To Treat Pain, Do You Treat the Body or the Brain?

Commonly, patients and providers assume that pain is the result of an injury or illness, or at least some type of condition in the body. So, for example, when pain in the low back occurs, it’s common to think of it as the result of some type of tweak or mild injury that must have occurred. When it goes on for some time, it’s also is common to want an MRI scan to see “what’s going on” in the back. Such scans often reveal some type of degenerative condition of the spine, which is subsequently considered the cause of the back pain. 

As a result, people with pain tend to seek therapies that target the condition in the body by means of physical therapy that strengthens the core, or undergo steroid injections, or even surgery. 

The same would be true if the onset of pain occurred in the shoulder or knee or hip. We’d tend to think of the pain as a sign that something is wrong in these joints, something orthopedic in nature, such as arthritis or a problem with a ligament or muscle. We’d tend to seek a scan to help in diagnosis followed by physical therapy, an injection or surgery,

The purpose of these types of assessment and therapies would be to treat the condition that is assumed to be the cause of pain. While doing so, we might take pain medications that act on the brain. 

Wait, what?

Yes. We tend to seek to reduce pain with therapies that treat conditions of the body all the while we take pain medications that treat the brain. Pain medications such as opioids, muscle relaxants, anti-epileptics, and antidepressants all work on the brain to reduce pain. Even anti-inflammatory medications have downstream effects on the nervous system, including the brain. 

We have, then, a disconnect in pain management. We tend to focus on tissue pathologies (muscles, ligaments, discs and joints) to treat what we assume are the causes of pain, all the while targeting the brain to reduce pain itself.

We neglect this fact when managing pain. Indeed, while taking centrally-acting pain medications (i.e., medications that work on the brain), we seek therapies that target the body, but question other therapies that target the brain. In this process, we wonder about other centrally-acting therapies, such as pain psychology, mild aerobic exercise, tai chi, yoga and mindfulness meditation. What, we tend to ask, do they have do with pain in the back or hip, or shoulder, or knee? And yet, all these therapies have been shown to be helpful to reduce pain.

It bears repeating: therapies that target the brain are effective at reducing pain, regardless of any initial cause of pain in the body.

Recently, the Institute for Chronic Pain published an article on pain psychology. The article Why See a Psychologist for Pain? attempts to demystify why and how pain psychologists provide effective therapies for the management of pain. The therapies that pain psychologists employ target the brain. As the saying goes, change your brain, you change the pain.

I thought that the article could be a nice way to introduce someone to seeing a pain psychologist, if they were referred to one. I also thought that referring providers might recommend it to patients when referring them to pain psychology.

I hope that you find it helpful.

Date of publication: February 21, 2021

Date of last modification: September 20, 2021

About the author: Murray J. McAllister, PsyD, is a pain psychologist and consults to clinics and health systems on improving pain care. He is the founder and editor of the Institute for Chronic Pain.