Is Chronic Pain All in Your Head? Understanding how the Brain Creates Pain & What Helps
If you've been told your pain is "all in your head," you probably felt dismissed. Maybe even angry.
And for good reason. That phrase usually means someone thinks you're imagining things or exaggerating. That your pain isn't real.
But here's what most people don't understand: pain always involves your brain. Every single time. That's not the same as saying it's imaginary.
When we talk about chronic pain therapy, we're talking about working with the way your brain interprets signals from your body. Not because your pain is fake. But because your brain plays a real role in creating the experience of pain.
And when we understand that role, we can change it.
What does "pain is generated in the brain" actually mean?
Let's start with something important: all pain is generated in the brain.
Even if you stub your toe, the pain you feel doesn't come from your toe. Your toe sends signals to your brain. Your brain interprets those signals. And then your brain creates the sensation we call pain.
This is true for all pain. Broken bones. Cuts. Migraines. Back pain. Everything.
Your brain is constantly receiving information from your body. Way more information than you could possibly pay attention to. So your brain filters. It decides what matters and what doesn't.
When your brain decides something is dangerous, it creates pain. Pain is your brain's way of getting your attention and telling you to protect yourself.
Most of the time, this system works great. You touch a hot stove. Your brain creates pain. You pull your hand away. The pain goes away as you heal.
But sometimes, the system gets stuck. Your brain keeps creating pain even after the injury heals. Or it creates pain when there's no injury at all.
This isn't a weakness. It's not your fault. It's just how brains work. And once we understand it, we can work with it.
Primary pain vs. secondary pain: What's the difference?
In medicine, there are two main types of pain: secondary pain and primary pain.
Secondary pain is what most people think of when they think of pain. Something is clearly wrong with your body. You broke a bone. You tore a ligament. You have a tumor pressing on a nerve.
The pain is secondary to that physical problem. Fix the problem, and the pain usually goes away.
Primary pain is different. Primary pain is when pain is the main problem, but doctors can't find a clear physical cause.
This happens a lot. In fact, research shows that about 88% of people with chronic pain have primary pain. They're hurting. The pain is real. But tests and scans don't show an obvious reason why.
Primary pain often comes from the brain's interpretation of signals from the body. The brain has learned to treat normal sensations as dangerous. So it creates pain to protect you—even when there's nothing to protect you from.
This type of pain used to be called "psychosomatic" or "functional" pain. But those terms made it sound like the pain was imaginary or caused by mental health problems.
Now, researchers sometimes call it neuroplastic pain. That just means the pain is caused by the brain's interpretation of bodily signals, not by ongoing damage to the body itself.
But we don't love that term either. Most people have no idea what "neuroplastic" means. And it can be confusing.
What matters is this: your pain is real. It hurts. And the source is your brain's alarm system, not tissue damage. Once you understand that, you can start to change it.
The fear-pain cycle and how it keeps you stuck
Here's where things get tricky. Once you have chronic pain, fear often makes it worse.
You start to worry about when the pain will hit. You avoid activities that might trigger it. You tense up when you feel even a hint of discomfort.
All of this is totally normal. Your brain is trying to protect you.
But here's what happens: when you're afraid of pain, your nervous system stays on high alert. It becomes more sensitive. It starts treating more things as dangerous.
This creates what we call the fear-pain cycle.
You feel pain. You get scared. Your nervous system ramps up. You feel more pain. You get more scared. And the cycle keeps going.
You see this a lot with conditions like migraines. People start to fear the next migraine. They avoid triggers. They monitor their body constantly for warning signs. And that constant vigilance can actually make migraines happen more often.
The same thing happens with back pain, neck pain, fibromyalgia, and other chronic pain conditions.
Breaking this cycle doesn't mean ignoring pain or pretending it doesn't hurt. It means teaching your brain that the pain signals aren't as dangerous as they feel.
How Pain Reprocessing Therapy retrains the brain
This is where therapy comes in.
Pain Reprocessing Therapy (PRT) is one approach we use at Aspire Counseling. It's based on neuroscience research about how the brain creates and maintains chronic pain.
The idea is simple: if your brain learned to create pain, it can also learn to turn it down.
PRT helps you pay attention to pain in a different way. Instead of treating pain as a sign of danger, you learn to notice it without fear. You practice recognizing when your brain is overreacting to safe sensations.
This isn't about positive thinking. It's not about convincing yourself the pain isn't real.
It's about retraining your nervous system. Showing your brain that it doesn't need to be on high alert all the time.
We also use other approaches like Internal Family Systems (IFS) and Mindfulness Oriented Recovery Enhancement (MORE). These methods help you work with different parts of yourself—the scared part, the frustrated part, the part that just wants relief.
All of these parts are welcome. We're not trying to get rid of anything. We're just helping your system calm down.
The research on these approaches is strong. Studies show that many people with chronic pain see significant improvement when they work on changing how their brain responds to pain signals.
This doesn't work overnight. Progress is usually not linear. You might have good days and bad days. But over time, many people find that their pain becomes less intense, less frequent, or easier to live with.
Am I imagining my pain?
Let's be really clear about this: no, you're not imagining your pain.
If someone has told you it's all in your head as a way to dismiss you, they were wrong. And you have every right to be angry about that.
Pain generated by the brain is not the same as imaginary pain.
Your brain is a physical organ. When it creates pain, that pain is real. It hurts. It affects your life. It matters.
The fact that pain comes from your brain's interpretation doesn't make it less real than pain from a broken bone. It just means we need to address it differently.
We've worked with people who spent years being told nothing was wrong. Who felt dismissed by doctors. Who wondered if they were going crazy.
That shame and frustration are part of what we address in therapy for chronic pain. Because living with chronic pain affects more than just your body. It affects how you see yourself and how you move through the world.
Understanding the brain's role in pain isn't about blame. It's about hope. Because if your brain is creating the pain, your brain can also change it.
You're not broken. You're not weak. Your nervous system just needs help learning that it's safe to turn down the alarm.
What does "retraining the brain" actually look like in practice?
When we talk about retraining the brain, people sometimes worry we mean ignoring pain or just pushing through it.
That's not what we mean at all.
Ignoring pain or forcing yourself to do things that hurt is actually the opposite of what helps. That approach usually makes things worse because it keeps your nervous system on high alert.
Retraining the brain is about changing your relationship with pain. It's about learning to notice pain without immediately panicking or bracing against it.
Here's what that might look like in therapy:
You might practice somatic tracking. This means paying attention to sensations in your body with curiosity instead of fear. When you feel pain, instead of immediately tensing up or thinking "oh no, here we go again," you pause. You notice where you feel it. What it actually feels like. Whether it changes as you pay attention to it.
This isn't easy at first. Your instinct is to fight pain or run from it. But fighting and running keep the fear-pain cycle going.
When you can notice pain without adding fear on top of it, something shifts. Your nervous system starts to learn that the sensation itself isn't dangerous.
You might also work with different parts of yourself. Maybe there's a part of you that's terrified of pain. A part that's angry about having to deal with this. A part that's exhausted from trying so hard.
In therapy, we make space for all of those parts. We don't try to get rid of them or talk you out of how you feel. We help those parts feel heard and safe.
When the scared part knows it's not alone, it doesn't have to scream so loud. When the angry part feels validated, it can relax a little. And when all of these parts work together instead of fighting each other, your whole system calms down.
This is slow work. It's not about one big breakthrough moment. It's about small shifts over time. Noticing that you moved in a way you usually avoid and nothing bad happened. Realizing you went a whole day without checking for pain. Feeling discomfort but not immediately catastrophizing about it.
These small changes add up. Your brain starts to learn that it doesn't need to protect you so aggressively. The pain signals start to quiet down.
Do I still need to see my doctor if I start therapy for pain?
Yes. Absolutely.
Therapy for chronic pain is not a replacement for medical care. It's a complement to it.
You should still work with your doctor. Get regular checkups. Rule out any serious medical conditions. Take medication if that's what you and your doctor decide is best.
Therapy works alongside medical care, not instead of it.
In fact, the best outcomes usually happen when your medical provider and your therapist are on the same page. When they understand what each other is doing and how it all fits together.
Some people worry that if they start therapy for pain, their doctor will think they're giving up on medical treatment. Or that the therapist will tell them to stop their medication.
That's not how we work. We respect the relationship you have with your medical providers. We understand that chronic pain is complex and often needs multiple approaches.
What we offer is expertise in how the brain and nervous system contribute to pain. Your doctor brings expertise in the medical side. Together, these approaches give you the most complete picture and the best chance of improvement.
If you've been working with a doctor and still have pain, that doesn't mean medical care failed. It might just mean there's another piece of the puzzle to address.
Many of our clients continue seeing their doctors while they're in therapy. Some take medication. Some have physical therapy. Some use other treatments.
All of that is fine. We work with whatever approach you're already using. We just add tools that target the brain's role in creating and maintaining pain.
And honestly, when your nervous system calms down through therapy, other treatments often work better too. Your body becomes more responsive. You're less tense. You sleep better. All of this supports healing.
What helps when pain is coming from the brain
So what actually helps?
First, education. Understanding how pain works is the foundation. When you understand that pain doesn't always mean damage, you can start to respond differently.
Second, changing your relationship with pain. This means learning to notice pain without immediately tensing up or catastrophizing. It means practicing being curious instead of scared.
Third, working with your nervous system. This might include somatic tracking (paying attention to body sensations without judgment), mindfulness practices, and gradual exposure to activities you've been avoiding.
Fourth, addressing emotions. Chronic pain often comes with anxiety, depression, frustration, and grief. Working through these emotions helps the nervous system calm down.
And fifth, being patient with yourself. Progress is usually slow. It's not linear. Some days will be harder than others. That doesn't mean you're doing it wrong.
At Aspire Counseling, we combine several evidence-based approaches to help people with chronic pain. We use Pain Reprocessing Therapy, Internal Family Systems, and mindfulness-based techniques.
We also recognize that everyone's pain is different. What works for one person might not work for another. So we tailor our approach to your specific situation.
The goal isn't to make you think positive or pretend everything is fine. The goal is to help your brain learn that it doesn't need to create so much pain to keep you safe.
Getting started with chronic pain therapy in Lee's Summit or online in Missouri
If this sounds like your experience, you're not alone.
Many people with chronic pain have been told their tests look fine. That there's nothing wrong. That they just need to deal with it.
But there is something you can do. And it doesn't involve ignoring your pain or pretending it doesn't matter.
Therapy for chronic pain works with your brain and nervous system to change how they respond to signals from your body. It's grounded in research. It's not about blame or shame. And it can make a real difference.
We work with people throughout Missouri—both in person at our Lee's Summit office and through telehealth. Our therapists understand chronic pain. We know it's real. And we have tools that can help.
If you're tired of being dismissed or if you're just ready to try something different, we'd be glad to talk with you.
You can learn more about our approach to chronic pain therapy or reach out to schedule a free consultation. We'll talk about what's going on and whether our approach might be a good fit. No pressure, no commitment required.
Call us at (573) 328-2288 or schedule online.
You don't have to keep living like this. Your pain is real. And there are things we can do to help.
Related reading:
Understanding Chronic Pain and the Brain: A New Path to Healing
When Pain and Emotion Collide: How Chronic Pain Affects Mood, Sleep, and Mental Health
About the Author:
This post was written by Jessica (Tappana) Oliver, LCSW, founder of Aspire Counseling. Years ago, Jessica regularly saw chronic pain clients in her own practice and saw firsthand how powerful the right therapeutic approach could be. These days, she focuses her clinical work on offering trauma therapy intensives at Aspire, but she remains passionate about chronic pain treatment. After countless conversations with Adam White, LPC, one of Aspire's chronic pain specialists, she's convinced he's the go-to expert in the Kansas City metro area for treating chronic pain through therapy. This post reflects Adam's approach, clinical expertise, and the concepts he's shared with her about how the brain creates and maintains chronic pain—and how we can help people find real relief. Adam practices at our Lee's Summit, Missouri location and also offers online therapy throughout Missouri.
