Tanner Murtagh Tanner Murtagh

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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Tanner Murtagh Tanner Murtagh

What Causes Neuroplastic Pain?

 

By Tanner Murtagh MSW, RSW

Many forms of chronic pain and symptoms are not the result structural damage or systemic diseases, but occur due to a rewiring of the brain and nervous system1,2,3. This is known as neuroplastic pain. Neuroplastic pain is triggered and perpetuated when the danger circuits in our brains become over-activated and our nervous systems are chronically dysregulated4,5.


Neuroplastic pain can develop in the following ways:

  1. Initial Injury
  2. Perceived Injury
  3. Stressful Situations or Life Transitions
  4. Trauma and Childhood Adversity
  5. Depression, Anxiety, or Obsessive Thinking
  6. Common Maladaptive Coping Mechanisms
  7. Feeling Unsafe in Your External World

  1. Initial Injury

    Neuroplastic pain can begin with a structural injury4. Typically, physical injuries heal within a few weeks to a few months, as our body is designed to heal. However, after an injury has healed the brain may maintain the neural pathways associated with the pain because the brain has learned to produce pain to protect you6. These learned neural pathways can be triggered and perpetuated by fear, difficult emotions and nervous system dysregulation, causing pain to continue long after an injury has healed4.


  2. Perceived Injury

    When in chronic pain, our primary fear is, “there is something wrong with my body”4. However, sometimes we incorrectly perceive an injury or believe our body is damaged. Research on pain and the brain shows us that, in absence of physical damage, fearing our body is damaged and expecting pain can trigger, amplify, and maintain pain in the brain7,8,9. At our clinic we frequently witness how fear and belief the body is damaged is enough to trigger pain, even when a client’s body is healthy.


  3. Stressful Situations or Life Transitions

    Stressful situations and life transitions, even positive ones, can trigger neuroplastic pain3,4. Events such as divorce, unemployment, going to university, having a baby, starting a new job, living through the pandemic, and experiencing the death of loved one can all cause difficult emotions and dysregulation in our nervous system. This can result in neuroplastic pain, as the brain triggers pain as a protective mechanism when the nervous system senses danger2. Pain being produced due to perceived danger is a normal survival response and a common part of being a human being.


  4. Trauma and Childhood Adversity

    Trauma can cause the brain and nervous system to become chronically dysregulated, which includes responses of fight, flight, freeze, or shutdown5. Trauma and adverse childhood experiences increase the likelihood of chronic pain developing10,11. In fact, adults are 2.7 times more likely to develop chronic widespread pain if they have significant trauma in their past, and 4 times more likely to develop chronic fatigue syndrome10,12. The connection between trauma and chronic pain and symptoms makes sense, as trauma causes our nervous system to function in a more reactive state that more readily perceives danger.


  5. Depression, Anxiety, or Obsessive Thinking

    Depression, anxiety, and obsessive thinking are signs that the nervous system is dysregulated and functioning in survival mode5,13. In our brain, the amygdala, posterior insula, anterior insula, anterior cingulate cortex, and mid cingulate cortex are involved in producing pain, emotions, anxiety, and depression14. When we are experiencing mental health concerns, both emotional pain and physical pain sensations can be produced, as shared brain regions are responsible for both14.


  6. Common Maladaptive Coping Mechanisms

    People with neuroplastic pain commonly engage in maladaptive coping mechanisms, which include perfectionism, conscientiousness, and people pleasing4. These coping mechanisms typically helped us create safety at some point in our lives, but as life changes, living this way can make us prone to self-criticism, worrying, and placing pressure on ourselves4. Over time, these coping mechanisms can cause chronic nervous system dysregulation, making us prone to developing chronic pain and symptoms.


  7. Feeling Unsafe in Your External World

    Studies have shown that social factors such as poverty, isolation, abusive or toxic relationships, race, gender and sexual orientation influence the likelihood of chronic pain developing and persisting15,16,17. Social experiences of violence, abuse, and oppression can cause us to feel unsafe in our communities and environments. “Pain is a danger signal”, and when we feel unsafe in our external world, neuroplastic pain can be triggered and perpetuated3,4.


As you can see, there are many ways neuroplastic pain can be triggered and perpetuated, unique to each person. The first step is assessment; as we gather evidence the pain is neuroplastic in nature, we can begin healing the pain at a brain and nervous system level. At our clinic we provide effective, evidence-based treatment to support our clients in reducing or eliminating their chronic pain.


Book a free 20-minute consultation with one of our therapists and begin your journey out of chronic pain today.

 

  1. Woolf C. J. (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2–S15. https://doi.org/10.1016/j.pain.2010.09.030

  2. Clarke, D. D., & Schubiner, H. (2019). Introductions. In D. Clarke, H. Schubiner, M. Clarke-Smith, & A. Abbass (Eds.), Psychophysiologic disorders: Trauma informed, interprofessioal diagnosis and treatment (pp. 5-25). Psychophysiologic Disorders Association.

  3. Gordon, A., Ziv, A. (2021). The way out: A revolutionary, scientifically proven approach to healing chronic pain. Sony/ATV Music Publishing LLC.

  4. Pain Reprocessing Therapy Center (2021). Pain reprocessing therapy training.

  5. Dana, D. (2018). The polyvagal theory in therapy: Engaging the rhythm of regulation. WW Norton & Co.

  6. Hanscom, D. (2019). Making the right choice about spine surgery. In D. Clarke, H. Schubiner, M. Clarke-Smith, & A. Abbass (Eds.), Psychophysiologic disorders: Trauma informed, interprofessioal diagnosis and treatment (pp. 83-98). Psychophysiologic Disorders Association.

  7. Castro, W. H., Meyer, S. J., Becke, M. E., Nentwig, C. G., Hein, M. F., Ercan, B. I., Thomann, S., Wessels, U., & Du Chesne, A. E. (2001). No stress--no whiplash? Prevalence of "whiplash" symptoms following exposure to a placebo rear-end collision. International journal of legal medicine, 114(6), 316–322. https://doi.org/10.1007/s004140000193

  8. Bayer, T. L., Baer, P. E., & Early, C. (1991). Situational and psychophysiological factors in psychologically induced pain. Pain, 44(1), 45–50. https://doi.org/10.1016/0304-3959(91)90145-N

  9. 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. https://doi.org/10.1093/aje/kwf136

  10. Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., Dube, S. R., & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European archives of psychiatry and clinical neuroscience, 256(3), 174–186. https://doi.org/10.1007/s00406-005-0624-4

  11. Green, C. R., FloweValencia, H., Rosenblum, L., & Tait, A. R. (2001). The role of childhood and adulthood abuse among women presenting for chronic pain. The Clinical Journal of Pain 17, 359-364.

  12. Afari, N., Ahumada, S. M., Wright, L. J., Mostoufi, S., Golnari, G., Reis, V., & Cuneo, J. G. (2014). Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Psychosomatic medicine, 76(1), 2–11. https://doi.org/10.1097/PSY.0000000000000010

  13. Dana, D. (2019). 2-Day Workshop: Polyvagal Theory Informed Trauma Assessment and Interventions

  14. Schubiner, H. & Kleckner, I. (2019). Introductions. In D. Clarke, H. Schubiner, M. Clarke-Smith, & A. Abbass (Eds.), Psychophysiologic disorders: Trauma informed, interprofessioal diagnosis and treatment (pp. 5-25). Psychophysiologic Disorders Association. 

  15. Mills, S. E. E., Nicolson, K. P., & Smith, B. H. (2019). Chronic pain: a review of its epidemiology and associated factors in population-based studies. British journal of anaesthesia, 123(2), e273–e283. https://doi.org/10.1016/j.bja.2019.03.023

  16. Schubiner, H., Jackson, B., Molina, K. M., Sturgeon, J. A., Sealy-Jefferson, S., Lumley, M. A., Jolly, J., & Trost, Z. (2023). Racism as a Source of Pain. Journal of general internal medicine, 38(7), 1729–1734. https://doi.org/10.1007/s11606-022-08015-0

  17. Zajacova, A., Grol-Prokopczyk, H., Liu, H., Reczek, R., & Nahin, R. L. (2023). Chronic pain among U.S. sexual minority adults who identify as gay, lesbian, bisexual, or "something else". Pain, 164(9), 1942–1953. https://doi.org/10.1097/j.pain.0000000000002891

 
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