HEALTH
I was recently listening to a Podcast which interviewed a pain psychologist by the name of Rachel Zoffness, PhD. She was promoting her new book, “Tell Me Where It Hurts: The New Science of Pain and How to Heal.” As a physical therapist, this is a statement that I use to prompt my patients everyday, but unfortunately, the simple answers I get in response are not enough on their own to help me solve years’ worth of chronic pain. In this book, Dr. Rachel Zoffness breaks down what pain actually is, and just how important pain neuroscience and our brains are to healing.
While I certainly cannot provide a fool-proof and comprehensive breakdown of all things pain neuroscience, I can help to provide a simple summary of what I learned in this book and how to apply it both to practice and everyday life.
Pain is More than Physical:
The first meaningful statement to note here is that pain is real, but it is much more complicated than a simple signal traveling from an injured body part to the brain. Instead, pain is constructed by the brain and influenced by a combination of biological, psychological, and social factors, often referred to in this book as the biopsychosocial model. What this means is that our emotions, thoughts, expectations, relationships, environment, sleep, stress levels, and past experiences can all influence how the brain interprets physical sensations. This does not mean that pain is imaginary or “all in your head.” As mentioned, the pain is real, but your brain is simply playing a much larger role in producing and regulating that experience than many people realize.
One example that Dr. Zoffness references in her book involves two construction workers. The first man jumped onto a 7-inch nail and saw it shoot right through his boot. The workers around him gasped, and he immediately felt severe pain. At the hospital, when they took his boot off, they realized that the nail went right between his toes; didn’t even penetrate the skin, not a drop of blood. His pain immediately went away. The second man misfired his nail gun. He saw a nail shoot across the room. His brain never considered that a second nail could have been ejected. After 6 days of experiencing a “tooth ache,” the man went to the dentist only to have discovered that a 4-inch nail was embedded in his jaw. The lesson: pain is not always an accurate measurement of physical damage and vice versa.
The “Pain Recipe”
A useful metaphor used throughout the book is the idea of a “pain recipe.” Pain can be thought of as a result of multiple ingredients coming together. Those ingredients can include physical injury, stress, fear, depression, past experiences, expectations, sleep, relationships, and the environments around us. Different combinations can produce very different experiences. Below are some examples of different factors that may contribute to your pain recipe.
The Pain Recipe Method helps to identify four things critical to pain reduction.
1. Pain triggers and amplifiers – stress is additive, the more stressors we have, the more they’ll amplify our pain.
2. High-pain ingredients that are in our power to change
3. Opportunities for intervention
4. A road map for creating a new, low-pain recipe.
The Brain Can Change
One of the most important themes of this book is neuroplasticity – the brains ability to change its patterns and connections in response to new information over time. In other words, changing the brain can change the experience of pain, but it takes work! Identifying non-physical contributors to pain and stressors in your pain recipe is essential to make these changes.
Emotions Are Part of the Treatment.
Acknowledging that stress, anxiety, depression, trauma, and fear can influence pain does not mean that the pain is “all in your head.” It recognizes that the body and our brains are constantly communicating with one another. For example, someone experiencing chronic pain may become afraid of movement (a physical therapist’s worst nightmare!). That fear can then lead to avoiding activities, which can result in deconditioning, isolation, and greater distress. Dr. Zoffness points out that “a brain in pain is in danger mode, making it prone to negative predictions.” In fairness, that is our human nature isn’t it, always assuming “worst-case scenarios,” but avoiding danger messages such as “I’ll be in pain the rest of my life, there is no cure,” or “this is going to hurt” is critical to healing chronic pain. Instead, identify your “Pain Voice,” the thing that tells you all those negative things and trade it in for some notes of positivity, words that heal, and a “daily dose of hope.”
Mindfulness is a great way to change pain response as it provides increased self and emotional awareness, relaxation and stress reduction, and improved cognitive control contributing to our ability to change negative thought patterns regarding pain.
Conclusion
The truth is that pain is complicated. I urge everyone to read this book or other pain neuroscience material to gain a better understanding of the multidisciplinary approach to healing our bodies and our brains, because you truly cannot heal one without the other. Dr. Zoffness offers many resources in this book designed to help patients and healthcare providers identify “pain recipes” and how to create new pain pathways.
For health care providers, avoid catastrophic, scary, or inflammatory language in your diagnosis; fear is a pain amplifier!
Zoffness, Rachel. Tell Me Where It Hurts: The New Science of Pain and How to Heal. Grand Central Publishing, 2026.
