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How Pain Works: The Brain is the CEO

Written By: Kendra-Lynn Bisconti, PT, DPT, PRPC on June 05, 2023

What is pain?
Pain is “an unpleasant sensory and emotional experience which follows actual or potential tissue damage or is described in terms of such damage,” as defined by the International Association for the Study of Pain. This means that pain can occur because of injury or in anticipation of injury. There can be times when you have pain, but no definitive injury or damage is occurring. 

How can this be? It’s all in how our brain and nervous system are wired to work. Our brain is the boss of our body. In other words, the brain is the CEO, and the nerves are its messengers. 
How Does Our Brain Work as the CEO?
First, the nerves send messages to the brain about what is going on in the environment and the tissues. Then the brain uses the nerves to communicate back to the rest of our body about what to do and how to respond in any given situation. 

The nerves communicate with the brain by “firing” or sending electrical impulses, like the wiring in a house. Pain can only occur when this firing happens - sending a message to the brain. The brain then must determine if this firing is a signal of danger. 

How does the brain make this decision? The answer: a combination of input from body areas (such as sensation), and several other factors including past experiences, memories, beliefs, illness, mental status, fear, the current environment, and more. 

If the brain decides that we are encountering danger, it wants to get more information from the messengers (nerves) so we can act accordingly and stay safe. This means the nerves fire even more, trying to communicate as much information to our brain as possible. When this occurs, our body becomes more sensitive.

This is an essential system for survival, however, if this increased firing continues abnormally, it can lead to persistent or increased pain even when tissues have healed. This sensitization is described in more detail in our previous post “How Pain Works: The Body’s Alarm System.” 

If the brain decides the information coming in is not dangerous, your nerves are told to quiet down, and things don’t feel as sensitive. We feel safe. 
Hurt Does Not Always Equal Harm
Because of the brain’s job as the CEO, our experience of pain does not always correlate with actual injury or tissue damage. Remember the definition of pain at the beginning of this article: pain follows “actual or potential” tissue injury. Think about a time when maybe you had a cut or a bruise, but you were not quite sure where it came from. In this situation, there was tissue damage, but you did not necessarily experience pain when it occurred. 

Just as you can have tissue damage without pain, you can have pain without having an actual tissue injury. This is a result of how your brain is interpreting and deciding whether something is dangerous or not.  

How Can We Influence the Perception of a Threat in the Brain? 
Words, images, stress management strategies, self-care, exercise, and relationships can all be helpful to change the brain’s interpretation of the incoming messages from our nerves. The amazing thing is our brains are “plastic,” meaning they are constantly changing and learning new pathways. Taking advantage of the brain’s learning processes allows us to influence the nervous system and therefore improve pain.  

Sometimes this is even more important than making changes to the painful body part itself, especially in the absence of issues in the tissues. Learning and understanding how pain works and how the brain processes pain has been shown to reduce the severity and functional limitations of pain. A skilled physical therapist can help guide you through your pain, learning more about what your triggers are, and how to manage it throughout your day. 

The Spaulding Outpatient Center for Pelvic Health at Care New England has multiple providers throughout Rhode Island who can assess and treat chronic pelvic pain. To be seen by a pelvic therapist, you will need a physician referral. 

To learn more information or schedule an appointment, click here: https://www.carenewengland.org/spaulding-pelvic-health-rehabilitation 

Disclaimer: The content in this blog is for informational and educational purposes only and should not serve as medical advice, consultation, or diagnosis.  If you have a medical concern, please consult your healthcare provider, or seek immediate medical treatment.  

Gifford, L. Pain, the tissues and the nervous system: A conceptual model. Physiotherapy (1998): 84(1).
Louw, A. et al. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice (2016).
Moseley, GL. A pain neuromatrix approach to patients with chronic pain. Manual Therapy (2003): 8(3), 130-140. 
Puentedura, EJ & Louw, A. A Neuroscience approach to managing athletes with low back pain. Physical Therapy in Sport (2012).