Chronic pain is more than just an annoying ache that lingers for too long—it's a condition that millions of people struggle with daily. What makes chronic pain so frustrating isn’t just the discomfort itself but how deeply it affects both body and mind. Here’s something that might surprise you: chronic pain can actually change the structure and function of your brain. This discovery helps explain why conventional treatments often fall short and points to new approaches that could offer real relief.
Pain as a Brain Thing
Think of pain as your body’s natural alarm system, a way to say, “Hey, something’s wrong—pay attention!” It’s a protective mechanism that’s meant to be temporary. But when pain lingers and turns chronic, it’s not just a signal anymore. It becomes a condition that feeds itself, fueled by the brain’s remarkable ability to adapt, or what researchers call neuroplasticity.1 Neuroplasticity is usually a good thing—it’s how we learn new skills, adapt to change, and recover from injuries. But when it comes to chronic pain, this adaptability can backfire.
Studies have found that chronic pain can rewire the brain’s sensory pathways and mess with how pain is processed. This rewiring can lead to something called central sensitization, where your brain becomes so sensitive that it starts flagging non-painful signals as painful.2 Essentially, the brain recalibrates itself in a way that locks in the perception of pain, even when the original injury has healed.
What Happens in Your Brain During Chronic Pain?
Brain imaging studies have revealed some startling facts. For starters, people dealing with chronic pain often show changes in the brain regions responsible for processing pain, like the prefrontal cortex, thalamus, and the limbic system.3 These areas do more than just scream, “Ouch!”—they also handle mood, attention, and memory. So, if you’ve ever wondered why chronic pain is often accompanied by anxiety or depression, there’s your answer.
For example, researchers have noticed that chronic pain can lead to a decrease in gray matter in areas like the prefrontal cortex and hippocampus.4 Why does that matter? These brain regions are involved in decision-making and memory. Less gray matter means the brain’s ability to manage pain and stress goes down, trapping individuals in a cycle of discomfort. On top of that, the amygdala—the part of the brain that processes emotions—tends to light up more in people with chronic pain, which can amplify feelings of distress.5
Chronic Pain's Emotional Ripple Effect
Chronic pain isn’t just a physical experience—it’s an emotional one, too. The longer pain sticks around, the more it disrupts the brain pathways involved in processing emotions. This disruption is why chronic pain is often linked to mood disorders like anxiety and depression.6 The relationship goes both ways: emotional stress can heighten pain perception, and ongoing pain can fuel emotional stress, creating a cycle that’s tough to break.
This connection explains why it’s so important to treat both the body and the mind when addressing chronic pain. Failing to do so can leave people stuck in an endless loop where pain and emotional distress reinforce each other.
The Mindset of Endurance Athletes
Interestingly, not everyone experiences pain the same way. Extreme endurance athletes, for example, are known for their exceptional ability to push through intense physical discomfort. Their secret? They train their brains to think about pain differently. Research indicates that athletes may develop strategies to manage and reinterpret pain through mental conditioning and cognitive training, enabling them to approach discomfort in more adaptive ways. This process involves techniques such as focusing on the purpose behind the pain or reframing it as a signal of progress, which can shift the emotional response to pain. These techniques often involve dissociating from the pain or embracing it as part of their training, effectively changing their emotional response.
One notable approach is known as “pain reappraisal,” where individuals actively reinterpret pain signals as non-threatening or as a sign of progress. This mindset doesn’t eliminate the pain, but it makes it more manageable by reducing its emotional effect. This cognitive shift can even dampen the activation of brain areas responsible for emotional distress, such as the amygdala and anterior cingulate cortex.7
Endurance athletes also benefit from an increase in endorphins and other neurochemicals that enhance pain tolerance and create a sense of euphoria, known as “runner’s high”.8 These natural opioids can help them push their pain threshold higher than the average person, illustrating the incredible power of the brain to influence pain perception.
Rethinking How We Treat Pain
Recognizing that chronic pain rewires the brain changes the treatment game. Instead of only using painkillers or physical therapy—which might help but don’t get to the root of the problem—new approaches are focusing on how to retrain the brain itself.9 Enter cognitive-behavioral therapy (CBT), mindfulness practices, and neurofeedback.
CBT can be a game changer because it teaches people to rethink how they view and react to their pain. This can lower the emotional burden and help tone down the brain’s overactive pain signals. Mindfulness-based approaches work similarly by helping individuals observe their pain without judgment, which can break the cycle of pain amplification.10 Neurofeedback, a newer treatment, takes it a step further by allowing people to train their brain to change specific brainwave patterns associated with chronic pain.
Looking Ahead
Thinking of chronic pain as a condition that’s partly rooted in the brain shifts our understanding and opens up new, promising ways to treat it. This perspective helps explain why some traditional methods don’t provide lasting relief—they don’t tackle the brain’s role in sustaining pain. By targeting the neural mechanisms that maintain chronic pain, innovative treatments can help recalibrate the brain and disrupt pain pathways.
Future therapies may combine these psychological and neurophysiological strategies for a more holistic approach. For instance, incorporating brain stimulation techniques such as transcranial magnetic stimulation (TMS) or deep brain stimulation (DBS) could complement CBT and mindfulness practices, enhancing their effectiveness. Advances in personalized medicine, driven by better imaging technology and machine learning, could also make it possible to tailor pain management strategies to each person’s unique neural profile.
Ultimately, chronic pain may change the brain in significant ways, but that same adaptability also offers a path to recovery.
Apkarian, A. V., et al. (2011). Chronic pain patients are impaired on an emotional decision-making task. Pain, 152(9), 2190-2199. https://pubmed.ncbi.nlm.nih.gov/15109516/
Tracey, I., & Mantyh, P. W. (2007). The cerebral signature for pain perception and its modulation. Neuron, 55(3), 377–391. https://doi.org/10.1016/j.neuron.2007.07.012
Baliki, M. N., Mansour, A. R., Baria, A. T., & Apkarian, A. V. (2014). Functional reorganization of the default mode network across chronic pain conditions. PloS one, 9(9), e106133. https://doi.org/10.1371/journal.pone.0106133
Seminowicz, D. A., Laferriere, A. L., Millecamps, M., Yu, J. S., Coderre, T. J., & Bushnell, M. C. (2009). MRI structural brain changes associated with sensory and emotional function in a rat model of long-term neuropathic pain. NeuroImage, 47(3), 1007–1014. https://doi.org/10.1016/j.neuroimage.2009.05.068
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Tracey, I., & Mantyh, P. W. (2007). The cerebral signature for pain perception and its modulation. Neuron, 55(3), 377-391.
Dietrich, A., & McDaniel, W. F. (2004). Endocannabinoids and exercise. British Journal of Sports Medicine, 38(5), 536-541. https://doi.org/10.1136/bjsm.2004.011718
Eccleston, C., et al. (2013). Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews, (11), CD007407. https://doi.org/10.1002/14651858.CD007407.pub3
Zeidan F, Vago DR. Mindfulness meditation-based pain relief: a mechanistic account. Annals of the New York Academy of Sciences. 2016 Jun;1373(1):114-127. DOI: 10.1111/nyas.13153. PMID: 27398643; PMCID: PMC4941786.