Understanding Chronic Pain: What You Need to Know

All Pain is Real

Pain is a real experience created by the brain and nervous system.

The following will help you understand how pain works. The information here isn't about dismissing your pain—it's about giving you tools to manage it more effectively.

Living with chronic pain can be challenging, but understanding how pain works can help you manage and even reduce your symptoms. Here are 3 key points to keep in mind:

1. Pain is a protective signal: Pain is a complex, personal experience created by the brain in response to threat signals… from the body and also from our environment, relationships, memories, and beliefs about pain. When the body detects a potential threat (such as an injury), it sends signals to the brain that then creates the experience of pain. This signal is designed to protect us, but it's not always a reliable indicator of injury because…
2. All pain is created by the brain: This means we can have injuries that are painful, and injuries that don't hurt. The brain can even create pain when there's no tissue damage at all. We call this "learned pain" or "neuroplastic pain"—pain that develops as the nervous system becomes more sensitive over time. These patterns are reversible, which is good news because…
3. Treatments that address how the brain processes pain can lead to recovery: In chronic pain, the nervous system can become overly sensitive, making pain persist and feel more severe. By understanding this, we can work with treatments that help the brain and nervous system feel safer, which can reduce or eliminate pain.

Understanding Different Types of Pain

Many people think pain only comes from tissue damage (like a broken bone or torn muscle)
or nerve damage (like a pinched nerve). While these can certainly cause pain, they're not
the whole story.

Pain from tissue or structural damage happens when there's an active injury or inflammation in the body—like a sprained ankle, arthritis flare-up, or fresh surgical wound. This type of pain usually improves as the tissue heals.

Pain from nerve damage occurs when nerves themselves are injured or compressed—like carpal tunnel syndrome or sciatica. This can create shooting, burning, or tingling sensations.

Learned pain (nociplastic pain) is different. This type of pain persists even after tissues have healed or when there's no structural damage found. Through training and experience—whether military service, difficult life circumstances, or living with persistent pain—the body can become highly tuned to respond to threats. This is adaptive and protective. However, sometimes the nervous system becomes overly sensitive, continuing to sound the alarm even when there's no actual threat. This is the most common type of chronic pain.

Here's what's important to understand: You can have more than one type of pain at the same time, and pain can shift from one type to another over time. For example, pain might start with an injury (tissue damage), but even after the injury heals, the nervous system may stay in a protective state, creating learned pain.

The good news is that learned pain responds well to treatments that help the nervous system become less sensitive and feel safe again. Understanding which type of pain you're experiencing—or which combination—can help you and your healthcare team choose the most helpful treatments.

Treatments That Help Your Brain and Body Feel Safer

If you are living with chronic pain, there are many approaches that can help reduce the threat signals the nervous system is receiving and increase feelings of safety.

General Approaches

• Pain education, or learning more about how chronic pain works, has been shown to improve pain and function and change how people think about their symptoms.
• Cognitive-behavioral therapy (CBT) is a type of talk therapy that helps you improve pain by changing thought patterns and behaviors that may be contributing to your symptoms.
• Movement-based therapies such as Physical Therapy, yoga, or tai chi can help you move with confidence and learn to experience sensations in the body as safe.
• Virtual reality (VR) programs use VR headsets for pain management strategies, including mindfulness, relaxation, and guided imagery.
• Whole Health services can empower you to take charge of your health, focusing on what matters to you and doing more of what brings you joy.

Therapies Designed for Learned Pain

There is also a family of therapies designed specifically to treat learned pain (also called primary or nociplastic pain)—pain that persists because of changes in how the nervous system processes signals.

• Pain Reprocessing Therapy (PRT) is a psychological approach that helps you understand chronic pain as a "false alarm" from an overprotective nervous system.
• Emotional Awareness and Expression Therapy (EAET) is an evidence-based therapy that helps you become more aware of unresolved emotional experiences and express emotions in healthy ways. EAET has been shown to be helpful in multiple clinical trials, including among Veterans.

Starting Your Journey: What You Can Do Next

Understanding chronic pain is an important first step. The next step is exploring treatments and resources that can help you improve your quality of life and get back to doing what matters to you.

Here are some ways to begin:

• Talk with your health care team about which treatments might be right for you
• Explore the resources below to learn more about pain science and mind-body approaches
• Start small with one or two changes—maybe a short daily walk or a few minutes of mindfulness
• Be patient with yourself —retraining the nervous system takes time
• Focus on what matters to you —what activities, relationships, or goals would you like to reclaim?

Multimedia Resources

Below, you'll find a curated list of educational resources to support your learning. These videos, articles, websites, and podcasts can help deepen your understanding of chronic pain and evidence-based approaches to treatment.