Is It All in My Head? How Psychology Can Help with Your Pain

Can changing what you think, change what you feel? Can you think your way out of chronic pain?

When pain persists, it's almost never only about what’s happening in the body. It’s also about what’s happening in the central nervous system to amplify and maintain pain. I won’t go too much into how and why this is, but you can find out more in our other blogs ‍. Traditionally however, treatments have focused solely on the body, with little reference to the way sensory information from the body is processed.

How sensory perception works

Take a look at square A and square B below, and decide for yourself which is darker. If you’ve been sneaky and looked at the second image, you’ll know that they are actually the exact same shade.

What’s happening is that you perceive color/shade based on information from the checkerboard AND on information already stored in your brain, both consciously and subconsciously. The information already stored in your brain in this case will be: checkerboards follow a dark-light-dark-light pattern; and shadows and light direction influence perception.

And so what you see is based on a combination of input from your eyes, and knowledge already in your brain.

Pain is no illusion

Pain is no joke, and certainly no illusion. But what illusions are good at is showing us how perception works behind the scenes, and what factors impact what we actually experience. As a pain researcher, I wrote a book explaining pain and perception using illusion if you're interested (see here).

Now let’s take the same principle described above, and that is perception is the result of part 1: input from your senses, and part 2: things already in your brain, and apply it to pain.

Part 1: Information from the body

‍Signals from the body are what most people think of as pain. But these signals are just one potential trigger of, or contributor to, pain. These signals first bounce around the nervous system in order to interpret, and then to suppress or amplify them before anything is actually felt. So, what is it that decides how signals from the body are interpreted?

Part 2: Things already in your brain

As I showed above, the two squares appear to be different shades, not because of signals from the page, but because of how information stored in your brain changed the interpretation of those signals (at a deep and subconscious level). In that case, your expectation of what a checkerboard should look like, and what the influence of shadows normally is, were as much an influence on what you saw as the information from your eyes.

Any conscious or subconscious information your brain already holds about your body can influence whether information from your body results in a little pain, a lot of pain, or no pain at all.

The way we think about pain can contribute to it

Does science support the idea that the way we think about pain can contribute to it?

Without question. For decades, we’ve known about placebo and nocebo effects. In a nutshell, these effects can be summarized as, ‘you get what you expect’. Thinking positively or expecting to get better reduces pain, and doing the opposite, increases pain. It’s worthwhile taking a few minutes to look at this excellent animated video on the wonders of the placebo effect.

We also know that what you believe about pain can affect your pain and the rate of your recovery. For example, if you tell someone the skin on their ankle is thin and fragile and then you zap them with a hot laser, it causes more pain than if you tell them their skin is normal (Wiech et al., 2010).

Why? Because their brain takes information from the body, combines it with other information that helps it determine if there is danger, and then decides whether to sound the pain alarm. A painfully cold metal bar has also been shown to cause more pain if it is accompanied by a red light than if it is accompanied by a blue light (Moseley & Arntz, 2007).

Why? Because from a young age, we learn that red is a signal of danger.

And signals of danger from vision (or your x-ray report, or your own worrying thoughts and memories) can combine and amplify signals about potential danger from the body. We know that after an injury, people are predisposed to having ongoing pain if they are more worried or concerned about it. Examples of this worried thinking might be having thoughts like ‘it’s never going to get any better’ and believing things like ‘rest is best, because if it hurts, I’m doing more damage’.

Can changing the way we think about pain can contribute to it?

Yes. There are now lots of clinical trials showing that taking a less worrying view of pain can really help people take control. As a lecturer in the physiotherapy school at the University of South Australia, the first thing I tell my students is that good, effective treatments-based movement, along with lifestyle optimization and psychology, make no sense until you understand how and why these things can influence pain, and that pain isn’t just about signals from the body.

But wait, there’s more to it than that. Changing your perspective on pain changes the way sensory information from the body is processed. This is the discovery and life's work of one of Australia’s leading researchers (and my colleague and mentor) Professor Lorimer Moseley AO (e.g., Moseley 2015). Professor Moseley’s discovery has now taken off in many directions by other researchers: recently, in the form of a treatment called ‘Pain Reprocessing Therapy’ which has been adopted into the MoreGoodDays® program.  

How can you change the brain's information processes?

MoreGoodDays® takes a broad approach, but one thing we really aim for is for people to change the way they think about and respond to pain. Using the Pain Reprocessing Therapy approach, we help people grasp that their pain is real, but that it’s not an indicator of worrying tissue damage. We help them regain trust in their body, and we work to make this learned at a deep level that changes the way their brains work. It changes the way the brain processes information from the body.

We don’t only rely on one approach (and more research is needed) but early data testing on this approach has been astonishingly good (Ashar et al, 2022). Good to the point that even if it turns out to be half as good as early research suggests, then it needs to be a Step 1, core part of chronic pain care.