Mind Your Body Podcast
Inspiration: Episode #16: Make it Make Sense of the Mind Your Body podcast with Dr. Nevo.
I’ve seen it hundreds of times in my practice. Someone comes in with debilitating back pain. The MRI shows nothing alarming. Meanwhile, another patient walks in with a herniated disc visible on imaging but reports minimal discomfort.
This disconnect puzzled me early in my career.
The answer lies in how your brain processes sensations. Pain isn’t a simple alarm system that rings when something breaks. It’s a complex interpretation your brain makes based on multiple inputs, and sometimes that interpretation gets it wrong.
Your Brain Creates Your Pain Experience
Research from the University of California, San Francisco, published in Nature Neuroscience in 2023, provides direct evidence that chronic and acute pain activate completely different brain circuits in the same person [1]. When you experience chronic pain, signals come primarily from the orbitofrontal cortex, the region associated with cognitive expectation. Acute pain, by contrast, activates the anterior cingulate cortex and doesn’t persist.
This explains why treatments that work for acute injuries often fail for chronic conditions. You’re dealing with different neural pathways entirely.
The International Association for the Study of Pain states it clearly: pain and nociception are different phenomena [2]. You cannot infer pain solely from activity in sensory neurons. Approximately 85% of chronic back pain cases show what researchers call “primary pain,” meaning medical tests cannot identify any clear bodily source such as tissue damage, osteoarthritis, or disc degeneration. [3].
When 50 people without symptoms receive lumbar spine MRIs, over half show incidental findings like disc herniation or arthritis. Yet they feel nothing [4].
Your brain, not your tissues, makes the final decision about pain.
The Miscalibrated Alarm System
Central sensitization represents an amplification of neural signaling within your central nervous system. The system shifts from high-threshold nociception to low-threshold pain hypersensitivity. This phenomenon creates many of the temporal, spatial, and threshold changes you experience in chronic pain settings. [5].
Central sensitization can result in painful sensations occurring without peripheral pathology or noxious stimuli. Researchers describe this as a “sensory illusion” where you experience pain as arising from your body when the actual source is altered processing in your central nervous system. [6].
Your brain becomes stuck in a feedback loop, continuing to register pain signals despite no actual tissue damage.
Think of it like a smoke detector that becomes oversensitive. It starts going off when you toast bread, not just when there’s an actual fire. The alarm is real. The sound is real. But the interpretation of danger is miscalibrated.
How Your Limbic System Flags Threats
Your limbic system, particularly the amygdala and hippocampus, plays a critical role in assessing whether sensations are threatening and generating the emotional dimension of pain. The amygdala signals to your brain that a threat has been detected, generating feelings of anxiety, depression, and learned fear. [7].
Research shows that chronic pain and anxiety are both “of tonic and allostatic nature with similar autonomic changes” and are “derived from uncertain threats.” [8]. Negative emotions generated by your limbic system bias your attention toward pain, increasing its unpleasantness [9].
Anger, sadness, and fear literally influence pain perception in ways that exacerbate suffering.
Studies demonstrate that the association between ongoing chronic pain intensity and brain activity maps primarily to limbic-affective circuits, with trait anxiety explaining much of this relationship. Your emotional state doesn’t just accompany pain. It shapes the experience itself. [10].
Everyone Has a Unique Pain Fingerprint
Research from the University of Essex reveals that gamma oscillations, fast-oscillating brain waves linked to pain and touch, differ widely between individuals in timing, frequency, and location. Some people show no waves at all [11].
This discovery of individual “pain fingerprints” challenges the assumption that pain perception follows uniform patterns. Previous research overlooked these individual differences, discarding them as “noise” in scans, when they represent fundamental variations in how each person’s brain processes pain signals.
This explains why pain experiences are so subjective and why one-size-fits-all treatments often fail.
Your brain evolved to prioritize survival, often overestimating danger rather than underestimating it. When your brain decides you’re encountering danger, nerves fire more intensely to communicate information, making your body hypersensitive. This is essential for survival, but if this increased firing continues abnormally, it leads to persistent pain even when tissues have healed.
The Brain Can Learn to Recalibrate
A 2021 randomized clinical trial published in JAMA Psychiatry demonstrated that pain reprocessing therapy, which teaches people to perceive pain signals as less threatening, resulted in 66% of participants reporting being pain-free or nearly pain-free after just four weeks. This compared to only 20% with placebo and 10% with usual care. [12].
Brain scans revealed substantial reductions in activity in pain-processing regions including the anterior insula and anterior midcingulate cortex. The reductions were maintained one year later [13].
This provides powerful evidence that when the causes are in the brain, the solutions can be there too. By reconceptualizing pain as safe rather than threatening, patients can alter the brain networks reinforcing the pain and neutralize it.
Your brain makes the determination of pain based on a combination of inputs including sensation, past experiences, memories, beliefs, illness, mental status, fear, and the current environment. When sensations don’t align with expectations, survival instincts trigger fear and anxiety, perpetuating the pain cycle.
Questioning Your Internal Measurement Tool
You wouldn’t trust a thermometer that consistently read 110 degrees in a comfortable room. You’d recognize the tool was broken, not that the room was dangerously hot.
The same logic applies to your pain assessment system.
When chronic pain persists without clear tissue damage, when medical imaging shows nothing alarming, when treatments targeting physical structures fail to provide relief, your brain’s interpretation system may need recalibration rather than your body needing more intervention.
This doesn’t mean the pain isn’t real. The pain is 100% real. But the source may be a sensitized nervous system rather than damaged tissues.
Understanding this distinction opens new pathways for healing. Instead of searching endlessly for a physical cause that may not exist, you can address the neural patterns that maintain the pain experience.
The Path Forward
Mind-body rehabilitation focuses on helping your nervous system learn that sensations previously interpreted as dangerous are actually safe. This involves acknowledging pain signals while consciously reassessing their validity, similar to recognizing a false fire alarm.
The process requires patience. Your brain learned these patterns over time, and unlearning them takes time too. But the evidence shows it’s possible.
When you understand that your brain creates your pain experience through interpretation rather than simple signal transmission, you gain agency. You’re no longer at the mercy of mysterious forces. You’re working with a system that can learn, adapt, and recalibrate.
This understanding has broader implications for how we approach mind-body medicine. Many physical symptoms may have roots in neural interpretation rather than tissue damage, potentially transforming treatment approaches across medical disciplines.
The separation between physical and psychological health is artificial. Your brain doesn’t distinguish between them. It processes all inputs together, creating your lived experience.
Recognizing this integration points toward more effective approaches to wellness. When you address both the physical sensations and the brain’s interpretation of those sensations, you work with your whole system rather than fighting against parts of it.
Your pain is real. Your suffering is valid. And here’s what I want you to hold onto: your brain’s remarkable capacity for change means you’re not sentenced to a lifetime of pain. The same neural plasticity that allowed sensitization to develop can work in reverse. Every moment you consciously reassess a sensation, every time you move despite fear and discover safety, every instance you challenge the threat narrative, you’re literally rewiring your pain pathways. This isn’t about positive thinking or willpower. It’s about working with your nervous system’s fundamental design. You have more agency than you’ve been told. The path forward exists, and it starts with understanding that the brain creating your pain experience can also learn to interpret those same signals differently. Your healing isn’t just possible. With the right framework, it’s already beginning.
Questions to Consider
As you reflect on your own pain experience, consider these prompts:
1. When does your pain intensify? Notice the contexts, emotions, or thoughts present when pain increases. Are there patterns related to stress, uncertainty, or specific situations rather than physical activity alone?
2. What stories do you tell yourself about your pain? Do you interpret sensations as evidence of damage, or can you recognize them as your nervous system’s attempt to protect you, even when protection isn’t needed?
3. Can you recall a time when expected pain didn’t appear? Perhaps you were distracted, engaged in something meaningful, or felt safe. What does this tell you about your brain’s role in the experience?
4. What would change if you trusted that your body is safe? How might you move, engage, or approach your day differently if you knew the pain signals were miscalibrated rather than accurate warnings?
These questions aren’t about dismissing your experience. They’re about opening space for curiosity, helping you become an observer of your pain patterns rather than solely experiencing them.
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] Wager, T. D., et al. (2023). Pain in the ACC? Anterior cingulate cortex has distinct roles in pain and cognition. Nature Neuroscience. University of California, San Francisco. https://www.ucsf.edu/news/2023/05/425386/has-science-cracked-code-chronic-pain
[2] International Association for the Study of Pain. (2020). IASP Terminology. Pain Terms. https://www.iasp-pain.org/resources/terminology/
[3] Lumley, M. A., et al. (2021). Pain and emotion: A biopsychosocial review of recent research. Journal of Clinical Psychology. https://www.colorado.edu/today/2021/09/29/how-therapy-not-pills-can-nix-chronic-pain-and-change-brain
[4] Brinjikji, W., et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.
[5] Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2-S15. https://pmc.ncbi.nlm.nih.gov/articles/PMC2750819/
[6] Nijs, J., et al. (2016). How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: Practice guidelines. Journal of Orthopaedic & Sports Physical Therapy, 46(5), 344-355. https://www.jospt.org/doi/10.2519/jospt.2016.0612
[7] Simons, L. E., et al. (2014). The role of the limbic system in chronic pain. Neuroscience & Biobehavioral Reviews, 39, 61-78. https://www.eztiahealth.com/blog/limbic-system
[8] Baliki, M. N., & Apkarian, A. V. (2015). Nociception, pain, negative moods, and behavior selection. Neuron, 87(3), 474-491. https://pmc.ncbi.nlm.nih.gov/articles/PMC5826179/
[9] Wiech, K., & Tracey, I. (2013). Pain, decisions, and actions: A motivational perspective. Frontiers in Neuroscience, 7, 46. https://www.sciencedirect.com/science/article/pii/S2213158216301206
[10] Hashmi, J. A., et al. (2013). Shape shifting pain: Chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain, 136(9), 2751-2768.
[11] Nickel, M. M., et al. (2023). Individual differences in pain-related gamma oscillations. Scientific Reports, University of Essex. https://www.sciencedaily.com/releases/2023/06/230620113739.htm
[12] Ashar, Y. K., et al. (2021). 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://www.nih.gov/news-events/nih-research-matters/retraining-brain-treat-chronic-pain
[13] Ashar, Y. K., et al. (2021). Brain mechanisms of pain reprocessing therapy for chronic back pain. JAMA Psychiatry. https://www.colorado.edu/today/2021/09/29/how-therapy-not-pills-can-nix-chronic-pain-and-change-brain