Understanding Chronic Pain: Why Your Pain Might Be an Attention Signal, Not Just a Warning

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Inspiration: Episode #18: Pain Attention of the Mind Your Body podcast with Dr. Nevo.

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I need to tell you something that might change how you think about your pain—and potentially transform your path to relief.

For years, we’ve been taught that chronic pain is a danger signal. A smoke alarm. Your body screaming that something is wrong, damaged, broken.

But what if I told you that’s only half the story?

What if persistent chronic pain is less like a smoke alarm and more like an alarm clock—not warning you of danger, but trying to get your attention about something you’ve been ignoring?

The Brain-Pain Connection: How Physical and Emotional Pain Overlap

Here’s what we know from the research: Nearly 25% of Americans—approximately 51.6 million people—experience chronic pain [1]. Among those who develop it, almost two-thirds still suffer from it a year later [2].

But here’s the part that changes everything.

Brain imaging studies show that chronic back pain actually shifts brain representation from nociceptive circuits (the ones that process physical sensation) to emotional circuits [3]. The pain processing literally moves from physical sensation areas to emotional centers over time.

The same brain regions that light up when you experience physical pain also activate during emotional pain. [4]

Think about that for a moment. Your brain processes the ache of a broken bone and the ache of a broken boundary through overlapping pathways.

This isn’t metaphor. This is neuroscience.

Understanding Nervous System Sensitization in Chronic Pain

Central sensitization is what happens when your nervous system gets stuck in hyperalert mode.

You become more reactive. More protective. Your pain threshold drops. Stimuli that wouldn’t have bothered you before now trigger intense responses.

But here’s what most people miss: sensitization isn’t just about physical danger.

Your nervous system can become sensitized to emotional threats too. Boundary violations. Values misalignment. Living in ways that contradict who you really are.

For many chronic pain patients, there’s no longer any traceable tissue injury. In fact, for patients with lower back pain, a precise physical cause is found in only 5% to 10% of cases [5].

So what’s causing the pain?

What Your Pain Is Really Trying to Tell You

When I work with chronic pain patients, I ask them to consider what their pain might be trying to communicate. Chronic pain syndromes such as low back pain, whiplash, and fibromyalgia share the same pathogenesis—sensitization of pain modulating systems in the central nervous system, not ongoing tissue damage [6]. Not what it’s warning them about, but what it’s trying to get them to pay attention to.

Common messages include:

The need to establish boundaries. Pain often shows up when we’ve been saying yes when we mean no, giving when we have nothing left to give, accommodating when we need to advocate.

Living more authentically. When there’s a gap between your core values and your daily life, your nervous system registers that as a threat. The pain becomes a signal that something fundamental is misaligned.

Addressing overwhelm and fatigue. Sometimes pain is the only socially acceptable reason to set boundaries, to rest, to say no. It becomes the permission slip your nervous system writes when you won’t give yourself one.

I’m not saying your pain isn’t real. It is. Brain imaging confirms it. The pain is 100% real. [7]

What I’m saying is that the source might not be what you think.

Chronic Pain Management: How to Identify the Root Cause of Your Pain

So how do you know if your chronic pain is a smoke alarm (warning of danger) or an alarm clock (grabbing your attention)?

Start by becoming a detective of context.

When does your pain flare? Not just what physical activity triggers it, but what emotional or social situations precede it. Are you about to have a difficult conversation? Did you just agree to something you didn’t want to do? Are you in an environment where you can’t be yourself?

What does the pain prevent you from doing? Sometimes pain protects us from situations our nervous system has learned to perceive as threatening—even when they’re not actually dangerous.

What would change if the pain disappeared tomorrow? This question reveals what the pain might be helping you avoid or what it’s giving you permission to do (or not do).

The brain decides whether to produce pain based on context, not just tissue state. The same sensation can be interpreted as dangerous or safe depending on what else is happening in your life.

The Paradigm Shift in Chronic Pain Treatment

This reframe changes everything about how we approach chronic pain management and treatment.

Instead of fighting pain as an enemy, we can start listening to it as a messenger.

Instead of asking “What’s wrong with my body?” we can ask “What is my nervous system trying to tell me?”

Instead of seeking to eliminate the alarm, we can address what the alarm is pointing to.

Research on neuroplastic pain demonstrates that pain is often the result of learned neural pathways in the brain—and just as pain can be learned, it can also be unlearned [8]. The brain can change through neuroplasticity, recalibrating its threat detection systems.

But that recalibration requires more than just understanding. It requires action.

Chronic Pain Relief: What This Means for Your Healing Journey

If your chronic pain is functioning as an attention-grabber rather than a danger signal, the path to pain relief looks different.

You need to identify what needs attention. What boundaries need to be established? What values need to be honored? What parts of your life are misaligned with who you really are?

You need to practice neutral observation. Before attaching meaning to a sensation, simply notice it. Pain is a sensation plus an emotional interpretation. You can work with both parts.

You need to build safety in your nervous system. Not by avoiding movement or activity, but by addressing the emotional and relational contexts that keep your system on high alert.

Over 67% of individuals with chronic pain are diagnosed with conditions such as major depressive disorder or generalized anxiety disorder [9]. This isn’t coincidence. It’s confirmation that chronic pain exists at the intersection of physical sensation and emotional experience.

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience”—not purely physical [10].

Chronic Pain Management Strategies: Your Actionable Steps

Here’s what you can do this week to begin managing your chronic pain:

1. Reframe your relationship with pain. Start thinking of it as an attention-grabber rather than purely a warning signal. Ask yourself: “What might this be trying to tell me?”

2. Become a detective of context. Keep a simple log. When does your pain flare? What was happening emotionally or socially just before? Look for patterns beyond the physical.

3. Practice sensation without story. When pain arises, pause. Notice the physical sensation before you attach meaning to it. Describe it neutrally: location, quality, intensity. Then notice what emotional meaning you’re adding.

4. Identify one boundary that needs attention. Where in your life are you saying yes when you mean no? Where are you giving beyond your capacity? Start there.

This isn’t about dismissing your pain or suggesting it’s “all in your head.” Your pain is real. The question is: what is it really about?

Sometimes the most important chronic pain healing happens when we stop fighting the alarm and start listening to what it’s trying to tell us.

Your nervous system isn’t broken. It’s trying to communicate.

The question is: are you ready to listen?

Remember: your pain might not be a smoke alarm signaling danger. It might be an alarm clock—waking you up to something that needs your attention. The question isn’t whether to silence it, but what it’s trying to wake you up to.

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Ready to Go Deeper?

If this paradigm shift resonates with you and you’re ready to explore how mind-body rehabilitation can transform your relationship with pain, I invite you to:

• Listen to the full episode of Mind Your Body podcast for deeper insights into pain as an attention mechanism
• Explore my courses on neuroplastic pain and nervous system regulation at MindBodyRehabilitation.com
• Work with me to develop a personalized approach to understanding and addressing your chronic pain

Your pain has been trying to tell you something. Let’s figure out what it is.

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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.

Listen: Mind Your Body Podcast
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. Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001-1006. Available at: https://www.ncbi.nlm.nih.gov/books/NBK553030/

2. National Institutes of Health. NIH Study Finds High Rates of Persistent Chronic Pain Among U.S. Adults. 2023. Available at: https://www.nih.gov/news-events/news-releases/nih-study-finds-high-rates-persistent-chronic-pain-among-us-adults

3. Hashmi JA, Baliki MN, Huang L, et al. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain. 2013;136(Pt 9):2751-2768. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4922795/

4. Eisenberger NI. The neural bases of social pain: evidence for shared representations with physical pain. Psychosom Med. 2012;74(2):126-135. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC3273616/

5. Buchbinder R, van Tulder M, Öberg B, et al. Low back pain: a call for action. Lancet. 2018;391(10137):2384-2388. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11801457/

6. Nijs J, Van Houdenhove B, Oostendorp RA. Recognition of central sensitization in patients with musculoskeletal pain: Application of pain neurophysiology in manual therapy practice. Man Ther. 2010;15(2):135-141. Available at: https://pubmed.ncbi.nlm.nih.gov/20036180/

7. Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13-23. DOI: 10.1001/jamapsychiatry.2021.2669

8. Moseley GL, Butler DS. Fifteen Years of Explaining Pain: The Past, Present, and Future. J Pain. 2015;16(9):807-813. Available at: https://www.painreprocessingtherapy.com/neuroplastic-pain/

9. Outcalt SD, Kroenke K, Krebs EE, et al. Chronic pain and comorbid mental health conditions: independent associations of posttraumatic stress disorder and depression with pain, disability, and quality of life. J Behav Med. 2015;38(3):535-543. Available at: https://www.ncbi.nlm.nih.gov/books/NBK553030/

10. International Association for the Study of Pain. IASP Terminology. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC7578761/