Chronic pain: the mind-pain connection

When pain is ongoing, it’s not just about damaged or unhealed tissues. Science shows that the brain has an important role in how we feel and interpret pain.

“We now understand that the brain and the nervous system are very good at learning,” says Neala Fulia, CEO of at-home pain program, More Good Days.

“This means that if pain has been around for a while, the nervous system can get better at producing pain.”

“We also know the body’s stress system and pain system are closely linked. This means ongoing stress can keep the pain system switched on, making the body more sensitive and reactive.”

Pain serves an important purpose, to warn, protect, and guide healing by alerting our bodies to danger or harm.

But pain that persists beyond the expected healing time (also known as chronic pain) can cause changes in the nervous system that make the body more sensitive to pain signals. This can cause a vicious cycle, called the mind-pain feedback loop, that is no longer protective.

If someone's pain is mainly being driven by the nervous system rather than ongoing physical causes, it's possible to retrain the brain so that pain reduces, and in some cases, resolves completely.¹

When your brain can interpret messages from your body as safe and not dangerous, the pain system can realise it doesn’t need to protect you.

There are several ways to break the mind-pain feedback loop:

Learning about your pain is the first, really important step.

If you’re experiencing ongoing pain, it’s likely to be best managed by a team of health professionals. Doctors, physiotherapists, exercise physiologists and psychologists could all have a role to play in helping you get on top of chronic pain.

Your healthcare team may encourage you to explore what’s driving your pain. What makes it better or worse over time?

The science of pain is complex. But the simple formula is: If there are enough reasons for your brain to protect you, you will have pain.

And if there are not, then you won't have pain. The challenge becomes finding and slowly retraining all the reasons for pain that are no longer protecting you.

This might be easier said than done, but it’s an important part of managing chronic pain.

“The brain tends to amplify whatever it's paying attention to,” explains Neala. “If you're constantly checking your pain, touching it, or worrying about it, it can actually make the pain louder and worse.”

With the support of your treating team, try to continue engaging in everyday activities.

Avoiding movement, work, or life in general can tend to make chronic pain worse. Finding ways to engage in activities that shift your attention may help turn down the volume of pain.

When something hurts, it's natural to stop moving so you don’t worsen the pain. But this isn’t always the best approach.

“When we are worried that movement might cause damage, it's natural to tense up or avoid activity altogether,” says Neala. “Over time, this can lead to more tension, reduced physical conditioning, and contribute to more ongoing pain.”

Aim for gentle, controlled movements and low-impact exercises prescribed by a GP or physiotherapist to help improve mobility and strength.

“Because the stress and pain systems of the body are closely linked, ongoing stress keeps the pain system switched on,” says Neala. “Stress is a key thing to target when it comes to helping with ongoing pain.”

“Certain patterns of thinking, particularly fear or worry about the pain, can make it worse.”

Mindful meditation may reduce activation in brain regions that process pain signals.²

You can find free guided meditations at Headspace, Calm, and Smiling Mind.

Pain Reprocessing Therapy (PRT) can help rewire pathways in the brain and nervous system to switch off chronic pain.

It involves educating about pain processes, reducing threat levels by focusing on safe sensations, and addressing lifestyle factors that contribute to a high-alert state.

“Pain Reprocessing Therapy is a technique where you gently observe pain sensations in your body without fear or judgment,” explains Neala. “Over time, you send messages of safety in your body to retrain your pain system to reduce pain over time.”

“Over time, the brain learns that these sensations of pain are not dangerous. This breaks the cycle where pain triggers fear, and fear triggers more pain. It’s not a quick fix, but it can make a meaningful difference for many people.”