Chronic Pain and other Physical Symptoms: Exploring the Mind-Body Connection

This is the third and final article about exploring the mind-body connection, at least for now. I previously wrote about the link between adverse childhood experiences and chronic illness in adulthood. You can find it here. This was followed by an article that was a continuation of the first but with a more specific focus on narcissistic abuse in relation to health outcomes. You can find it here. The present article explores physical symptoms like pain, fatigue and dizziness in relation to the mind-body connection, but specifically focusing on chronic pain. Please note that the information here is not suitable or relevant for everyone's situation.

The mind-body connection refers to the link between our thoughts, emotions, behaviours, and our health. This relationship is bidirectional, meaning our minds and bodies influence each other in both directions, sometimes in complex ways. For example, positive thoughts can trigger the release of chemicals like dopamine and serotonin that make us feel good. Similarly, physical sensations can affect our mental state in both positive and negative ways. Our emotions are also connected to the autonomic nervous system, which controls the involuntary functions of our organs, blood vessels, and glands. Indeed, when we feel threatened, our bodies have what is called a stress response, which prepares our bodies for fight or flight. When this response remains highly activated for long periods of time, usually due to chronic stress and adversity - especially in childhood - it can eventually affect our health in negative ways, potentially leading to inflammation, a weakened immune system, chronic pain and fatigue. The brain also has a capacity to create real symptoms caused by how we react to stress through various unhelpful coping strategies, but also through learned brain patterns, and habitual processes. We often refer to these mind-body connections as Mind-Body Syndrome. Understanding these mind-body connections is absolutely essential for determining appropriate interventions or treatments, to ensure an acceptable health-related quality of life.

What is Mind-Body Syndrome (MBS)?

MBS describes a condition where physical symptoms are heavily affected by psychological factors or various brain processes rather than tissue damage. In other words, it describes symptoms that result from alterations in the brain and nervous system and stemming from reversible psychophysiological processes. It offers a useful perspective for understanding and managing chronic pain and other physical symptoms, and describes how the mind can influence the body's perception of symptoms in conditions where the cause is not purely physical; where stress and other brain processes significantly contribute to the presence or severity of symptoms. Neuroscience indicates that our brains can actually create what we experience in our bodies, and studies have demonstrated a connection between psychological stress and physical pain. In addition to pain, mind-body syndrome may also present with symptoms such as fatigue, nausea, palpitations, dizziness, gastrointestinal problems, and skin conditions. 

The brain can indeed create physical sensations through thoughts and imagery alone. Let's demonstrate this using the 'Lemon test'. The lemon test refers to the act of vividly imagining a lemon in your mind, which usually leads to a physical sensation of salivation and a bitter taste in your mouth, despite not having eaten a lemon. Try it for yourself: Think about a lemon. Really visualize it in your mind's eye; its colour and all the little pits on its skin. Using a knife to slowly cut it in half. Noticing the juices splashing around the knife as you cut through it. Seeing the juicy, bright yellow flesh on the inside. Taking one half of the lemon and placing it on your tongue; licking it. My guess is, you have a sensation by the sides of your tongue right now, almost as if you're actually tasting the lemon, yet there is no lemon there. The same can apply to pain and other physical symptoms. This demonstrates the powerful connection between our thoughts and physical responses, highlighting how our brains can trigger physiological reactions based on mental imagery alone. 

Emotional stress and psychological factors can also manifest as physical symptoms by affecting the nervous system. The origin of this may stem from a challenging childhood, which might have influenced the development of the nervous, endocrine, and immune systems, rendering them susceptible to health issues and inflammation. Indeed, MBS is often triggered by stress, anxiety, repressed emotions, trauma and personality traits like perfectionism, people pleasing and self-criticism. Additionally, habitual processes and established neural pathways in the brain can also be contributing factors. Diagnosis involves excluding other conditions, understanding the patient's coping and emotional history, and recognizing the pattern of symptoms. Treatment options include therapies like brain retraining, nervous system regulation, trauma-informed therapy, somatic therapy, somatic exercises, and grief counseling. I will explore the different causes and treatments in greater detail below.

Many people with some form of MBS may have been gaslighted by the medical profession, sometimes for years, and been labelled as 'all in the head' patients and possibly even a time waster. However, symptoms from this syndrome are as real as those from any other 'tissue breakdown' illness (i.e. those not considered an MBS). This dismissive attitude and invalidation stemming from ignorance by healthcare professionals may have caused years of distress for these patients, leading to defensiveness and further suffering. I want to assure you that symptoms from MBS are as real as those from any other diagnosable illness; the etiology just differs, and thereby how we respond to it in terms of treatments.

I should also mention that many illnesses can worsen when we're under stress, particularly those involving pain and fatigue. This is why stress management is so important when managing a long-term condition. Indeed, an area of medicine known as psychoneuroimmunology has demonstrated that changes in our stress levels and emotional states can cause real changes in the immune reactions of the body. For example, 'tissue breakdown' illnesses like muscular sclerosis, asthma, systemic lupus and rheumatoid arthritis can also be made worse when exposed to stress.

I'm now going to focus more on chronic, 'neuroplastic' pain as applied to the Mind-Body Syndrome but much of what I'm going to discuss below can also be applied to other physical symptoms such as fatigue, dizziness, skin and gastric issues. Just change the word 'pain' to another potential MBS symptom that better applies to you and your situation.

What is Neuroplastic Pain?

Neuroplastic pain is considered a mind-body syndrome as it refers to pain that is primarily driven by the brain's interpretation of signals, often influenced by psychological factors like stress, trauma and automatic learned brain processes, rather than solely by physical damage to the body. Typically, pain serves as a beneficial and crucial warning signal that helps us safeguard our bodies. When we sustain an injury, the body transmits signals to the brain, alerting us to tissue damage. This results in us feeling pain and trying to avoid the source of the pain. However, sometimes, the brain can make a mistake. Neuroplastic pain results from the brain misinterpreting safe messages from the body as if they were dangerous even when no structural injury exists. In other words, neuroplastic pain is a false alarm.

Brain-generated pain without tissue breakdown is often referred to as neuroplastic pain because changes (plasticity) in neural pathways are the primary cause of pain. Even though neuroplastic pain is generated by the brain, it is not imaginary. All pain is real! The brain interprets and processes pain signals sent from the body, meaning the sensation of pain is ultimately created within the brain itself. That means that pain is always generated by the brain, whether it originates from an injury or not.

Research has indeed demonstrated that certain pains, such as chronic back pain, neck pain, headaches, and other forms of chronic pain, often stem not from structural causes but from reversible psychophysiological processes. In fact, recent research indicates that almost 90 percent of chronic pain stem not from structural issues, but from reversible processes involving both psychological and physiological factors. In other words, it describes pain that results from alterations in the brain and nervous system. Even when structural causes are present, there may still be an element of neuroplastic involvement. Sensations may include burning, tingling, shooting, numbness, throbbing, aching, increased pain with movement or touch, and sensitivity to temperature or light. Neuroplastic pain can be extremely stressful, potentially creating a cycle of pain, frustration, and distress.

What causes neuroplastic pain?

Adverse childhood experiences: Chronic pain has been linked to significant adverse experiences in childhood and its effect on the developing nervous, immune, and endocrine (hormone) systems. It is also linked to the resulting personality traits often formed from childhood trauma such as a tendency towards guilt, feeling responsible for others, people-pleasing, self-criticism, low self-esteem, perfectionism, and having high self-expectations. The hallmarks of a rough childhood can take the form of emotional, physical, and sexual abuse, neglect (physical and emotional), household dysfunction (parental divorce, substance abuse and mental illness within the family) and exposure to violence within the home. Over time, this can affect the child's brain development, nervous system, immune system, endocrine system, and through epigenetic changes and how their DNA is read and transcribed. When the body is subjected to prolonged stress, it releases stress-related neurochemicals and hormones in excessive quantities. These are naturally occurring and play a crucial role in normal bodily functions. However, their prolonged release due to stress can be harmful to the developing brain and body. Over time, this heightened state can result in inflammation. Inflammation is strongly associated with disease development and can further disrupt the body's ability to regulate inflammation and pain. It can also affect the structure and function of brain regions associated with emotion regulation, potentially leading to difficulties with behaviour, and social interaction, all of which may be linked to the formation or experience of pain.

Trauma: The body utilizes stress hormones to prepare itself for action when confronted with a threat. We call this the fight and flight mechanism. For example, in Post Traumatic Stress Disorder (PTSD), a common characteristic is a malfunctioning threat response system, where threats are perceived even in the absence of actual danger. Individuals with PTSD often experience hypervigilance, keeping their bodies frequently on high alert. This persistent state of alertness is mentally and physically draining for the individual and, if left untreated, can switch the body's stress response system into high gear and dysregulation. This elevated stress response can lead to increased vulnerability to the formation of chronic pain. Indeed, the common denominator between chronic pain and trauma is the nervous system. Trauma can make the nervous system persistently reactive, sensitive, and overprotective. Once an acute painful injury or illness occurs, people with an already reactive nervous system are more prone to develop chronic pain.

Thoughts and emotions: Not everyone with neuroplastic pain has experienced trauma or had a difficult childhood. Indeed, those with happy childhoods can also get MBS through various psychological and behavioural mechanisms, but also through priming, conditioning, and habitual processes. Indeed, how we respond to pain can influence its presence and intensity. For example, our thoughts (cognitions) about the pain can exacerbate it where our beliefs about its cause, such as whether it is permanent (or temporary) and uncontrollable (or curable), may worsen the pain, while emotions related to the pain, like fear, worry, frustrations, and resentment, will further amplify it. Indeed, most of us living with pain know that it tends to spike when we're stressed or angry. Your brain would interpret that as a danger signal. That can create a loop where pain ends up with a component of neuroplasticity that serves to maintain the pain signals. I will talk about that in more detail below.

Repressed emotions: In contrast, repressing (an unconscious process) or suppressing (consciously) our emotions, particularly negative ones like anger or sadness, can significantly contribute to the development and worsening of chronic pain, where the act of holding back emotions can create physical tension and stress within the body, thereby amplifying pain perception. Essentially, the brain's pain pathways become more sensitive due to unresolved emotional distress. The brain regions responsible for processing emotions overlap with those processing pain, meaning emotional distress can directly influence pain perception. When emotions are repressed or suppressed, the body's stress response system can become overactive, leading to increased inflammation which is often associated with chronic pain conditions. Studies have particularly highlighted the link between suppressed anger and increased pain intensity, as anger is a powerful emotion that, when held back, can manifest physically. 

Coping: How we manage pain can influence whether it becomes chronic; the brain learns pain through fear and avoidance. When we fear pain and respond by avoiding certain activities, we reinforce the belief that the pain is dangerous. This can create a vicious cycle where pain causes fear and avoidance, which then result in more pain (or dizziness, fatigue etc.). Indeed, the brain cannot verbally communicate that we are in danger, so to prompt us to steer clear of a potential threat, it provides the sensation of pain. Yet, if this warning is incorrect, avoidance as a coping strategy will in fact reinforce and intensify the pain further, as the act of avoidance itself will communicate to the brain that it was correct to avoid and that the threat was indeed real. That will produce more symptoms. Social isolation, a lack of social connection, loneliness and being excluded or rejected by others, can also significantly worsen chronic pain, leading to a vicious cycle where the pain itself may cause people to withdraw socially, further increasing their isolation and pain levels. 

Priming: Pain can also be 'primed'. That means that a previous experience of pain, even if minor, can make someone more sensitive to future pain stimuli, essentially priming their nervous system to perceive pain more readily; this can happen at the level of the spinal cord and brain, leading to a heightened pain response to even mild stimuli. It can also mean that when neural circuits become ingrained (like riding a bicycle), after, say a car accident or a fall, pain pathways that were created in the past from those events can re-emerge and create the same type of pain later on. They can lie dormant and years later can activate. The brain remembers it! Priming is seen as a factor that contributes to chronic pain conditions, where even slight pain triggers can cause substantial discomfort because the pain pathways are in a primed state. Negative emotions or stress linked to past pain experiences can condition the brain to interpret future pain as more intense. For example, if you injure your ankle once, even a minor twist later might feel much more painful due to the primed state of the surrounding nerves, and anticipating pain can actually increase the perceived intensity of pain when it occurs. 

Learned processes (conditioning): Symptoms such as pain can also be triggered by certain stimuli through association. These may have been developed through the process of 'conditioning'. For example, once a pain cycle is initialed, certain triggers will begin to develop through exposure and add to the pain response. Food, wine, light, screens, a particular environment, meeting a certain person etc., can be triggers and cause pain such as a headache or a migraine. Remember Pavlov's dogs? He conditioned them to associate a bell with food which caused them to salivate, yet later, when there was no food present, they still salivated when they heard the bell. The same can be true for pain (and other symptoms). Some pain may simply be a learned response through association that later became chronic through habitual processes, fear and avoidance.

Habitual processes: Repeated experiences of pain can create neural pathways that make the brain more likely to perceive pain in the future. Symptoms can become ingrained in the brain's routine and turn into a habit. The brain has learned to continuously send symptom signals, even when there's no real threat or injury. This doesn't mean the symptoms aren't genuine; they are VERY real. It's just that the brain has become accustomed to sending these signals, almost like it's on autopilot. It indicates that the brain has formed a neural pathway for the symptom, which it can continue to use simply out of habit. Indeed, neurons that fire together wire together. In the case of chronic pain and other symptoms, the brain can easily learn to misinterpret harmless sensations and signals as threatening, leading to a habitual response of triggering symptoms. However, we can learn to relate to our experiences differently, and eventually create a different neural pathway, and thereby a different outcome; less pain. Indeed, just as the brain learns to send these signals, it can also learn to stop sending them.

How do we treat Neuroplastic Pain?

Before we decide on a treatment approach, we must first determine whether the pain is neuroplastic or not. The physician should evaluate the patient's symptoms, medical conditions, and lifestyle factors, and eliminate the possibility of tissue breakdown disorders that need biomedical treatments (such as Lupus, Muscular Sclerosis, etc.) or other issues such as fractures, infections, and nerve damage. Indeed, diagnosing neuroplastic pain requires a comprehensive medical history, a physical exam, and occasionally imaging tests like an MRI or CT scan. At times, an MBS diagnosis is quite straightforward. However, in other instances, evidence collection is necessary. This process resembles detective work, demanding curiosity and a keen eye for detail, such as observing changes in the pain's location, its intensity at various times, or in different social situations. Seeing a psychologist experienced in pain management may definitely be helpful here.

Signs that pain may be neuroplastic are as follows: pain that arises without an injury (although an injury can become chronic through neuroplastic processes); pain that occurs during stressful periods; pain that is inconsistent (e.g. pain while standing but not while running); pain that is present only in particular environments or situations; pain that spreads or moves throughout the body; a history of diverse symptoms (e.g. stomach pain, migraines, knee pain, etc.); experiencing childhood adversity or past trauma; and, personality traits inclined towards anxiety, hypervigilance, and perfectionism. None of these alone is conclusive; each one is indicative. The presence of more indicators increases the likelihood that the pain is neuroplastic. It's also important to note that people with medical diseases can also develop MBS symptoms in response to the stress experienced while being ill. Indeed, even pain caused by a chronic illness may have a neuroplastic component.

The above demonstrates the complexities of chronic pain. There is seldom one straight approach due to variability in how people respond to their pain, their background and current support network. However, using techniques like Somatic Tracking as part of a technique called Pain Reprocessing Therapy (PRT), you can train your brain to recognize that these signals are unnecessary and break the cycle. As we saw earlier, in neuroplastic pain, the brain misinterprets harmless signals from the body as though they were threatening. PRT operates on the idea that chronic pain may be intensified, and sometimes even generated, by neural pathways in the brain that have been learned. So, PRT is a psychological approach designed to assist individuals in interpreting pain signals as non-threatening, aiming to diminish or eradicate chronic pain. The main objective of PRT is to rectify this misunderstanding and instruct the brain that these sensations are actually safe.  It's all about helping your brain understand that it's safe and there's no need to keep activating the alarm.

PRT consists of five key components of psychological methods designed to retrain the brain to correctly interpret and respond to bodily signals, thereby disrupting the cycle of chronic pain: 1) educating individuals about the brain-based origins and reversibility of pain; 2) collecting and reinforcing personal evidence supporting the brain-based origins and reversibility of pain; 3) viewing and evaluating pain sensations from a perspective of safety; 4) dealing with other emotional threats, and; 5) focusing on positive feelings and sensations. The primary method in PRT is somatic tracking. This technique involves a specific way of perceiving and focusing on the pain. Usually, when we focus on pain, we may focus on its severity, whether it will get worse and whether we'll be able to complete planned tasks on that day. Although these reactions are completely understandable, such concerns strengthen danger signals to the brain, maintaining the pain signals. Somatic tracking enables us to change this approach. Rather than viewing the pain as a threat, we perceive it through a perspective of safety. Somatic tracking has three elements: 1) mindfulness; 2) reappraising sensations as safe, and; 3) generating positive emotions. Through mindfulness, we focus on the painful sensation in our bodies without fear or judgment, and without attempting to interpret or eliminate it. We simply allow it to be just as it is in that particular moment. We then reappraise the sensation as safe by reminding ourselves that the pain is a false alarm, not a sign of bodily injury. Additionally, we cultivate positive emotions, enabling us to approach the sensation with a relaxed and easy-going mindset. This usually must be done daily over many months to be effective.

When we're on high alert, we're prone to see everything as a possible danger. Unexpected loud sounds can startle us, gentle touches might make us pull away, or bodily sensations are more likely to be perceived as threatening and painful. Therapy seeks to reduce a person's general sense of threat. This involves assisting someone in processing threatening emotions more constructively by signaling safety to our fight-or-flight system. As fear and stress levels decrease, the brain is more inclined to interpret signals from the body as non-threatening, leading to a reduction in pain. Indeed, the goal of somatic tracking is to pay attention to the pain with a sense of safety and ease, viewing the sensation as fundamentally non-dangerous. This neutralizes the perceived threat, allowing our brains to reprocess the sensation as safe. As this happens, the pain will eventually fade.

The pain will not vanish right away when you first attempt somatic tracking, and that's perfectly normal - it takes time to rewire the brain! Although the ultimate aim of somatic tracking is to eradicate pain, the immediate objective is to conquer the fear of the pain. Fear fuels neuroplastic pain, and by diminishing that fear through the various techniques discussed above, a reduction in pain will follow. However, many people with chronic pain don't identify with the fear label; they may not feel particularly frightened. However, fear signals may also go by other names like frustration. You may even communicate threat to your brain by changing your diet, constantly seeking reassurance, constantly engaging in help-seeking behaviours, belonging to a large number of support groups, or by engaging in avoidant coping strategies after some kind of stressful illness or situation.

In my experience, the best treatment for neuroplastic pain may involve a multimodal approach by delivering different types of therapies together. This may also include medical interventions to manage symptoms (although these usually have limited efficacy). Therapy to address psychological factors that contribute to pain perception is vital. This might involve a trauma-informed approach, focusing on improving nervous system regulation by tolerating and managing triggers and challenging emotions without avoiding or reacting. Incorporating sleep hygiene and exercise like yoga and walking (if possible) may be helpful, as is improving people's social access to reduce isolation. It's important to remember that while psychological and behavioural methods can address the pain and even remove it completely, this doesn't mean the pain isn't real. Brain imaging studies have proven that the pain is as genuine as the pain from a broken ankle and originates from the same place in the brain. It's also important to remember that a broken ankle doesn’t cause the pain but the brain’s danger/alarm signal in the brain does; the same is true for neuroplastic pain. Physical pain and emotional pain are also handled in the same way by the brain.

Reducing or eliminating your pain requires time and consistent daily effort, and this journey is rarely straightforward, nor is it linear. It's important to recognize that there may always be a risk of the pain returning. Even if the pain pathways become unused, they still exist, and during a crisis, reverting to old coping thoughts and behaviours can reactivate them, making it feel like a setback. This can be discouraging. The good news is that you have also developed new pathways and can remind yourself to return to your new and more helpful coping methods; sooner rather than later, you get back on track. This is why self-efficacy is crucial here; believing in your ability to handle whatever comes your way despite setbacks, and knowing that the setback is just temporary. This may prevent you from panicking and falling back into another downward spiral of fear and avoidance, which may take some time to recover from.

A good resource (and an easy read) for understanding neuroplastic pain is a book by Alan Gordon called 'The way out'. Another helpful book about the Mind-Body Syndrome is by Dr. Howard Schubiner called 'Unlearn your pain' (4th ed). The premises of these books also apply to other symptoms such as fatigue, dizziness and nausea, even anxiety and depression. I would encourage you to read both, especially if you live with chronic pain, even if you have been diagnosed with an illness or injury and you suspect that your pain has become chronic with a neuroplastic component. Another really helpful resource is the Curable App which is not only educational, but includes many different practices you can apply wherever and whenever it's convenient to you. Curable is designed to help people with persistent pain to reduce their symptoms and calm their nervous system. It provides evidence-based chronic pain lessons and uses a combination of pain science education and research-backed techniques. It is also really helpful, and often essential, to speak to a psychologist trained in this area, who also has an understanding of the complexities of pain, e.g. by taking into account other important issues such as childhood trauma and grief.

If this is something you’ve been affected by, please leave a comment below. If there’s something important you’d like to add, please do so. I'd love to hear from you.

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Dr. Ingela Thuné-Boyle is a licensed Practitioner Health Psychologist and a Doctor in Behavioural Medicine who specializes in stress and loss, especially in improving the quality of life of people struggling with long-term health problems, chronic pain and medical trauma. She runs a private online (telehealth) practice at www.ingelathuneboyle.com.

Please note: Advice given in this blog is not meant to take the place of therapy or any other professional advice. The opinions and views offered by the author is not intended to treat or diagnose, nor is it intended to replace the treatment and care that you may be receiving from a licensed physician or mental health provider. The author is not responsible for the outcome or results following their information and advice on this blog.