TL;DR: New research on ultra-endurance athletes confirms what I see in my clinic every day: pain tolerance is a trainable skill, not a fixed trait. The nervous system learns to reframe pain as “safe” through gradual exposure and accurate body awareness. The same principles behind Pain Reprocessing Therapy explain exactly how this works, and why it matters far beyond the world of sport.

• Pain tolerance develops through repeated exposure and reframing, not genetics.

• Experienced athletes and chronic pain patients both benefit from accurate interoception (sensing your body’s internal state).

• Neuroplastic pain is physiologically real but shaped by learned nervous system responses.

• Somatic tracking, practiced without an agenda, recalibrates your pain signal over time.

• Self-compassion and patience are the non-negotiable foundations of this work.

Researchers at the University of Leeds recently published something that challenges a deeply held assumption about pain tolerance.

Ultra-endurance athletes don’t just push through pain. They’ve trained their nervous systems to interpret it differently.

Over time, these athletes learn that the pain of extreme physical effort is “safe” to experience. Aching legs and burning lungs don’t signal impending destruction. They signal effort. Progression. Proof of life.

They’ve essentially rewired their brains.

And the same principles apply to you.

When I first read this research, I recognized something immediately. These athletes were doing somatic tracking without knowing it. The same technique I use in Pain Reprocessing Therapy.

What ultra-athletes discover through thousands of miles, you can learn in your living room.

What Is the Recalibration Problem?

Here’s what most people misunderstand about chronic pain.

Your pain signals aren’t broken. They’re miscalibrated.

In the setting of a healed or non-actively threatening injury, pain gets amplified by one thing: the conviction that danger is still present. The fear or frustration you feel when pain arrives reinforces and amplifies both its intensity and its chronicity. Research confirms that mind-body therapies significantly improve interoceptive awareness and reduce pain in adults with chronic pain.

It’s a feedback loop. Fear feeds the signal. The signal feeds the fear.

Pain Reprocessing Therapy works by desensitizing the emotional energy you activate when you experience negative sensations. Somatic tracking helps your nervous system recalibrate, learning that sensations are safe, not catastrophic.

“The pain is real. The interpretation is trainable.”

Ultra-athletes do this naturally through thousands of miles of exposure. Research published in Sports Medicine shows that adaptive coping strategies like mindfulness and enhanced interoception help athletes navigate pain while optimizing performance.

But you can compress that learning curve.

Key Point: Chronic pain is not a broken signal. It’s a miscalibrated one, shaped by emotional responses you can learn to change.

How Does Pain Appear Before Movement?

I often start with imagined movements.

Patients visualize an activity that typically triggers their pain. And frequently, the pain arrives before they’ve moved a single muscle.

That’s not nothing. That’s everything.

Pain appearing during anticipation proves it isn’t purely structural. It’s a learned association called neuroplastic pain. Brain imaging studies confirm that while this pain is psychologically influenced, it remains physiologically real and measurable.

Your brain is creating pain before your body has a reason to feel it.

That moment of recognition changes things. People begin distinguishing what pain that’s out of context actually feels like.

They’re developing interoceptive accuracy.

The Leeds research identifies this as one of ultra-athletes’ core advantages: unusually accurate interoception. They read their body’s distress signals correctly, pacing themselves over long efforts without quitting prematurely or overexerting.

You’re learning the same skill. Sensing the difference between “my tissue is actually threatened” and “my nervous system is reacting to a learned pattern.”

Key Point: When pain shows up before you move, that’s not a sign of severity. It’s a sign of a learned pattern, and learned patterns can be unlearned.

Why the Signal Isn’t Broken

Your pain signals have become unreliable because they’ve been miscalibrated by your responses to feeling pain.

By correcting those reactions and responses, you recalibrate the signals themselves with more precision and accuracy.

This is where agency comes in.

“You can’t always control the sensation. You can always influence your response.”

The Leeds research found that individuals with a more internal “locus of control,” those who believe they can influence outcomes rather than being passive recipients of circumstance, handle pain better. Studies confirm that internal locus of control is associated with lower pain severity, reduced chronic opioid use, and increased physical functionality. Higher internal locus of control at pre-treatment was linked to greater reduction in pain intensity post-treatment.

The work is about restoring that agency. Giving you back the understanding that you have the power to modify the intensity, chronicity, and even presentation of your pain.

You do this by deconstructing the factors that sensitize and reinforce learned pain patterns and habits.

Key Point: Agency isn’t a soft concept. It’s a measurable clinical variable, and rebuilding it changes outcomes.

How Do You Give Pain Back Its Job Description?

Veteran ultra-athletes view pain as a “necessary rite of passage.” Novices see it as purely negative.

That reframe matters enormously.

But in chronic pain, there’s no finish line. No medal. So how do you make pain meaningful instead of just pointless suffering?

By returning to its original purpose.

Pain is a protective mechanism aimed at survival. It carries an unfortunate built-in negativity bias, but one that has been evolutionarily critical for our species. At the same time, pain is often a signal for attention. A sign that we’ve been neglecting internal needs or pushing through overwhelm and fatigue past the point of reason.

You’re giving pain back its original job description: protector, messenger.

Not meaningless tormentor.

“Pain isn’t the enemy. Fear of pain is.”

Key Point: Pain has a purpose. Understanding what it’s actually communicating is the beginning of a different relationship with it.

What Is the Pause That Changes Everything?

When someone starts seeing pain as information rather than injury, the first practical change looks deceptively simple.

Pause.

Appreciate its presence in the moment. Make sense of the context of that pain in each individual instance.

Don’t fight it or run from it. Pause and identify. Notice before reacting. This is how you learn to appraise pain more accurately in real time.

But here’s what most people get wrong about that pause.

The noticing must be without intensity. More with curiosity. Trust the process, not with the intent to reduce pain. Forcing mantras without visceral buy-in doesn’t work.

If you’re approaching somatic tracking with the desperate hope of “please make this stop,” you’re reinforcing the danger signal. The paradox is real: trying to eliminate pain keeps it alive.

So how do you build genuine curiosity when you’re exhausted and just want the pain to end?

You practice somatic tracking when you’re not in active pain. Or only in mild discomfort. This is the desensitization process. Little by little. Microexposures.

You build the skill in lower-stakes moments. Training wheels before the big ride.

“Master calm waters before you sail the storm.”

The Leeds research shows that ultra-athletes develop this capacity through gradual exposure over years. The same principle applies to chronic pain patients doing microexposures with somatic tracking.

Progression looks like this: you notice you’re not as overwhelmed by your pain. It becomes less influenced by non-physical factors like irritability, stress, depression, or anxiety. The pain becomes more predictable. Less emotionally hijacking.

Key Point: Curiosity without an agenda is the skill. Practice it when the stakes are low, and it becomes available when they’re not.

What Does the Data Actually Show?

The NIH-funded Boulder Back Pain Study provides meaningful validation.

66% of patients randomized to Pain Reprocessing Therapy were pain-free or nearly pain-free at post-treatment. Compare that to 20% for placebo injections and 10% for usual care.

At one-year follow-up, the treatment effects largely held. 52% of PRT patients remained at 0 or 1 out of 10 on the pain scale.

The average duration of pain before treatment: 10 years.

This validates what I see clinically. Pain can be unlearned through systematic retraining of neural pathways. Brain imaging studies confirm that while the pain is physiologically real, it often results from learned neural patterns that can be retrained.

But there are limits. Understanding those limits is as important as understanding the possibilities. Always take new or changing pain symptoms seriously. They need proper evaluation.

Key Point: The data is clear: the nervous system can be retrained. But wisdom means knowing when a symptom needs medical attention, not just reframing.

Can Pain Be a Learned Skill?

To an extent, yes.

As long as the pain feels familiar, you can work with it. But you cannot become biased or careless. Any new pain symptom should be taken seriously and properly evaluated.

You’re building tolerance without becoming dangerously dismissive of new signals.

That’s the critical balance.

“Wisdom isn’t ignoring pain. It’s knowing which pain to listen to.”

What Is the Ultra-Athlete Advantage, Really?

Before you try to apply this research to your chronic pain, understand what you’re comparing yourself to.

Ultra-athletes typically start with advantages that aren’t available to most chronic pain patients.

• A foundation of pre-existing fitness, conditioning, and activity tolerance.

• Intrinsic motivation, grit, perseverance, and resilience that likely self-select into this population.

• A body that is not yet deconditioned, fearful, or marked by years of medical trauma.

These athletes are similar to first responders or active military in their psychological resilience profile. They’re a biased sample.

They’re not starting from where you are. And that matters.

Because comparison is the thief of healing.

Key Point: Ultra-athletes are a self-selected group with unique advantages. Their experience is instructive, but it’s not a benchmark for where you should be.

What Principle Translates Universally?

Given those differences, what actually applies to everyone, regardless of starting point?

Self-compassion for wherever you are, foundationally and fundamentally, when you find yourself in pain.

Start where you are. Not where you think you should be.

Don’t compare yourself to others in pain, especially when you share a diagnosis name. The correlation between diagnosis, imaging findings, clinical presentation, and prognosis varies wildly from person to person.

“Your MRI doesn’t feel your pain. You do.”

Use the tools of psychoeducation to deconstruct your neuropsychosomatic makeup. Reverse engineer how you’re sensitized to process and deal with discomfort at this very moment.

Understand that neuroplasticity allows for change. But these changes work like habits: they take time, energy investment, and patience. You’ll move through extinction burst periods and occasional setbacks. Worsening before improvement is part of the rewiring.

Setbacks aren’t failures. They’re data points.

Key Point: The most universal principle from this research isn’t resilience or fitness. It’s self-compassion paired with informed patience.

Your Actionable Steps

Here’s your roadmap to recalibrating your pain response:

1. Start with microexposures during low-pain states. Build the skill when the stakes are low.

2. Practice noticing sensations with curiosity, not intensity. No agenda to make pain disappear.

3. When pain arrives, pause before reacting. Identify the context. Is this familiar pain or something new?

4. Distinguish between tissue threat and nervous system pattern. Learning this difference is the work.

5. Reframe pain as a protective messenger. Not a meaningless enemy.

6. Track progress by emotional response, not just pain intensity. Are you less overwhelmed? Less hijacked by stress, irritability, or anxiety?

7. Be patient with the recalibration process. Neural pathways change like habits form: gradually, with consistent practice.

8. Approach yourself with self-compassion. You’re not competing with ultra-athletes or anyone else. You’re reverse engineering your own patterns.

You’re building your own interoceptive accuracy. Reclaiming your agency one microexposure at a time.

The signal isn’t broken. It’s miscalibrated.

And calibration is a learnable skill.

Key Takeaways

• Pain tolerance is trainable, not fixed. Ultra-athletes prove the nervous system can learn to interpret pain differently through repeated exposure.

• Neuroplastic pain is real and changeable. Pain appearing before movement reveals learned patterns, not structural damage.

• Your pain signals are miscalibrated, not broken. Changing your response recalibrates the signal itself.

• Curiosity without agenda is the method. Desperate attempts to eliminate pain reinforce the danger signal.

• Practice in low-stakes moments. Build somatic tracking skills when pain is mild or absent.

• Self-compassion is non-negotiable. Your starting point is valid, wherever it is.

• Setbacks are part of the process. Neural pathway changes work like habits: gradual, nonlinear, and worth it.

Reflection Questions

Take a moment to consider:

• When your pain flares, what’s your first emotional response? Fear, frustration, or curiosity?

• Can you recall a moment when pain showed up before you actually moved? What does that tell you?

• On a scale of 1-10, how much agency do you feel over your pain experience right now?

• What would change if you viewed your pain as a messenger instead of an enemy?

• Where are you being too hard on yourself in your healing journey?

Frequently Asked Questions

Can pain tolerance actually be trained, or is it genetic?

Research on ultra-endurance athletes shows that pain tolerance is largely a learned skill. While genetics play a role in baseline sensitivity, repeated exposure and psychological reframing significantly shift how the nervous system interprets pain signals over time.

What is somatic tracking and how does it work?

Somatic tracking is a technique used in Pain Reprocessing Therapy. It involves observing bodily sensations with curiosity and without reactivity, teaching the nervous system that sensations are safe. The goal is not to eliminate pain, but to change the emotional interpretation of it.

What is neuroplastic pain?

Neuroplastic pain is pain that originates from learned neural pathways rather than active tissue damage. It’s physiologically real and measurable, but it’s maintained by the nervous system’s conditioned responses rather than ongoing injury.

How is interoception related to chronic pain?

Interoception is your ability to sense your body’s internal state accurately. In chronic pain, interoception becomes miscalibrated, amplifying signals beyond their actual threat level. Recalibrating this through mindful awareness is a core part of recovery.

What is locus of control and why does it matter for pain?

Locus of control refers to how much you believe you can influence your own outcomes. People with a more internal locus of control, meaning they believe their actions affect their pain, tend to have better outcomes: lower pain severity, reduced opioid use, and greater physical function.

Can I apply ultra-athlete pain strategies if I’m deconditioned or have comorbidities?

Yes, with adjustments. Ultra-athletes begin with significant physical and psychological advantages. For chronic pain patients, the same principles apply, but at a much gentler pace. Microexposures in low-pain states are the starting point, not finishing lines.

What does a setback in pain reprocessing mean?

A setback is a temporary worsening of pain during the retraining process. It’s a normal part of neural pathway change, similar to how habits take time to form. It doesn’t mean the approach isn’t working. It means the nervous system is actively reorganizing.

When should I take pain seriously instead of reframing it?

Always take new or changing pain symptoms seriously. Pain reprocessing applies to familiar, chronic pain in the context of a healed or non-threatening injury. New pain signals should be evaluated by a qualified medical professional before being attributed to learned patterns.

Join The Conversation

Which insight resonated most with you?

Share this article with someone navigating chronic pain. Your story might be exactly what someone else needs to begin their own recalibration.

Every person who has learned to reframe their relationship with pain started exactly where you are now.

The question isn’t whether you can change your pain experience.

The question is: are you ready to start?

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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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Learn & Join: Mind-Body Rehabilitation Community

Visit the Clinic: Body & Mind Pain Center

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.

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References

1. Paley, C., & Johnson, M. (2025). Pain management in ultra-endurance athletes: A systematic review. Sports Medicine. https://link.springer.com/article/10.1007/s40279-025-02277-4

2. Khalsa, S. S., Adolphs, R., Cameron, O. G., et al. (2018). Interoception and mental health: A roadmap. Frontiers in Psychology, 9, 798. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2018.00798/full

3. Ashar, Y. K., Gordon, A., Schubiner, H., et al. (2022). Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: A randomized clinical trial. JAMA Psychiatry, 79(1), 13-23. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784694

4. Rutter, C. E., Bobos, P., Varacallo, M., & Tadi, P. (2024). Mind-body therapies improve interoceptive awareness and pain outcomes in adults with chronic pain: A systematic review and meta-analysis. Pain Medicine. https://pubmed.ncbi.nlm.nih.gov/38169051/

5. Lucey, S. M., Wren, A. A., Aouad, P., et al. (2019). Locus of control and health outcomes in adolescents with chronic pain. The Clinical Journal of Pain, 35(8), 662-669. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626892/

6. Schubiner, H., & Betzold, M. (2016). Unlearn Your Pain: A 28-Day Process to Reprogram Your Brain. Mind Body Publishing. Referenced in Pain Reprocessing Therapy overview. https://www.physio-pedia.com/Pain_Reprocessing_Therapy_(PRT)