Your Brain on Pain- When Chronic Pain Changes the Way We Think and Feel (Guest Spotlight)
By Faith Davis
If you’re living with chronic pain, chances are you’ve thought at some point, ‘I just don’t feel like myself anymore.’ Research now shows that feeling isn’t all in your head — it’s actually in your brain.
Chronic pain can change the brain’s structure and chemistry, particularly in areas involved in emotion, memory, and motivation. Many of these areas of the brain are responsible for what makes you feel like you. When they’re disrupted by pain, it can leave you feeling isolated and distanced from yourself. Understanding how these changes occur can help with managing chronic conditions and knowing when to seek support.
Acute vs Chronic Pain: When the Alarm Won’t Stop
The brain processes temporary pain, called “acute pain”, and chronic pain a bit differently. Acute pain is the type of transient pain you may experience in response to an injury or illness — like stubbing your toe. When your toe encounters a high amount of pressure from being jammed against something, that pressure triggers special messengers to send pain signals to the brain. These signals can be sent in response to a variety of pressure, temperature, or chemical changes, like those involved with tissue inflammation, that the body experiences.
In response to acute pain, a pain signal is only communicated to the brain when an injury or illness occurs, and while it’s healing. When the injury or painful trigger disappears, so does the pain. Things change when pain becomes chronic.
In some chronic conditions, pain is caused by ongoing injury or illness; in others, pain can be experienced by the brain even when the body is healthy. Due to changes in how the brain processes pain itself in chronic conditions, some people may experience both.
Over time, constant pain can also change some of the ways emotions are processed, increasing the risk of negative emotional experiences alongside painful ones. These complex changes in pain and emotional processing can add to the mental stress experienced by people living with chronic pain.
The Connection Between Pain and Emotion
Pain and emotions have a close relationship in the brain. Pain is processed both by regions of the brain that inform us about the sensory world — things you taste, touch, see, hear, and smell — and by regions of the brain that typically inform our emotional world. This is why stubbing your toe may not only be painful, it can also make you angry, or cause you to cry.
In chronic conditions, this means that increased or abnormal pain signals can also lead to frequent negative emotional signals- like persistent feelings of sadness. When this happens, it can change how we think and feel on a daily basis. Understanding how these two systems overlap may help explain why many people living with daily pain also experience persistent negative emotions.
We can think of pain processing in the brain like a mailing system. One pain signal is like a single letter being mailed. Just like a physical letter, that signal is sent along a defined “mail” route until it reaches its destination. For most pain “letters”, this route includes stops at the brain’s emotional processing centers.
In acute pain, these centers receive the message of pain and send back a negative emotion associated with it. But just like the pain itself, this negative emotional experience is temporary. You hit your head, shed a tear, and continue with your day.
In chronic pain, however, the more that pain itself occurs, the more often negative emotional signals are released by these brain regions. Using our letter analogy, if acute pain is sending one letter a day, chronic pain is sending a thousand. With that many letters, it’s easy for messages to go to the wrong address or get sent out at the wrong time.
These constant pain signals disrupt the natural pain and emotional messaging systems. Negative emotional signals that should have only been released in response to pain can start to be released spontaneously — even in the absence of physical pain itself. This can result in broad spectrum changes in a person’s daily mood and cause persistent negative feelings like depression, anxiety, and increased irritability.
When the Messages Get Disrupted
In normal pain responses, a specific amount of a trigger, like pressure or temperature, has to occur in order for you to feel pain. This is called a pain threshold. It’s what allows a gentle hug to feel good, but for it to feel painful when someone squeezes you tightly. That extra squeeze meets the pain threshold that allows for a message of “pain” to be sent to the brain — and for you to tell the person to hug a little softer.
Problems arise when the brain receives pain signals too often. Constant pain causes the brain to lower its threshold for how much of a trigger is required before sending off the message that you’re in pain. So, that once-pleasant hug could suddenly be enough to send out a painful message and be experienced as equally as painful as a tight squeeze. This an example of how those suffering from chronic pain may experience ordinarily arbitrary sensations as painful ones. In essence, chronic conditions can produce pain in ways that have nothing to do with the original injury or illness, making long term care and diagnosis challenging for many individuals.
Pain thresholds are not the only ones that can be lowered by constant pain messages. Thresholds for triggers of other types of communication in the brain can also be affected by
chronic pain. Some of the brain regions involved in the emotional processing of pain are also involved in learning and memory. Similar to how a certain amount of a painful trigger is needed to send a message of “pain” to the brain, these regions require certain amounts of other triggers to communicate to the brain if we need to remember or recall something.
Research has shown that people with chronic pain have lower thresholds for triggering one of the factors that prevents necessary processes for learning and memory from occurring. This means that successful learning and memory recall is likely being prevented more often than it should. It’s possible this difference contributes to why chronic pain sufferers report worsening memory or general “brain fog”.
Changes to Brain Structure
If you don’t feel like yourself since dealing with chronic pain, it’s likely due in part, because your brain is not structurally the same as it was before the pain started. In chronic pain sufferers, certain parts of brain cells themselves change their physical structure over time to adapt to the new demands of processing constant pain signals. This can affect the way those cells communicate in subtle ways, even when performing non-pain related communication for daily tasks.
Research has also found that some regions of the brain, such as those involved in motivation and emotion, can decrease in volume over time in the brain of a chronic pain sufferer. This means that those parts of you that let you feel motivated to get up early and start your day, or give you the patience to deal with small annoyances, are less active overall when living with pain. Making motivation-based tasks and emotional management much more of a challenge than they would be in the absence of chronic pain.
Adjusting to the Changes
Studies have found that the best way to address these brain changes is by treating the cause of chronic pain itself. That’s why it’s important to continue to consult with your doctor and let them know the challenges you’re facing both physically and mentally.
However, when pain persists despite treatment, it can be helpful to give yourself grace, knowing that your brain is constantly adapting to care for itself and the demands of the body. Remind yourself that it’s normal to feel a little different these days, because your brain is different. But there is hope.
Just because your brain has changed, that doesn’t mean it can never change again. Seeking out the right resources, including mental health therapy, can help support the “re-wiring” of some of the disrupted signals chronic pain can cause improving emotional regulation and motivation, and helping get you back to feeling like you again.
Note from Destiny: I'm excited to introduce a new feature on the blog—guest spotlights from experts and writers doing important work at the intersection of chronic illness, neuroscience, and mental health. This piece by Faith Davis beautifully explains the neuroscience behind why chronic pain affects so much more than just our bodies. As a licensed counselor who works with chronically ill clients, I think this information is crucial for understanding the full scope of what people are dealing with when they live with persistent pain.
Disclaimer: Everything we discuss here is just meant to be general education and information. It's not intended as personal mental health or medical advice. If you have any questions related to your unique circumstances, please contact a licensed therapist or medical professional in your state of residence.
Faith Davis is a freelance science journalist specializing in neuroscience, healthcare, and disability reporting. She has a bachelor’s degree in neuroscience and previously worked as a paramedic for emergency ambulance services. Her work has appeared in Grey Matters Journal and other healthcare publications. Faith is also the author of The Synaptic Press blog. Read her work at thesynapticpress.com or view her featured portfolio at https://faithdavis.journoportfolio.com.
Meet Destiny - The host of The Chronic Illness Therapist Podcast and a licensed mental health therapist in the states of Georgia and Florida. Destiny offers traditional 50-minute therapy sessions as well as therapy intensives and monthly online workshops for the chronic illness community.
Destiny Davis, LPC CRC, is solely responsible for the content of this article. The views expressed herein may or may not necessarily reflect the opinions of Sarah Stasica.