Footstep 1

Pain and the Brain

Persistent pain is very different from the kind of pain you experience when you touch something hot or injure yourself. It goes on long after the original cause, and affects different parts of the brain and nervous system.

Sensations can resemble the original injury or damage, so it feels as though the damage has not healed, when it actually has. It’s like a radio switched on permanently and the volume turned up.

So what can change? Is it possible to turn the volume down?

Pain and the brain – how it really works

Many of us have a very simple view of how pain works...

But in reality, pain is a two-way street...

Pain is one of our protective systems. It is designed to keep us safe and well, and it’s controlled by the brain.

Our brain decides when to protect us based on information it receives from: 1) areas of the body, and 2) many other factors it gathers from elsewhere

It assesses the current situation based on both these types of information.

If the brain decides it needs to protect, pain will happen.

In persistent pain, even though the original trigger for the pain may have stopped, the other factors are still there, so the brain becomes over-protective and keeps the pain going. It’s a bit like the brain struggling to turn down the ‘volume control’.

Persistent pain can cause a range of problems, including:

Excitable nerves. Slight pressure can cause unpleasant and painful sensations like pins and needles or electric shocks.

Sensitivity. Skin, muscles or nerves can be more sensitive to pressure, touch or heat.

Faulty brain activity. The systems that turn down pain don’t work.

Low mood. Living with persistent pain can cause strong feelings such as anger and frustration.

So what can you do to reduce persistent pain?

It can come as a bit of shock to realise that, to reduce your pain, you need to help your brain to turn the pain down.

You can retrain the brain by getting fitter and stronger, balancing your activities and focusing more on your valued goals and less on the pain.

Over time as you are living a more healthy life, being more active and doing things normally and focusing on living life, your brain will become less overprotective and your pain more manageable.

The rest of the Footsteps in this online resource will show you more about how to do this.

As people who have learned to self manage say: “I now run my life rather than the pain running it.”

Pain is a very isolating and invisible – no one else can see or feel your pain. This adds to the frustration of living with it.

Emotions like anger, anxiety or depression can wind up pain nerve networks making them more sensitive. Try to remember: “this is not your fault.”

Find out more about pain and emotions in Footstep 6 - Managing moods

Resources for you to use

What is pain?

by Dr Patrick Hill A simple explanation of pain, long term or chronic pain and fatigue.

Explaining Pain

There’s an awful lot about persistent pain that people don’t understand. This booklet explains:

  • what persistent pain is
  • what is going on inside us when we have persistent pain
  • why people develop persistent pain in the first place
  • how persistent pain makes us feel and what we can do about it

Managing pain with medicines

Opioids (‘strong painkillers’) can be really useful for a short time – after an injury or surgery. But longer term they aren’t much help. They only reduce pain for about 10 percent of people in the long term. And they cause powerful side effects and even addiction.

This handy leaflet helps you think about whether your pain medicines are really helping.

Flippin’ Pain

Flippin’ Pain is a public health campaign, with a clear goal: to change the way people think about, talk about and treat persistent pain. Their website has some very useful information to help you understand more about your persistent pain.

Pain and the Brain: key ideas

  • Persistent pain is different from the kind of pain you experience when you injure yourself
  • It goes on long after the original damage has healed – it's as if the brain can no longer 'turn down the volume'
  • Reducing persistent pain involves retraining your brain
  • Learning self management skills so you can live your life despite the pain are the best way to 'turn down the pain'