The most important thing to understand about pain is that ALL PAIN is actually in our brain, not in our body.
What do I mean by this?
Let’s say you cut a finger or hurt your leg in an accident. You have nerve fibers in the finger and in the leg (and all over the body). The injury activates signals in these nerve fibers. The signal then travels from your finger to your brain (via spinal cord). Only when the signal reaches your brain, you actually “feel” the pain. If your finger is cut and we stop the signal from being processed in the brain, you will have the injury and the start of the pain signal but NO FEELING OF PAIN.
Hard to believe, but true.
Actually you already know this. I am sure you or someone you know has undergone surgery under anesthesia. May be someone in your family had a cesarean delivery. During surgery, we stop the pain signal processing in the brain by giving general anesthesia. Therefore, even when the surgeon cuts your belly, you feel no pain. Because your brain has been put to sleep.
So, now you understand and agree that the PAIN is actually felt in the BRAIN not in the BODY.
Now let’s understand chronic pain.
Science tells us all our body areas are mapped inside the brain and this is called brain map. In other word, our finger, legs, toes, back, face all have a specific area of the brain devoted to them. So if my injury is in the finger, the “finger” area of the brain map is activated.
When you have an acute injury such as a cut to your finger, gradually the cut heals. The finger nerves stop sending signals to your brain and your pain goes away.
However, sometimes, even when your injury gets healed, the pain signal in the brain doesn’t go away. For some reason, the brain has stored this pain signal inside so even in the absence of fresh pain signals from finger nerves, the brain keeps feeling (and you keep feeling) the pain in the finger. This phenomenon is quite common in chronic low back pain. Even when your muscles in the back are no longer tight, you keep feeling the back pain because the brain area for back pain has become abnormally activated.
There is another example – say in Fibromyalgia. Normally, you would expect the level of pain in the brain to be proportionate to the severity of injury or pressure. In other words, a deeper cut, more pressure, bigger injury would cause more pain signal in the brain. However, in Fibromyalgia, a disease with chronic pain in multiple body parts, the pain signal processing in the brain is enhanced. Small amounts of pain or pressure that would be unnoticeable in a normal person, causes significant pain in a patient with fibromyalgia.
Treatment of Chronic Pain
This includes many conditions such as fibromyalgia, back pain and neck pain, chronic headaches, generalized body ache etc.
As you can see, since much of the chronic pain is being caused by brain pain signals, it cannot really be treated successfully with common pain medications that are anti-inflammatory medications such as ibuprofen, paracetamol, diclofenac etc. These medicines are working on the body level and not on the brain level.
Therefore, many patients with chronic pain will report only temporary relief or no relief with these medications (plus they have a lot of side effects).
To successfully treat chronic pain, we need to correct brain’s processing of pain signals. We need to get this abnormal “pain activation” in the brain to be corrected back to normal. To do this, we need to supply new corrective signals to the brain that can cancel the abnormal pain signals. This can be done by giving positive signals within the brain (such as meditation) or through positive signals from the body to the brain (such as through exercises and positive touch).
Some of the treatment modalities to do this successfully include:
- Proper exercises including therapeutic massage.
- Meditation and yoga; positive mental visualization
- Relaxation and stress reduction
- Non-invasive brain stimulation to modulate (alter) brain’s pain signal.
Non-invasive brain stimulation (tDCS) – This is a superficial non-invasive brain stimulation in which the patient undergoes 20 min sessions daily for a certain duration. This is a non-invasive procedure and there are no side effects.
More information about the use of tDCS in chronic pain is available at