Chronic Pain Isn't Just Physical It's Learned by the Brain

Areas of pain around the body

If chronic pain is pain that lasts longer than three months, what do we call pain that has lasted longer than ten years? At that point, it feels less like a diagnosis and more like a long-term relationship no one asked for and can’t seem to break up with.

I’ve tried nearly every treatment available from physical therapy, ortho specialists, spine specialists, massages, acupuncture, cryotherapy, Ayurveda, medications, different diets, yoga, pilates, and the list goes on. I’ve had test after test. Over and over again, the results came back mostly normal. That’s when I started learning more about the science behind pain, not because I was curious, but because I was desperate for answers. While trying to heal myself, I learned that chronic pain isn’t just pain that lasts a long time. It’s pain that changes the way the nervous system works.

When pain persists for weeks, months, or years, the brain and nerves don’t keep reporting the same signal, they adapt to it. Pathways strengthen. Responses speed up. The nervous system becomes more efficient at producing pain, even when the original injury has healed or can no longer fully explain the intensity of symptoms. This doesn’t mean the pain is imagined. It means the body learned pain and learned it very well.

I didn’t understand this until much more recently. When many of my test results kept coming back negative, I was in deep denial. How could this much pain not be structural? How could something so physical, so limiting, not show up on scans? Accepting this explanation felt almost insulting at first, but it was also the first one that didn’t require my body to be irreparably broken. This type of pain is often referred to as neuroplastic pain.

Chronic Pain Is a Nervous System Condition

Acute pain is protective. It’s the sharp signal that tells you to pull your hand away from a hot stove or rest an injured joint so it can heal.

Chronic pain is different. It persists long after tissues should have healed. Over time, pain stops being a warning and becomes a state the nervous system maintains. In chronic pain, the brain is no longer simply responding to danger, it’s anticipating it.

This could explain why my hip and quad would start hurting the moment I put my gym pants on. My body was already expecting my workout to hurt me. I was probably unconsciously clenching, bracing, and preparing for pain before I even moved. Looking back, my body wasn’t betraying me. It was trying to protect me the only way it knew how.

It might also explain why my back would start hurting the moment I thought about doing a dance performance. Dance stresses me out, not because I don’t love it, but because my mind immediately jumps to "Will this hurt me?" My body answers that question before I ever step on stage.

Neuroplasticity: How the Brain Learns Pain

Neuroplasticity refers to the brain’s ability to adapt based on experience. It’s how we learn languages, build habits, and recover from injury. Pain uses this same mechanism.

When pain signals fire repeatedly, the brain becomes faster and more efficient at producing them. Pathways strengthen. Thresholds lower. Over time, it takes less and less input to trigger the same or even greater pain response. The nervous system isn’t broken. It’s doing exactly what it was designed to do: adapt.

I had moderate whiplash from a rear-end car accident when I was 16. Medications, physical therapy, chiropractic care, cryotherapy, numerous types of massages and none of it fixed the problem. The pain was excruciating and lasted three years… and then one day, it magically disappeared. But not long after, a new pain showed up in my right hip and IT band. That pain lasted years too, followed by lower back pain. Lately, instead of staying in one place, the pain seems to rotate between my neck, hip, and back.

For a long time, this shifting made me doubt myself. The last thing I would have thought is my chronic pain is coming from a highly overactive nervous system. It felt random and unpredictable until I learned that learned pain pathways don’t follow anatomical rules. Just today, my neck hurt in the morning and my hip hurt in the afternoon. I used pain reprocessing techniques to manage it.

The Brain, the Spinal Cord, and Amplified Signals

In chronic pain states, the spinal cord can amplify incoming signals before they ever reach the brain. Sensory input such as pressure, movement, even light touch that once registered as neutral may now be interpreted as threatening. This process, often referred to as central sensitization, helps explain why pain can feel widespread, unpredictable, or completely disproportionate to physical findings.

I realized central sensitization was definitely part of my issue when six reps of cable squats at ten pounds instantly tightened and caused pain in my right hip which had been perfectly fine moments earlier. After some deep breathing and distracting myself for a while, the pain was gone. That moment didn’t cure me, but it changed my awareness and future reactions.

Stress, Safety, and the Pain Loop

The brain processes pain in the same regions involved in threat detection and emotional regulation. When the nervous system perceives ongoing danger, physical or emotional, it stays on high alert. Stress doesn’t cause chronic pain, but it absolutely can fuel it by reinforcing the brain’s expectation of threat. Over time, pain and stress form a loop, each amplifying the other.

I’ve had back pain flares start after receiving a stressful email or text. I remember watching dance practice for my cousin’s wedding. As I imagined myself performing in front of a crowd, my back started aching and clenching from anxiety. Nothing had physically happened to me, but my body reacted as if something had.

This Does NOT Mean the Pain Isn’t Real

Understanding the brain’s role in chronic pain does not make the pain psychological, imagined, or exaggerated. Pain is always real. It is a lived sensory experience. What changes is where and how the signal is being generated, not whether it exists.

I used to wonder why posture, form, and exercise didn’t “fix” me. I know people who do none of those things and somehow aren’t in pain at all. With the strange triggers and how intensely tiny movements can hurt my back, I knew there had to be a different explanation. I’m still searching for a clear diagnosis, but I know this is a major factor. I’m not afraid of treatment, I’m afraid of getting a band-aid solution that temporarily quiets symptoms while catapulting worse problems in the future, instead of addressing the root cause.

Why This Science Actually Brings Hope

The same neuroplasticity that allows pain pathways to strengthen also allows them to change. Chronic pain is not static. The nervous system remains adaptable throughout life. Understanding pain as a learned and reinforced pattern opens the door to approaches focused on safety, regulation, and retraining, rather than constant suppression. Understanding how pain works doesn’t make it disappear overnight, but it can change how you relate to your body.

If you’re living with persistent or complex pain, you’re not broken, and you’re not failing at healing. Progress doesn’t always look like elimination of symptoms. Sometimes it looks like understanding, adaptation, advocacy, and slowly building resilience in a body that has been through a lot. There may not be one answer, one diagnosis, or one solution, but there is room for learning, for hope, and for approaches that support you as a whole person. For many people, that shift from fear and confusion to understanding and empowerment is the first real step forward.

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*This article reflects my personal experience and research into pain science and is not medical advice.

Sources (Direct Links)

National Institute of Neurological Disorders and Stroke (NINDS), NIHhttps://www.ninds.nih.gov/health-information/disorders/pain

NIH Research Matters – Retraining the Brain to Treat Chronic Painhttps://www.nih.gov/news-events/nih-research-matters/retraining-brain-treat-chronic-pain

JAMA Network Open – Central Sensitization Inventory and Chronic Pain Outcomeshttps://jamanetwork.com/journals/jamanetworkopen/fullarticle/2801714

Cleveland Clinic Journal of Medicine – Central Sensitizationhttps://www.ccjm.org/content/90/4/245

Cleveland Clinic – How Stress Affects Chronic Painhttps://health.clevelandclinic.org/how-stress-affects-chronic-pain/

PubMed Central – The Mutually Reinforcing Dynamics Between Pain and Stresshttps://pmc.ncbi.nlm.nih.gov/articles/PMC11609167/

Harvard T.H. Chan School of Public Health – Anti-Inflammatory Diethttps://nutritionsource.hsph.harvard.edu/healthy-weight/diet-reviews/anti-inflammatory-diet/

Harvard Health Publishing – Pain and Inflammationhttps://www.health.harvard.edu/topics/pain