Your Brain’s Role In Pain
You've probably been told that pain is a direct measure of tissue damage. The more it hurts, the more something must be wrong.
But what if I told you that this fundamental assumption about pain is not just wrong – it's actually making your pain worse?
One of the most important discoveries in modern pain science is that your brain controls your pain experience, and it's constantly making decisions about how much “protection” you need based on everything happening in your life. Not just what's happening in your tissues, but everything – your thoughts, your stress, your beliefs, your environment, even your conversations.
The Brain That Never Sleeps
When it comes to the brain and pain there's no single "pain center" in your brain. Instead, pain emerges from a complex network of brain regions working together, constantly evaluating a simple but crucial question:
“How much danger am I in right now?”
Your brain operates like a sophisticated security system, processing thousands of inputs every second. It's reading signals from your body, yes, but it's also monitoring your thoughts, your emotions, your environment, your memories, and your beliefs. All of this information gets balanced into the brain interpreting more safety or more danger.
When danger signals outweigh safety signals, your brain doesn't just turn on pain – it activates an entire protective response system. Your fight-or-flight response kicks in, your immune system ramps up, your muscles tense, and your cognitive focus narrows. It's all designed to keep you safe, but sometimes this system can become overprotective.
What’s Leads To More Safety Or More Danger?
Modern pain science has given us a powerful framework for understanding this process: Danger In Me (DIMs) and Safety In Me (SIMs). Think of these as your brain's personal threat assessment tools.
DIMS are anything that provides credible evidence of danger to your brain. While tissue damage and fatigue plays a role thoughts like "my back is crumbling," beliefs like "I'll never get better," or even conversations where you hear "Bill's got a bad back, just like yours." All get processed and lead the brain thinking there is more danger.
SIMS are the opposite – they're anything that provides credible evidence of safety. A good night's sleep, a supportive friend, movement that feels good, or even understanding how your pain works can all be powerful SIMs.
But here's the crucial part: your brain treats psychological DIMs and SIMs as real as physical ones. When you think "my spine is degenerating," that thought influences your pain experience. It's not "just in your head" – it's a real biological process happening in your nervous system.
How Thoughts Become Biology
The connection between what you think and how you feel isn't just philosophical – it's measurable. Experimental evidence shows that when people perceive they are being negatively evaluated, their immune cells produce more pro-inflammatory cytokines in blood tests. (Dickerson et al., 2009). When someone expects to be in pain, they move differently, even before any pain occurs (Neige et al., 2018).
Take someone who wakes up every morning and immediately checks: "How bad is it today?"
They’re constantly scanning for pain, telling themselves "my neck is getting worse," and avoiding activities they used to love. Each of these thoughts and behaviors is a DIM – a danger signal that keeps their brain convinced their neck needs protecting. their pain stays high, their muscles stay tense, and their world keeps getting smaller.
Now imagine if they understood that their morning ritual was actually feeding their pain. What if instead of scanning for danger, they started her day by gently moving her neck, reminding themself that movement is medicine, and focusing on what their body can do rather than what hurts?
Think of it this way: your body has developed a memory for threats. If you've been stressed, angry, or fearful for months, your body system learns to be more reactive. It's like having a smoke detector that becomes increasingly sensitive – eventually, even burning toast sets it off.
This happens through something called neuroimmune coupling – the intricate dance between your nervous system and immune system (Watkins & Maier, 2005). Your brain and immune cells are in constant communication, and when your brain detects threats (including psychological ones), it can trigger immune responses that actually increase inflammation in your body.
The Biggest Pain Myths
Before we dive deeper, let's address some dangerous misconceptions that might be sabotaging your recovery:
Myth: "Pain always means something is damaged or broken."
Reality: Pain is your brain's opinion about how much protection you need, not a direct measure of tissue damage. You can have significant tissue changes with little pain, or intense pain with minimal tissue changes.
Myth: "If I have chronic pain, I just have to live with it."
Reality: Chronic pain is not a life sentence. Your brain's protective systems can learn to calm down through understanding, movement, and addressing the DIMs and SIMs in your life.
Myth: "Strong pain medications are the only real solution."
Reality: While medications can be helpful, they're just one tool. Often, the most powerful interventions involve changing the content of your life – your thoughts, beliefs, stress levels, and daily habits.
Myth: "I should avoid activities that might cause pain."
Reality: Appropriate movement and activity are often the best medicine for persistent pain. Avoidance actually teaches your brain that you're in more danger than you are (Vlaeyen & Linton, 2000).
The Content of Your Life Matters
So what does this mean for your daily experience? It means that the content of your life directly influences your pain. The conversations you have, the thoughts you think, the beliefs you hold, the stress you carry – all of these become part of your brain's danger/safety calculation.
Consider these common DIMs that might be impacting how your feel.
- Repeatedly telling yourself your body is "breaking down"
- Catastrophic thinking about worst-case scenarios
- Chronic stress from work, relationships, or finances
- Believing that pain always means damage
- Isolation and lack of social support
- Language that frames your body as fragile or unreliable
The good news? You have more control over this process than you might think. Just as DIMs can accumulate and increase your brain's protective response, SIMs can accumulate and help your brain feel safer.
Building Your Safety Arsenal
The beauty of understanding DIMs and SIMs is that it gives you concrete ways to influence your pain experience. You can't always control what's happening in your tissues, but you can absolutely influence the content of your life.
Powerful SIMs to help teach the brain there is more safety than danger.
- Learning about how pain really works (knowledge is genuinely protective)
- Gentle, enjoyable movement that reminds your brain your body is capable
- Strong social connections and support systems
- Stress management techniques that work for you
- Positive self-talk that frames your body as resilient
- Engaging in activities that bring you joy and purpose
- Getting quality sleep, which is one of the most powerful SIMs available
The Power of Neuroplasticity
Perhaps the most hopeful aspect of this entire framework is something called neuroplasticity – your brain's remarkable ability to change and adapt (Zao & Hao 2024). Just as your nervous system can become overprotective, it can also learn to be appropriately protective.
This means that chronic pain isn't a life sentence. Your brain, which learned to be hypervigilant, can also learn to calm down. The neural pathways that became superhighways for danger signals can be rewired. The immune system that became overreactive can find its balance again.
But this process requires patience and consistency. Remember, if your brain has been practicing being overprotective for months or years, it will take time to learn a new pattern. Every SIM you add, every DIM you reduce, every positive interaction with your body is teaching the brain to feel more safety or more danger.
Your Brain, Your Choice
The next time you notice pain, try asking yourself: What's the content of my life right now? Are you surrounded by DIMs that are convincing your brain you're in danger? Are you missing SIMs that could help your brain feel safer?
This isn't about blaming yourself for your pain or suggesting it's "all in your head." Your pain is real, your brain is doing its job, and your protective systems are working exactly as they're designed to. But understanding how these systems work gives you the power to influence them.
Pain and the Brain
Your brain is constantly making decisions about how much protection you need based on everything happening in your life – not just what's happening in your tissues. Thoughts, beliefs, stress, and emotions all provide real biological input to your pain experience. The good news? This means you have more control over your pain than you might have realized - but this first step is realizing there is a connection.
Start paying attention to the DIMs and SIMs in your daily life. Notice the language you use about your body, the thoughts you think about your future, and the content of your conversations. Then, choose one small SIM to add to your day – maybe it's learning something new about pain, taking a gentle walk, or calling a supportive friend. Your brain is listening, and every positive input matters.
When it come to chronic pain we can often feel broken, like our body is crumbling, but now we know that when we think this way about our body - it’s not only untrue - it also sets our brain up to sense more danger and increase our chance of feeling more pain.
Remember, you're not broken. You're not falling apart. You're a complex, adaptive human being with a remarkably sophisticated nervous system that's trying to keep you safe. And now that you understand how it works, you can start working with it instead of against it.
Below is a Danger In Me versus Safety In Me Assessment - go through the questions, see what your score is and see if there is a way you can make your brain feel a little safer.
DIM/SIM Assessment
Assess Your Danger In Me Versus Safety In Me Rating
This assessment will help you understand your personal balance of danger signals (DIMs) and safety signals (SIMs) that influence your pain experience.