By: Gail Kaiser, PT, OCS, TPS, CSCS
You stub your toe on the bedframe. “OUCH!” you shout, rushing to grab ice for the throbbing ache. That sharp pain is your body’s built-in warning system: Something’s wrong—stop what you’re doing or get help! Without this alarm, we wouldn’t know when we were sick, injured, or in danger. As C.S. Lewis once wrote, “Pain insists upon being attended to.”
Pain is more than an unpleasant sensation—it’s your body’s sophisticated danger detection system. Think of it like a firefighter sounding an alarm. The alarm doesn’t just ring; it signals the team to act. In the same way, pain is a complex conversation between your body and brain, designed to protect you and prompt action when something needs attention.
Chronic Pain and When That Alarm Keeps Ringing
Pain is universal, evolutionary, and has a purpose. We all will experience pain in our lives. But like any system in our body, the pain system is imperfect. Sometimes there are glitches in the system. For example, the brain can misinterpret signals from the body as dangerous, even in the absence of tissue damage or injury. Sometimes the system gets too protective, and that’s when pain persists longer than the expected healing times. This is what is defined as chronic or persistent pain, like an alarm that keeps ringing.
The question often comes up: If pain is meant to be helpful, why does it still hurt even after an injury has healed?
Sometimes, even after the body has physically recovered, the brain and nervous system keep interpreting signals as painful even when pain is no longer needed for protection. In these cases, pain is no longer a warning sign of injury, but a sign that the nervous system is stuck in overdrive.
With chronic pain, documented neuroplastic changes occur in both our peripheral and central nervous systems, meaning we have essentially “learned” pain. The exciting breakthrough from these scientific discoveries is that we can also “unlearn” pain. We all have the ability to heal and rewire our pain system. Approaching persistent pain through the lens of brain retraining is one-way physical therapists help people overcome chronic pain. A positive mindset and a willingness to engage in pain reprocessing are key ingredients in this journey. Chronic pain can be overcome, and with the right approach to treatment, healing is possible.
How Pain Works
Pain is complex and it varies from person to person. If you feel it, it is real…make no mistake about that. Some pain comes and goes quickly. Pain lasting less than three months is characterized as acute pain. Chronic pain is usually defined as pain lasting longer than expected, typically defined as pain that lasts three months or longer. Pain persisting longer than six or nine months is generally agreed to be defined as chronic pain. At that point, it’s not just about the tissues anymore, it’s about the nervous system staying sensitive.
Your nervous system is firing for protection, but it may be overprotecting you. Even though the injury is healed, the brain is still interpreting signals as dangerous. This can happen for a few reasons. In the general population, about one in five people may have a more sensitive nervous system. They go through an injury, and while most people’s systems calm down, theirs stay heightened. It takes less stimulus to set it off, and it reacts more quickly.
Even non-dangerous things, walking, stretching, and sitting can be perceived as a threat. Despite the fact we experience pain in our bodies, pain is actually constructed by the brain. There is not just one pain center. It is a multi-system output involving several areas of the brain: the prefrontal cortex, motor and sensory areas, the limbic system for emotions, and the hippocampus for memory. These parts of the brain all work together to interpret signals from the body and decide how to respond.
It is also important to know that the brain acts like a prediction machine. If it believes something is dangerous from a previous experience, it may produce pain when none is required for our protection. If it senses safety, it can actually modulate pain and reduce the response.
Emotions, Fear, and Pain Sensitivity
Fear is a big driver of pain. When someone is afraid, anxious, or constantly focused on what might happen next, their body goes into a fight-or-flight state. That raises nervous system sensitivity and makes pain worse.
Techniques like diaphragmatic breathing, mindfulness, and learning how the pain system works can help reduce that sensitivity. Even understanding pain makes it less scary, which can calm the system.
See how to practice more mindfulness to manage your pain in “Mindfulness For Chronic Pain” on the Spooner Blog.
Rebuilding Safety Through Movement
Fear of pain during movement or fear of re-injury is real. In physical therapy, you gradually regain mobility, build strength, endurance, and speed: all within a controlled, safe environment. Your physical or occupational therapist guides you through activities designed to help your body adapt, improve, and strengthen your physical resilience. This repetition forms new neural pathways in your brain, reinforcing safety and confidence. Believing that your body can heal, combined with your therapist’s reassurance, plays a powerful role in reducing nervous system sensitivity and pain. This process is essential for a successful return to your sport or recreational activities.
With pain science–informed physical therapy, you learn that things that make you anxious can actually increase your nervous system’s sensitivity and trigger pain. For example, the extra pressure from a high-stakes competition can feel like a threat to your body, making pain worse not because your injury hasn’t healed, but because your nervous system is on overdrive. This can happen in everyday life too. After an accident, it’s common to experience post-traumatic stress, which affects the nervous system and can contribute to ongoing pain.
Bottom-Up and Top-Down Strategies for Recovery
Recovery interventions can be divided into two types. Bottom-up approaches focus on physical work, like improving mobility, strength, motor control, and power, to help restore function. Top-down strategies, on the other hand, address the mind, recognizing that thoughts, emotions, and mindset all influence pain.
People who bounce back from ongoing pain often have one thing in common: a naturally positive mindset, even if they don’t realize it. Staying hopeful, thinking positively, and feeling less fear can actually help calm the nervous system and reduce how sensitive it is to pain.
Physical and Occupational therapists who are trained in the mental side of recovery know how to spot when something emotional or psychological might be getting in the way. If someone’s feeling stuck, they’ll notice it and offer practical tools not just for the body, but for the mind too.
Communicating with Your Therapist Matters
Sometimes, it’s hard to put your feelings into words, especially after an injury. You might not even realize you’re dealing with fear or anxiety about returning to your sport or your usual activities. That’s why it’s important to be open during rehab or therapy. Even if you’re unsure what you’re feeling, sharing that helps your therapist support you better. They’ve worked with other people in the same position and can help you rebuild confidence, create a sense of safety, and give you clear feedback on your progress and readiness to return to your desired activities.
Moving Forward with Support
Pain is real and often complex. But learning how it works, how your nervous system reacts, and how emotions play a role can help you move forward. If you’ve been in pain for a while, you’re not alone, and there’s no shame in it. Physical therapy isn’t just about the physical body, it’s also about calming the nervous system, building confidence, and restoring a sense of safety. Your physical or occupational therapist is there to support you physically and emotionally, helping you recover one step, one rep, and one day at a time.