Why "It's All in Your Head" Is the Most Harmful Thing We Can Say to Chronic Pain Patients

The Cartesian split between mind and body served medicine well for centuries. But in chronic pain management, it has become our biggest obstacle.

Here's what current neuroscience tells us: trauma doesn't just affect the mind—it physically rewires the nervous system. Survivors of chronic stress, adverse childhood experiences, and traumatic events show measurable changes in brain structure, HPA axis function, and immune response. These aren't psychological abstractions. They're anatomical realities.

The result? A nervous system stuck in protection mode, generating real pain signals even when tissues have healed.

Enter Nociplastic Pain

In 2017, the International Association for the Study of Pain gave us a crucial new term: nociplastic pain—pain arising from altered nociception despite no apparent tissue damage or nerve lesion.

This isn't "psychogenic pain." It's not imagined. It's a mechanistic description of what happens when the central nervous system becomes hypersensitive.

Think of it this way: the hardware (tissues) may be intact, but the software (processing) is malfunctioning. The alarm system rings when there's smoke from burnt toast, not an actual fire.

This distinction matters enormously for patient care. It validates suffering while redirecting treatment toward the actual source: the sensitized nervous system.

Research from the Cleveland Clinic found that 68% of adults with chronic primary pain reported at least one traumatic event, and nearly 20% showed clinically significant PTSD symptoms alongside their pain.

These patients reported higher pain intensity, greater functional interference, and elevated depression and anxiety compared to non-trauma-impacted pain patients.

The relationship runs both directions. Trauma induces pain through HPA dysregulation and central sensitization. Chronic pain induces trauma through unrelenting suffering, loss of function, and invasive medical experiences. It's a trap—and treating one without addressing the other rarely succeeds.

Why Validation Is a Clinical Intervention

Social rejection activates the same brain regions as physical pain. When we dismiss a patient's experience—even unintentionally—we're not just damaging rapport; we're also undermining trust. We're literally increasing their pain.

A 2024 cohort study of 1,470 chronic low back pain patients found that physician empathy was a stronger predictor of positive outcomes than opioids or surgery.

The mechanism is straightforward: empathy signals safety. When patients feel heard, their threat-response system downregulates. The sympathetic "fight or flight" response gives way to the parasympathetic "rest and digest" response—creating physiological conditions conducive to healing.

A Better Way to Explain It

The challenge is acknowledging the brain's role without implying the pain is imaginary. Here's language that works:

Instead of: "There's nothing wrong with you."

Try: "Your tissues are healthy, but your alarm system has become sensitive."

Instead of: "Is it possible you're just depressed?"

Try: "Chronic pain often drains the brain's neurochemicals, which can lower both your mood and your pain threshold. Treating one often helps the other."

The elevator pitch: "Pain is 100% real, and it's 100% constructed by the brain. This doesn't mean you're imagining it—it means your brain is doing its job to protect you. After trauma or prolonged stress, your brain gets 'better' at producing pain. Our job isn't to fix a broken part, but to help your nervous system learn that you're safe enough to turn down the alarm."

What Works: Evidence-Based Interventions

Once patients understand the "protective alarm" model, several approaches show strong evidence:

For survivors of violence, abuse, or medical trauma, the physical examination itself can trigger dissociation or flashbacks. Simple adjustments matter:

We don't need to become trauma therapists to practice trauma-informed pain care. We need to:

The separation of mind and body in pain treatment is a relic that continues to harm our patients. Acknowledging trauma's role isn't an accusation of mental illness—it's recognition of neurobiological reality.

When we move from "detecting the lie" to "honoring the protection," we offer our patients something powerful: the dignity of being believed, and the best possible chance at reclaiming their lives.

At Anodunos, we're committed to transforming how healthcare professionals approach chronic pain management. Our training programs equip clinicians with the tools to integrate trauma-informed care into everyday practice—from communication frameworks that validate patient experience to implementation strategies for the biopsychosocial model.

Through the Anodunos Method, we train Pain Navigators and Healthcare Providers to treat the whole person, not just the symptom. We partner with healthcare organizations to implement pilot programs and advocate for expanded insurance coverage of integrative treatments, including acupuncture, massage therapy, and nutritional counseling.

Because we believe in the principle of "Nothing About Us, Without Us"—centering patient voices and lived experience in everything we do.

Ready to learn more? Connect with us to explore how trauma-informed pain care training can benefit your team and your patients. Email certification@anodunosmethod.com

What approaches have you found effective in addressing the trauma-pain connection in your practice? We welcome your thoughts.