How your brain learns pain, and how it can learn something new
In my last letter, I wrote about something I've seen again and again in thirty years as a physical therapist: two people can have the same scan, and only one of them hurts.
Today I want to go deeper into why. Because once you understand how pain really works, something important opens up. If your brain learned pain, it can also learn something new.
What the scans don't tell you
When you're in pain, it makes sense to want a picture of what's wrong. An MRI or X-ray feels like proof.
But the research tells a surprising story. In 2015, researchers looked at 33 studies of spine imaging in more than 3,000 people who had no back pain at all. Here is what they found:
Disc degeneration showed up in 37% of 20-year-olds, and in 96% of 80-year-olds.
Disc bulges showed up in 30% of 20-year-olds, and in 84% of 80-year-olds.
Disc protrusions showed up in 29% of 20-year-olds, and in 43% of 80-year-olds.
None of these people were in pain. Many of these changes are as normal as gray hair or wrinkles. They are part of living in a body over time.
The opposite is true too. Some people live with real, everyday pain while their scans look perfectly clear.
Either way, the picture and the pain don't always match. So if the scan isn't the whole story, what is?
Pain is an alarm, not a damage meter
Learning the science of pain changed how I explain it to every person I work with.
One idea changed everything for me: pain is produced by the brain to protect you. It is not a direct measure of damage in your tissues.
Think of a smoke alarm. Its job is to warn you about fire. But a sensitive smoke alarm can go off when you burn toast. The alarm is real. The noise is real. But it's not telling you the house is on fire.
Your brain works the same way. Before it decides how much something should hurt, it weighs everything it knows: what's happening in your tissues, yes, but also your stress, your sleep, your past experiences, your fears, and what you've been told about your body. If the brain senses danger, it turns the alarm up. If it senses safety, it turns the alarm down.
This is why worry can live in your body. When you're frightened, exhausted, or bracing for the next bad thing, your brain is already on high alert. And a brain on high alert is quicker to sound the alarm.
None of this means your pain is "all in your head." Your pain is real. It is being made by a real nervous system, doing its job a little too well.
How the alarm gets stuck
Your brain is always changing. Scientists call this neuroplasticity. Every time a pathway in the brain is used, it gets a little stronger, like a path through tall grass that becomes easier to walk each time you take it.
When pain goes on for months or years, the brain can get very good at making pain. The alarm system becomes more sensitive. It starts to sound for smaller and smaller reasons. Worry about the pain adds more danger signals, and the loop keeps going: pain, then fear, then more pain.
This is the part that can feel discouraging. But it's also the source of real hope.
It's not just back pain
The same alarm system runs through your whole body. That's why this isn't only about backs.
Maybe your pain moves around. Your back hurts one month, your neck the next, then your hip. Maybe it isn't only pain. It's headaches, a gut that won't settle, tiredness that sleep doesn't fix, a racing heart, or nights you can't sleep. Maybe you've seen a different specialist for each one, and every test looked at one piece at a time.
When symptoms show up in many places, it's easy to think something new is wrong each time. Sometimes it is, and it's worth checking. But often there's a common thread: a nervous system that has been on high alert for a long time. A sensitive alarm doesn't only sound in one room. It can go off all over the house.
This is true for many people living with chronic illness too. The illness is real. And on top of it, a nervous system worn down by years of symptoms, appointments, and uncertainty can turn every signal up louder.
It's not always one thing. Often it's one system, working hard to protect you.
The good news: your brain can learn safety
If the brain can learn pain, it can learn something else. This is what people mean when they talk about "rewiring the brain."
Two approaches have shaped my work here.
Understanding pain. Research has found that simply learning how pain works can lower pain and fear for many people. When you understand that a sensation is an overprotective alarm and not a sign of damage, your brain has one less reason to sound it.
Somatic tracking. This is a gentle practice I use with the people I work with. It means turning toward a sensation with curiosity instead of fear. You notice it gently, without trying to fix it, while reminding your brain that you are safe. Over time, the brain begins to learn that this sensation is not dangerous, and the alarm can quiet down.
The results can be striking. In a 2021 study published in JAMA Psychiatry, 151 adults with chronic back pain were divided into groups. After four weeks of a therapy built around somatic tracking, 66% of those in the therapy group were pain-free or nearly pain-free, compared with 20% who got a placebo and 10% who continued their usual care. Most kept their relief a year later. And brain scans showed that areas involved in processing pain had become quieter.
That is what rewiring looks like.
Try it: a few minutes of somatic tracking
You can try a simple version of this today. It takes two or three minutes.
Find a comfortable position, and let your breathing slow down a little.
Notice one sensation in your body. It might be tightness, warmth, aching, or tingling.
Get curious about it, the way you'd watch clouds move. Is it sharp or dull? Does it stay still or shift?
As you notice it, quietly remind yourself: "This is my alarm system. I am safe right now."
If the sensation changes, notice that. If it doesn't, that's okay too. The goal isn't to make it go away. The goal is to show your brain there's no emergency.
Go slowly. If it feels like too much, open your eyes and look around the room. Name a few things you can see. That's part of the practice too.
A note of care
Not every pain is an overprotective alarm. New, sudden, or changing pain always deserves a visit with your doctor. This work sits alongside good medical care. It doesn't replace it.
Maybe your scan showed changes, and you were told that's why you hurt. Or maybe your tests came back clear, and you were told nothing was wrong. Either way, if the picture and your pain don't match, I want you to know there is a way forward. Your brain learned to protect you. It can also learn that you're safe.
Stay in touch
If this sounds familiar, I’d love for you to join me on Substack, where I share new letters and you can comment and tell me what you’d like me to write about next. And if you’re ready for more support, you can book a free consultation at eveannette.com.
Sources
Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 2015. https://www.ajnr.org/content/36/4/811
Ashar YK, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain. JAMA Psychiatry, 2021. Summary: https://eurekalert.org/news-releases/929827