Often people in pain that are being educated around pain and the brain will often ask this. You may have asked it yourself, or been asked it as a therapist. The true and simple answer is YES, any painful experience will be produced by the brain. BUT this does not mean than anyone is insinuating that or that your pain is not real. This blog will hopefully answer some of the questions you have, or give you practical examples you can use with patients to help with their understanding.

Firstly let’s discuss some basic simples, as to why we experience pain. Pain is commonly in the general public seen to be associated with damage. Research and real life examples have proven this not to be a true fact of life (reference). Life example of this would be a migraine, paper cut, menstruation and sun burn; where no to minimal damage is occurring but pain levels can be severely high.

Pain is more associated with the threat of harm or injury and is important to protect us. Aka after a sprain or fracture, we experience pain when putting weight on our injured foot initially to take the weight off of the foot and allow it to heal. Because every part of our brain is interconnected and is in constant conversation with other areas of our brain, pain can also be influenced by mood, stress, thoughts, beliefs and previous experiences. A practical example of this could be that you sprained your back 3 years ago at the same time you were under stress at work and believed you were possibly going to be made redundant. 3 years on, your back had healed and got better but you were again under stress at work or in your personal life and your back pain has returned despite no injury or damage caused. This video is a great example of how previous experience and thoughts are linked to a painful experience (Snake Bite).

That is a very basic overview of pain and would recommend this resource for any further reading or more information (PainBooklet).

Why does pain persist then?

So if we know that your injury would have healed or that there is no structural damage occurring why does pain persist?

This is because our CNS (central nervous system) can get very sensitive after an initial painful experience and continue to fire painful messages long after an injury has healed.

Our CNS is the processing centre of our body. It is connected to our spinal cord and to the rest of our body by our nerves. It is similar to that of a electrical circuit of a computer where messages are sent via our nerves to our CNS where they then get interpreted and our brain then decides what information it needs to send back. This can include sensory information such as pain or a motor output such as a reflex.

The posh term for the process of the CNS becoming sensitive is central sensitisation

What does becoming sensitive mean?

The simplest way to think about how this happens is to imagine the CNS as our own alarm system. If it feels that we are in danger or need protecting from something it will let us know by sending a sensation to a certain area of our body to make us aware what is happening there.

This alarm system can become oversensitive similar to the way in which a fire alarm can. Think about how many times the fire alarm has gone off at either your home or in your place of work, probably several times. How many times has there been a real fire? Probably never. Why does it usually go off? Usually for a burnt bit of toast. So the alarm system is going off when we do activity that is not harmful and is going off at a rate which is unnecessary for the activity we are doing; like getting a sudden flare-up of back pain when getting something from the freezer.

So if it’s in my head, I can turn it off?

Unfortunately not. The continuous nerve firing that is happening because of our oversensitive CNS is an automatic action. This is similar to how we breathe, blink and the feeling of an itch. Our body will do it without conscious thinking.

Another simple way to visualise this is the occasional feeling of falling before we wake up. Although it’s not actually happening and we are not physically harming ourselves we undergo physical and psychological changes. Our heart rate increases, we become out of breath and we feel scared or frightened.

Could you stop your heart rate, breathing or fear before the feeling of falling? No.

How do we become less sensitive?

The first step is understanding why you are in pain. If you are aware of this process and that we are not causing ourselves harm or damage then we are more likely to use the injured limb. By doing this it will become stronger and longer. You will also be less fearful of moving and doing physical activity and feel less stressed about the potential outcome. There is strong evidence to suggest that these emotions of fear and stress can contribute to a pain experience (reference). A practical way to demonstrate how we hurt more when we are stressed is comparing different times when you stub your toe. For example if you stubbed your toe when you are angry at your partner compared to when you are out for your birthday, which would hurt more?

The second step is to get going again! Once you start exercising and getting stronger, your nervous system starts to become less sensitive. A nice easy way to imagine this is to imagine your brain like an overprotective parent. The first time their child falls over, the parent is very anxious and worried about the wellbeing of their child. Once they realise that the child is not harmed the fear reduces. The next time they fall over, the parent is less anxious and concerned. This is similar to how our CNS becomes less sensitive as it starts to realise that movement or activity we are doing isn’t harmful and doesn’t require the painful and over-reactive response that occurs.

So at this point you can either throw yourself in the deep-end and go and play that game of squash you haven’t done for a year, or return to playing football or start up jogging. Or you can gradually expose yourself. This may be starting off lightly with a few different exercises and building up the amount of repetitions, frequency of the exercise, or the resistance.

As always, if you are struggling with this or want reassurance that this is safe for you to do, then get yourself referred to a health professional. Or alternatively get in touch with myself for any advice or appointment enquiries!

So to summarise:

  • Pain is always produced in your head whether you stubbed your toe or slept awkwardly
  • Pain is not linked to damage or the severity of damage
  • Pain can be influenced by stress, beliefs, emotion and fear
  • Pain usually persists secondary to increased sensitivity, NOT further damage
  • Central sensitisation is automatic and can’t be just switched off
  • Getting moving again and exercise can help decrease this sensitivity
  • Finding ways to decrease stress and fear can help decrease pain
  • Struggling to get going? Ever in doubt, get checked out!

Thanks for reading and please leave any comments or requests below!

Charlie Ludlow




3 thoughts on “Are you saying it’s all in my head?

  1. Thank you for the nice journal you had taken my brain into.
    Your article had answered many questions in my head, and let me think more deeply in cases of my patients.
    It is really amayzing how our body works!

    Liked by 1 person

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