Why Does the Brain's Alarm System Sometimes Send a False Alarm?

Think of pain as an alarm system designed to protect you from danger. When there is an actual injury or threat, the alarm serves an important purpose.  Pain alerts you that something is wrong and signals you to protect the injured area, avoid activities that could make the injury worse, and allow your body time to rest and heal.  But sometimes the brain's alarm system becomes overly sensitive and starts sending danger signals even when there is no actual danger or ongoing tissue damage. In other words, the alarm is sounding, but it's a false alarm.

When you experience an injury, the brain creates neural pathways associated with pain. These pathways help protect the injured area while the body heals. However, the brain doesn't necessarily forget those pathways once the injury has healed. Over time, the nervous system can become increasingly sensitive, and the brain may continue activating those learned pain pathways even when the original injury is no longer present.

This means the body can heal, but the brain can continue generating pain.

Why Does the Brain Turn Up the Volume on Pain Signals?

Another way to understand this process is to imagine a volume knob. Think about wearing a hearing aid. Someone may be speaking at a normal volume, but if the hearing aid is turned up too high, their voice sounds much louder than it actually is.

Something similar can happen with chronic pain. Our bodies constantly send information to the brain about sensations such as movement, muscle tension, pressure, and changes in position. Most of these sensations are completely normal and harmless. But when the brain becomes overly sensitive and interprets these ordinary sensations as potential threats, it can turn up the volume on the signals it receives.

A sensation that would normally register as mild or neutral may suddenly feel painful. The brain is essentially amplifying the sensation because it believes the body may be in danger.

What determines whether the brain turns the volume up or down? In part, it depends on how much danger the brain believes there is.

How Do Stress and Emotions Influence Chronic Pain?

The brain doesn't just evaluate physical sensations when deciding whether something is dangerous. It also responds to stress, fear, past experiences, and emotional threats.

Interestingly, brain imaging research has found that when someone has a physical injury, brain regions light up, showing that the brain is activating pain in response to that physical injury.  Interestingly, emotional pain, such as rejection, betrayal, or the loss of an important relationship, activates the same brain regions when a physical injury occurs.  

This helps us understand why emotional experiences can influence physical symptoms.

For some people, ongoing stress, unresolved emotional experiences, and suppressed emotions can contribute to the brain's protective response, keeping the nervous system on alert and making it more sensitive to physical sensations.  This can contribute not only to chronic pain but also to symptoms such as fatigue, dizziness, brain fog, and other persistent physical symptoms.

This does not mean that everyone with chronic pain has unresolved emotional trauma or that pain is simply caused by emotions. Rather, it highlights the important connection between our emotional experiences, brain, nervous system, and physical health.

Can Childhood Trauma and Adverse Experiences Contribute to Chronic Pain?

Research has identified an association between adverse childhood experiences (ACEs) and an increased likelihood of experiencing chronic pain in adulthood. ACEs include potentially traumatic or stressful experiences during childhood, such as physical, emotional, or sexual abuse; neglect; witnessing violence; or growing up in a home affected by substance abuse, mental illness, or significant instability.

A 2023 systematic review and meta-analysis involving more than 826,000 adults found that individuals who experienced adverse childhood experiences had higher odds of reporting chronic pain as adults. The likelihood increased as the number of adverse experiences increased. 

Why might this happen? When children experience ongoing stress, fear, or trauma, their developing brains and nervous systems adapt to help protect them. They may become especially alert to potential threats, learning to anticipate danger and remain prepared to respond. These protective patterns can continue into adulthood, even when the person is no longer in the environment where those experiences occurred.

For some individuals, these learned patterns of protection may influence how the brain processes physical sensations, responds to stress, and generates or amplifies pain. Traumatic experiences and ongoing stress in adulthood can also influence these patterns.

It is important to understand that this does not mean everyone with chronic pain has experienced trauma or that trauma is always the cause of persistent physical symptoms. Pain is complex, and each person's history and contributing factors are different. An ACE score also does not tell the whole story of someone's life or determine whether they will experience chronic pain.

How Can Therapy Help Address These Connections?

Understanding the possible connection between past experiences, the nervous system, and physical symptoms can help people recognize factors that may be contributing to their pain. Therapy can provide a supportive environment to explore these connections, address unresolved emotional experiences, and develop new ways of responding to stress and physical sensations.

For individuals whose histories include trauma or distressing experiences, EMDR (Eye Movement Desensitization and Reprocessing) may be a helpful part of treatment. EMDR helps people process distressing memories and reduce the emotional intensity associated with them. When past experiences are contributing to ongoing stress or heightened threat responses, addressing them may support the broader healing process.

This does not mean you have to revisit every painful experience or identify as someone who has experienced trauma to benefit from brain-based approaches to chronic pain. Trauma processing is not necessary for everyone. Treatment is individualized and proceeds at a pace that respects your history, needs, and sense of safety.

Is Neuroplastic Pain Real, Even When There Is No Ongoing Injury?

One of the biggest fears for people living with chronic pain is that something must still be physically wrong with their bodies. After all, if you are hurting, shouldn't there be an injury or structural problem causing it?

Not necessarily.

Research in neuroscience has shown that pain is an experience generated by the brain. While acute pain is often triggered by actual tissue injury, the brain can also generate pain through learned neural pathways, even when there is no ongoing tissue damage to explain the symptoms.

When this happens, the pain is sometimes called neuroplastic pain, also known as neural circuit pain. These terms describe pain generated by learned neural pathways in the brain rather than ongoing tissue damage or structural problems adequately explaining the symptoms.

The pain is real, not imaginary, exaggerated, or something a person is making up. The brain is generating a genuine pain experience in response to perceived danger, even when there is no ongoing physical threat.

The encouraging news is that the brain is capable of change. Just as it can learn patterns of pain and protection, it can also learn new patterns. Treatment involves helping the brain recognize that certain physical sensations are safe rather than dangerous, reducing the fear and sensitivity surrounding those sensations, and creating new neural pathways.

Through neuroscience-based approaches such as Pain Reprocessing Therapy and Emotional Awareness and Expression Therapy, individuals can work toward retraining the brain's response to pain and finding lasting relief.