BLOG 3: UNDERSTANDING CHRONIC PAIN - What BRAIN SCIENCE HAS DISCOVERED

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Written by Rachel Kirkbride

The ‘Sciency’ Bit

The ‘Sciency Bit

I deliberated at first about whether the science should come before talking about the “why me?” and the practical strategies I am using in my own recovery from fibromyalgia.

In the end, the answer felt fairly simple.

In hindsight, if I were diagnosed with a chronic pain condition today, gaining a basic understanding of pain, the brain and the nervous system is where I would begin - unequivocally, every time.

As I explained in Blog 2, for years I focused predominantly on physical ways to ease my symptoms; most distressingly, constant widespread pain and muscle stiffness. Some genuinely helped to an extent, but they didn’t explain the wider pattern.

This is where that conversation deepens.

When I was diagnosed around a decade ago, this wasn't an explanation I was offered. Neither was much of what we know now about pain science as widely acknowledged or available. It was only years later that I began to discover this way of understanding chronic pain and persistent symptoms.

This is the explanation I wish I’d had at the start.

Because once I began to understand why pain can behave the way it does, so much more started to make sense.

 

A Lightbulb Moment: Understanding Pain

The explanation I wish I’d had at the beginning

The growing sense that I was missing part of the picture eventually led me to search for a pain therapist, where I was first introduced to Pain Reprocessing Therapy (PRT).¹

From there, I discovered the work of experts and clinicians including Dr John Sarno, Dr Howard Schubiner, Nicole Sachs and Alan Gordon, as well as organisations such as SIRPA UK. I immersed myself in books, podcasts, documentaries and research, trying to understand whether there might be another explanation for what I had been experiencing.

I'll admit, I was sceptical at first.

But I've always tried to keep an open mind and I'm generally of the opinion, “don't knock it until you've tried it.”

I’m so glad I did.

For the first time, I encountered the concept of neuroplastic pain (sometimes also described as nociplastic pain) and a much broader body of modern pain science, exploring the role of the brain and nervous system in persistent pain. I also discovered the earlier work of pioneering physician Dr John Sarno, who had described a mind-body approach to persistent symptoms decades before.².

What I began to understand was surprisingly much simpler than it sounds:

1. I learnt that neuroplastic pain (like many other persistent symptoms) - are real, often debilitating physical conditions. But rather than necessarily reflecting ongoing damage within the body, it can be driven by how the brain and nervous system process and interpret signals.¹ ³

2. What I hadn’t realised, is that every experience of pain is produced by the brain and nervous system - whether the source is a fresh injury, an infection, inflammation, structural pathology or a sensitised nervous system. ³

That doesn't make pain imaginary or “all in your head” in the dismissive sense in which that phrase is so often used, and indeed, I have experienced myself.

 

Your Body’s Alarm System - Pain Is a Protector

3. Most significantly, I learnt that pain is, first and foremost, a protective response. ³ ⁴

That message really began to sink in when I listened to Dr Schubiner’s 2022 podcast conversation with Dr Rangan Chatterjee.  A phrase Schubiner uses repeatedly - and one echoed throughout the work of many experts in this field - is simply:

“Pain is a protector.” ⁴

When we burn a hand or break a wrist, pain is doing exactly what it is designed to do. It encourages us to stop, protect the injured area and allow it to heal.  

It is an extraordinary and essential survival mechanism designed to keep us safe.

4. What I hadn't understood, was that sometimes this same protective system can become overprotective. Rather than settling once the original danger has passed, the brain and nervous system can continue producing pain long after the tissues have healed. Triggered by learned associations or anticipated and perceived danger - for example, sensations, movements or situations associated with previous pain, while fear, expectation or perceived threat can further influence the pain we experience. ³ ⁵

The pain is still real.

But the brain is responding as though we need far more protection than the present situation actually requires.

This genuinely felt like a lightbulb moment.

 

Stress, survival and when the brain becomes overprotective

5. This knowledge also helped me understand a connection I had already noticed between stress and my own symptoms.

During difficult periods, my widespread pain and stiffness would flare. I was more likely to develop headaches or migraines, my IBS became more troublesome and my sleep deteriorated.

And I suspect this is something many of us recognise to some extent. Have you ever noticed pain worsening, returning or even appearing somewhere new - perhaps a headache, back pain or stomach pain - when you're anxious, overwhelmed, exhausted or under pressure?

But why should our emotional state make such a difference to what we're experiencing physically?

Modern pain science gave me a possible explanation. ³ ⁴

In his 2022 conversation with Dr Rangan Chatterjee, Dr Howard Schubiner gives a brilliant example of how context and perceived danger can influence the brain's protective responses.

Imagine running across a field and breaking your ankle. Ordinarily, the pain would encourage you to stop and protect it.

But now imagine breaking that same ankle while being chased by a lion.

Suddenly, stopping isn't your brain's priority.

Surviving the lion is.

Your brain may temporarily suppress the pain so you can escape.⁴

The injury hasn't changed. The context has.

That example really stayed with me because it helped me understand something much bigger: our protective systems don't respond only to what is happening physically. They are constantly interpreting context and whether we are safe or under threat. ³ ⁴

And although, thankfully, most of us aren't regularly being chased by wild animals, modern life contains a lot of bloody “lions”!

Deadlines. Financial worries. Illness. Responsibility. Relationship difficulties. Perfectionism. People-pleasing. Constant notifications. And the hundreds of smaller pressures we absorb every day.

Our nervous systems can respond to emotional and psychological pressures as well as physical threats.

When those pressures accumulate without enough time to recover, the brain and nervous system can become increasingly sensitised. Instead of returning fully to baseline our protective systems can remain on high alert. Muscles tighten. Breathing becomes shallower. Digestion changes. And protective responses - including pain - can remain active, become easier to trigger and harder to settle, even when there is no immediate physical danger. ³ ⁵

This doesn't mean stress causes every pain condition, or that every stressful experience will produce pain. But it helped me understand why my own symptoms so often seemed to worsen when life became particularly demanding.

In her book Mind Your Body, psychotherapist Nicole Sachs describes this beautifully when she says that:

"Pain becomes the alarm". ⁶

Think about a smoke alarm. If your kitchen is genuinely on fire, you absolutely want it to sound.

But imagine an alarm that has become so sensitive it goes off every time you make toast. The alarm isn't fake. It really is ringing.

But it has become oversensitive.

Perhaps the system responsible for protecting me had simply become too good at its job.

 

Pain does not always equal damage

6. Another part of the science surprised me even more, and that I came across repeatedly, was this: pain is not always a straightforward reflection of structural or tissue damage. ³ ⁵ ⁷

I learnt that an injury can exist without experiencing pain and, conversely, pain can be experienced without any injury at all. ³ ⁷

Experts often reference scan findings as a good example. A disc bulge, hip impingement or arthritic change may be clinically relevant and absolutely should not simply be dismissed - but they do not automatically tell us how much pain a person will experience, or even whether they will experience pain at all.⁷

I discovered how, two people could have remarkably similar scan results, yet only one may experience severe pain, while the other has none.

What appears on the image matters, but so too is how the brain and nervous system interpret those signals, the wider context in which that information occurs, and whether the brain believes protection is required. ³ ⁵

For me, that was an enormous shift. For years I had assumed:

Pain = something in my body is damaged or wrong.

Now I was beginning to understand:

Pain = my brain and nervous system believe protection is required.

Sometimes that is because there is genuine injury or disease.

Sometimes an overprotective system may be contributing significantly.

And sometimes both may be happening at once. ³

 

Before assuming your pain is neuroplastic & why it doesn’t have to be either / or

7. Before assuming pain is neuroplastic, underlying medical causes need appropriate assessment.

In Mind Your Body, Nicole Sachs explains the importance of first working with a doctor to rule out causes such as cancer, infection or inflammatory disease. Where that assessment has taken place and someone is instead left with a condition considered “incurable”, she writes:

“…it’s highly likely that nervous system dysregulation is the cause.” ⁶

That process of medical investigation had been part of my own journey before I received my fibromyalgia diagnosis.

8. But I also learnt something equally important: pain does not always fit neatly into two boxes:

structural or neuroplastic.

The two are not necessarily mutually exclusive.³

Genuine structural pathology can coexist with a sensitised nervous system, and structural findings can contribute to pain without necessarily explaining all of it.³

That nuance became particularly important when I later looked back across my wider health history - including conditions where very real structural pathology had been present.

I’ll return to that later in the series.

But at this stage, considering that at least some of my symptoms might involve a neuroplastic or sensitisation component offered an entirely different way of understanding what I was experiencing.

 

Why understanding pain matters: knowledge before tools

9. Perhaps the most significant thing I noticed was how much importance the clinicians, researchers and organisations I encountered in this field placed on understanding the new neuroscience of pain.¹ ⁴ ⁵

Because it was the foundation upon which recovery is built.

I don't think that means everyone needs to acquire the equivalent of a PhD in pain science!

But, for me, a general understanding of neuroplastic pain and the brain changed everything. Because our interpretation of pain influences how we respond to it. ¹ ⁵

If every painful sensation automatically means:

Damage. Danger. Something is wrong.

then fear is a perfectly understandable response.

We protect.

We brace.

We monitor.

We avoid.

Our brain becomes even more attentive to the painful area.

But if appropriate medical assessment has taken place and we begin to understand that some sensations may reflect an overprotective nervous system rather than damage, our response can start to change. ¹ ⁵

For me, pain no longer automatically meant that my body was damaged every time it hurt, or that I needed to fear every sensation.

My symptoms were not imagined. The pain was real.  But my brain and nervous system may have learnt to produce or amplify some of that pain in a misguided attempt to protect me - keeping me safe in what Nicole Sachs often describes as an increasingly "unsafe way."

And if protection can be learnt, another question naturally follows.

Can the system learn something different?

 

Learning safety - the part that finally gave me hope

10. A general knowledge of modern pain science, led me to understand something fundamental: if the brain and nervous system can learn pain and other protective responses, neuroplasticity means they also retain the capacity to change and they can learn safety too. ¹ ⁴

This is a principle I encountered repeatedly in Dr Schubiner's work and captures a central principle in neuroplastic pain and recovery - put very simply:

If pain can be learnt, it can be unlearnt too.

Indeed, the idea sits at the heart of his longstanding work on Unlearn Your Pain. ⁴ ⁸

With the right understanding and approaches, the brain can gradually learn that the body is safer than it has come to believe. New neural pathways can be strengthened. Old danger responses can become less automatic and, over time, the brain and nervous system can begin responding differently - learning from new evidence that particular sensations, movements or situations do not require the level of protection they have come to expect is necessary. ¹ ⁴

In essence, this is also what experts such as psychotherapist and author Alan Gordon, mean when they talk about retraining or “rewiring” the brain. ¹ ⁹

In other words, for some people living with chronic pain or other persistent symptoms, substantial improvement or recovery may be possible - and in some cases, symptoms may even be reversed.

For someone who had been told that fibromyalgia was “incurable”, that understanding brought something I hadn't felt for a very long time:

Hope.

 

Next Time…

BLOG 4: THE PIONEERS AND EXPERTS BEHIND MODERN PAIN SCIENCE: FROM THEORY TO MEASURABLE PROOF


If Blog 3 has left you wondering where this new understanding of pain science came from - or simply wanting to see more of the evidence behind it - that's where we're going next.

We’ll look at how our understanding of persistent pain has evolved, from early clinical observations and pioneering ideas, to modern neuroscience, brain imaging, treatment, research, and recoveree stories, that helped me answer the question I still needed to ask:

Could I actually trust this?

 

Gentle Reminder: I am not a medical expert. Everything I share here and on Instagram is based on my own lived experience and the approaches that have helped me personally, drawing on research and literature from those who are experts. This content is not a substitute for professional medical advice. Always speak to your doctor or another appropriately qualified healthcare professional if you are concerned about symptoms or a medical condition, and before beginning a new exercise programme where appropriate.

References and further reading

The references and further reading below, inform this ongoing series.

 

Join the wider conversation

This post is part of an ongoing series exploring Chronic Pain and the mind-body connection.
If you’d like to see the accompanying Instagram reels, or related content across Chronic Pain, Pilates and Movement, Mind-Body Wellbeing, or if you’d like to leave a comment

You can find it over on Instagram @rachel_kirkbride

 

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BLOG 2: THE BEGINNING - WHEN PAIN ENTERED MY LIFE