How Does the Brain Control Pain?

May 7, 2020

Ted Carter

by Ted Carter
PT, DPT, OCS, CSCS, Cert. TDN Ahwatukee Location

Pain is one of the few common experiences we can all relate to. Everyone has experienced pain at one time or another in their lives. No one enjoys being in pain, but it is a necessary part of helping keep us alive. To gain a deeper understanding of pain we will look at the various parts of the brain that control pain.
Pain is defined as “an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage” which was developed by the International Association for the Study of Pain. Pain is an output from the brain when the brain thinks we are threatened. Tissues (muscles, joints, ligaments, and nerves) are just one input for the brain. The brain receives millions of inputs every second before it determines the output (pain or no pain) and processes them at an incredibly rapid rate, millions per second.
These inputs are messages sent to the spinal cord and brain, letting the brain know about temperature (so you know whether to wear a tank top or winter coat), blood flow (is it time to get up and move?), stress levels (hormones including adrenaline and cortisol), movement (your eyes are moving as you read this), and the immune system (such as when you have the flu). If the brain determines that something is a threat it can make you feel pain even in the absence of tissue damage. Processing pain is much more complicated than just a tissue being damaged, so let’s take a deeper look.
Scientists once thought that when tissues are damaged a special “pain center” in our brain lights up telling us we have pain and when tissues are healed this area turns off. We now know through brain scans that when we experience pain, nine areas of our brain light up, we call this our neuromatrix. Everyone experiences pain differently, my pain is different from your pain and your pain is different than your neighbor’s pain but we all have the same nine areas light up, they just light up differently. So what are the nine areas, what are they responsible for, and most importantly why does the neuromatrix matter?

  1. Premotor/Motor Cortex – organizes and prepares us for movement
  2. Cingulate Cortex – concentration and focus
  3. Prefrontal Cortex – problem solving and memory
  4. Amygdala – fear and addiction
  5. Sensory Cortex – sensory discrimination
  6. Hypothalamus/Thalamus – response to stress and motivation
  7. Cerebellum – movement and cognition
  8. Hippocampus – memory and fear conditioning
  9. Spinal Cord – first stop to process information from peripheral inputs (tissues) before sending the info up to the brain

Understanding that there are several areas of the brain that control pain is important. We now know that these nine areas do not just light up together when we experience pain but also communicate with each other when we experience other events such as memories and coordinating movement. This helps explain why when some people experience pain for prolonged periods they report difficulty concentrating at work, feel more stress, have a harder time completing physical activities, or can experience pain without tissue damage.
The good news: we can change the way that our brains light up through treatment interventions used in physical therapy. Education, manual therapy, trigger point dry needling, physical activity, and modalities are all ways that physical therapists can modify brain inputs to help people experience less pain and increase our ability to perform functional activities.
If you’re in pain, don’t wait any longer! Click here to make an appointment at your nearest clinic.
In Health,
Ted Carter, PT, DPT, OCS, TPS, CSCS, Cert. DN
Foothills Sports Medicine Physical Therapy

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