: “What story am I telling about this pain?” Write it down. Then ask: “What if this sensation is just my nervous system being protective, not a sign that I’m broken?” Notice how the reframe changes your emotional response.
3. The Compassion Check
When you catch yourself in self-criticism (“I should be better by now” or “Why can’t I handle this?”), pause. Ask: “What would I say to a friend experiencing this?” Then offer yourself that same kindness.
These aren’t magic solutions. Some days they’ll work better than others. The practice itself matters more than perfect execution.
Moving Forward
I returned to my practice changed. I listen differently now. I recognize the courage it takes to show up for treatment when your body feels like a battleground. I understand the vulnerability required to trust someone with your pain story.
My patients taught me this during my recovery, and I’m grateful.
We’re all learning together—how to live with bodies that sometimes betray us, how to find meaning in suffering, how to maintain hope when the path forward feels unclear. The research supports what ancient wisdom has always known: we can transform our relationship with pain through awareness, through community, through the simple act of paying attention differently.
Your nervous system can learn. Your brain can change [9]. Your experience can shift.
And sometimes, the most powerful healing happens when we stop trying to be strong and allow ourselves to simply be human.
About the Author
Dr. Zev Nevo is a double board-certified physiatrist, chronic pain survivor, and founder of the Body & Mind Pain Center. He helps people with persistent pain rebuild capacity and confidence using an evidence-based, trauma-informed mind-body rehabilitation approach.
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Medical Disclaimer
The information in this article is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. New or changing pain symptoms should always be properly evaluated by a medical professional.
References
[1] Yong, R. J., Mullins, P. M., & Bhattacharyya, N. (2022). Prevalence of chronic pain among adults in the United States. JAMA Network Open, 5(3), e2215849. https://doi.org/10.1001/jamanetworkopen.2022.15849
[2] Kollmann, J., Gollwitzer, M., Spada, M. M., & Bernardy, K. (2016). The association between pain intensity and pain catastrophizing: The role of perseverative thinking and unhelpful metacognitive beliefs. Journal of Psychosomatic Research, 91, 1-7. https://doi.org/10.1016/j.jpsychores.2016.09.012
[3] Wiech, K., & Tracey, I. (2013). Pain, decisions, and actions: A motivational perspective. Frontiers in Neuroscience, 7, 46. https://doi.org/10.3389/fnins.2013.00046
[4] Ferreira, C., Escaravelho, C., & Gillanders, D. (2021). Effectiveness of metacognitive therapy in improving mental health: A meta-analysis. Journal of Contextual Behavioral Science, 20, 83-93. https://doi.org/10.1016/j.jcbs.2021.03.005
[5] Moseley, G. L., & Flor, H. (2012). Targeting cortical representations in the treatment of chronic pain: A review. Neurorehabilitation and Neural Repair, 26(6), 646-652. https://doi.org/10.1177/1545968311433209
[6] Bouton, M. E. (2004). Context and behavioral processes in extinction. Learning & Memory, 11(5), 485-494. https://doi.org/10.1101/lm.78804
[7] Hooten, W. M. (2016). Chronic pain and mental health disorders: Shared neural mechanisms, epidemiology, and treatment. Mayo Clinic Proceedings, 91(7), 955-970. https://doi.org/10.1016/j.mayocp.2016.04.029
[8] Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., … & Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain, 161(9), 1976-1982. https://doi.org/10.1097/j.pain.0000000000001939
[9] May, A. (2011). Experience-dependent structural plasticity in the adult human brain. Trends in Cognitive Sciences, 15(10), 475-482. https://doi.org/10.1016/j.tics.2011.08.002