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How Does Pain Become Chronic: Understanding and Reversing the Cycle

Chronic pain is not just a physical condition; it’s also a learned pattern in the brain. Similar to how we can learn to play the piano or speak a language with practice, our brain can, unfortunately, also learn to produce pain.

How the Brain Learns Pain

Repeated activation of pain signals strengthens neural connections in the brain, making the pain response more efficient over time7. This process, called central sensitization, can cause the nervous system to become overly responsive, leading to heightened sensitivity and long-lasting symptoms.

In one ground-breaking study, researchers looked only at brain scans to predict which patients would recover from back pain and which would develop chronic pain2. Increased connectivity between the nucleus accumbens and the prefrontal cortex was a strong predictor. This suggests that our brain’s response to pain plays a huge role in whether pain fades or lingers3.

The Nervous System’s Response to Pain

When pain strikes, many of us enter a state of nervous system dysregulation. This can show up in four main patterns:

  • Fight: frustration, anger, pushing through, over-fixing
  • Flight: fear, anxiety, hypervigilance, constant seeking of help
  • Fawn: people-pleasing, perfectionism, self-pressure
  • Freeze: despair, shutdown, helplessness, emotional numbing

These stress responses can reinforce pain signals, creating a feedback loop that keeps the pain cycle going. We call this feedback loop The Sensitization Cycle.

 
 

Fear and the Amplification of Pain

Two studies demonstrate how fear and perception can amplify pain:

  • The Scary Picture Study4 showed that people experienced more pain, and even felt pain without a stimulus, when viewing frightening images.
  • The Pain-Related Fear Study6 found that individuals with more fear about their pain were more likely to still have pain six months later.

These findings highlight a critical truth: pain is not always a direct reflection of tissue damage, it’s deeply connected to emotional and cognitive factors.

Breaking the Cycle: Evidence-Based Therapies

At Pain Psychotherapy, our goal is to help you shift out of the sensitization cycle and into the desensitization cycle, teaching the brain and body to feel safe again.

 
 

We utilize the following two therapy approaches, along with several others, to support clients in entering the desensitization cycle to heal their chronic pain or illness.

Pain Reprocessing Therapy (PRT)

In a landmark clinical trial, 98% of people receiving PRT reported pain reduction, and 66% became pain-free or nearly pain-free, even after an average of 10.7 years of treatment-resistant chronic back pain1. Brain scans showed reduced activity in pain-related brain areas.

Emotional Awareness and Expression Therapy (EAET)

In a study of 230 people with fibromyalgia, EAET significantly reduced widespread pain, with 22.5% of participants experiencing at least a 50% reduction in pain5. By helping clients identify and express emotions safely, EAET calms the nervous system and reduces pain.

Are You Ready to Heal?

Book in for a free 20-minute consultation with one of our therapists to begin your healing journey:

 

  1. Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., ... & Wager, T. D. (2021). Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: A randomized clinical trial. JAMA Psychiatry, 78(11), 1–11.

  2. Baliki, M. N., Petre, B., Torbey, S., Herrmann, K. M., Huang, L., Schnitzer, T. J., ... & Apkarian, A. V. (2012). Corticostriatal functional connectivity predicts transition to chronic back pain. Nature Neuroscience, 15(8), 1117–1119.

  3. Gordon, A., & Ziv, M. (2021). The role of the brain in chronic pain. Pain Medicine, 22(2), 281–289.

  4. Kirwilliam, S. S., & Derbyshire, S. W. G. (2008). Increased bias to report heat or pain following emotional priming with fear. Pain, 137(1), 60–65.

  5. Lumley, M. A., Schubiner, H., Lockhart, N. A., Kidwell, K. M., Harte, S. E., Clauw, D. J., & Williams, D. A. (2017). Emotional awareness and expression therapy, cognitive-behavioral therapy, and education for fibromyalgia: A cluster-randomized controlled trial. Pain, 158(12), 2354–2363.

  6. Picavet, H. S., Vlaeyen, J. W., & Schouten, J. S. (2002). Pain catastrophizing and kinesiophobia: Predictors of chronic low back pain. American Journal of Epidemiology, 156(11), 1028–1034.

  7. Song, Q., Zhang, X., & Liang, Y. (2024). Neural mechanisms of chronic pain sensitization. Neuroscience Bulletin, 40(3), 211–223.

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