I want to start off by saying, if you have been struggling with pain for a long time... I am sorry, I deeply feel for you. I have personally learned so much from folks with chronic pain and grateful for the knowledge it has given me today. I am passionate about helping others and it has helped me on this journey, and I want to share with you what I now know to be true about pain.
The connection between your mind and your pain is real, it's measurable, and it is not the same thing as saying your pain is imaginary. However, if you have ever heard the term, the pain is in your head... take a pause and think through that. Every patient I've ever treated with chronic pain has had real pain. Full stop. What the research has taught us over the past few decades is that pain is more complicated, and honestly more interesting, than the simple story most of us grew up with.
The old story and why it falls apart
The old story goes like this. Tissue gets damaged, damage sends a pain signal, brain receives signal, you hurt. More damage means more pain. Healing means less pain. Simple. This type of pain certainly does exist, and it is called nociceptive pain. It's easy to understand because there are true causes and effects.
However, there are 2 additional types of pain worth exploring: neuropathic and nociplastic. Examples of neuropathic types of pain are also easier to understand in the sense that they often follow simple rules (referred pain from a nerve or spinal nerve root etc.)
So, what is nociplastic pain, then? Simply put, nociplastic pain is an experience with multiple types of causes. Radiologists have scanned thousands of people with no back pain at all and found bulging discs, arthritis, and torn tissue in huge numbers of them. People walking around feeling great, with scans that look rough. Meanwhile, other people have severe, life-limiting pain with scans that look nearly perfect. If pain were just a damage meter, none of that would be possible.
What are we left with? The type of pain that is hardest to explain. The best way I can put it is that nociplastic pain type is your brain's assessment of threat, not a true explanation of tissue damage. Your nervous system takes signals from the body, then weighs them against everything else it knows. How stressed you are. How you slept. What do you believe about your body. What happened last time you felt this. Then it produces a pain experience at whatever volume it judges appropriate for protecting you.
What changes when pain becomes chronic
Most injured tissue heals on a fairly predictable timeline, weeks to a few months depending on what was hurt. But in some people, the pain outlives the injury. The research here is solid and worth knowing about.
When pain persists, the nervous system itself changes. The pathways that carry danger signals become more sensitive, like a smoke alarm that starts going off when you make toast. Scientists call this central sensitization. The alarm system is now part of the problem, separate from whatever started it. This is why chronic pain can spread, why light touch can start to hurt, and why flare-ups can happen without any new injury. Nothing about that is imaginary. It's nervous system physiology, and it's been documented repeatedly.
And here's where the mind-body connection earns its place in the conversation. The things that turn the sensitivity up are not just physical. Poor sleep reliably makes pain worse the next day, and that's been shown in controlled studies, not just surveys. Ongoing stress keeps the threat system on high alert. Fear of movement, which is incredibly common and completely understandable, leads people to move less, which leads to stiffness and weakness, contributing to poorer health overall, all while reinforcing the fear of movement. Depression and anxiety don't cause the pain, but they turn the volume knob in the wrong direction.
None of this means the pain started in your head. It means your head is part of the equipment that produces every pain experience you'll ever have. That's true for me too, and for most everyone.
Why this is actually good news
If pain were purely a damage meter, your only options would be fixing the tissue or numbing the signal. But because pain is produced by a sensitized system, you have more doors to walk through, and the research supports several of them. One of the reasons I am so passionate in educating others about this and helping those who need it most, is to help folks avoid unnecessary surgeries and procedures that we now know won't fix the problem but actually worsen it over time.
Understanding pain helps by itself. This surprised even the researchers. Teaching people how pain actually works, the way I'm doing right now, measurably reduces pain and fear for many people with chronic symptoms. When the alarm makes sense, it's less frightening, and fear was feeding the alarm.
Graded movement is the closest thing we have to universal treatment. Not pushing through agony, and not resting until it goes away, because neither works. The approach with the best evidence is finding the amount of movement you can do today, doing it consistently, and nudging it up slowly. The nervous system recalibrates when it repeatedly experiences movement without disaster.
Sleep and stress deserve real attention. Treating them isn't a side project next to the "real" treatment. For many of my patients, a stretch of better sleep did more than any hands-on technique I could offer.
If you've been living with pain for months or years, I know you may have heard dismissive versions of this message before, and I'm sorry if you have. The honest science is the opposite of dismissive. Your pain is real, your nervous system is doing exactly what it learned to do, and systems that learned can relearn. That's not wishful thinking. That's what the evidence says. And it's a much better starting point than another scan and another shrug. Please contact me today and learn more about how you can help yourself through some compassionate guidance.
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Dr. Neetu Trivedi, DPT, is the founder of TrivediCare. She has spent over twenty years helping employers and their teams prevent injuries and move better at work.