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I have pain. Is it all in my head?

Let’s not beat around the bush. The answer to the above question is undoubtedly “YES”. Your pain is 100% in your head, but that doesn’t mean that it’s not real. It doesn’t mean that you’re crazy. It means that you are human. Let me explain.

Over the last couple years, I have become more and more fascinated with the mindset/psychological aspects of rehabilitating injuries. I did the math and I’ve seen somewhere in the ballpark of 14,000 individual patient encounters in my career. I keep running into the same question over and over again. How can two people with an identical injury, similar age and stage of life, and socioeconomic status have vastly different rehab outcomes? There has to be more to the picture right?

Chronic pain and management of musculoskeletal pain is an incredible problem. John Hopkins University estimated that over 635 BILLION dollars a year are spent treating and fighting chronic pain. That’s more money than is spent on heart disease or cancer and metabolic diseases such as diabetes. Epidural steroid injections are the new frontline and on average cost 2,195 dollars per injection. In many cases these injections are not curative, but simply a way to manage pain long term. If it sounds like slapping a band-aid on a shark attack victim, you’re getting the right picture. Speaking of band-aids, we’re prescribing pain medications at record and alarming levels. According to the National Institute of Drug Abuse 22-29% of people prescribed opioids for pain will end up abusing them within their lifetime. Again, exchanging band-aids for bullet wounds.

Our healthcare system has forgotten some basic human facts while pandering to the billion- dollar pain industry. People are not machines and have physical symptoms that are heavily impacted by emotional, psychological, socio-economical, and spiritual factors. Treating pain according to imaging or physical symptoms will ALWAYS fall short if other factors aren’t being addressed.

This is the 4 step process in how pain works in simple terms:

1. A stimulus activates a nerve ending somewhere throughout your body.

2. That signal is transported up your spinal cord to your brain.

3. That signal is modulated and up or down regulated before it gets to it’s final destination in the brain. This may or may not occur based on how you have learned to think about pain and your specific life experiences.

4. Perception occurs when that pain signal is processed in the brain into a meaningful physical sensation that is also very individualized and based on your unique makeup and experiences.

So how do we take control of pain? We have to tame the lion. Our brains are masters of survival and deciphering information. Information that your brain deems most important to your survival and success will be processed first and fastest. Let me give you an example. Let’s say you’re in an important business meeting in a busy restaurant. It’s very loud but you are keying in on every word that your associates say. The people sitting at the table next to you are having an equally loud conversation, but you don’t hear them. Why? Your brain has filtered out their conversation because it’s not important to your success or survival. This is called frequency bias. Pain works the same way.

Here’s another example. Let’s say you’ve just broken one of your fingers and are waiting in the emergency department lobby for x-rays. Suddenly a ravenous lion comes roaring through the door. What happens? Your brain quickly shuttles adrenaline into your system and blood flow to the musculature of your legs and you RUN. Your broken finger is no longer even on your radar and it’s certainly not painful. Our brain processes pain in relation to it’s perceived threat. In order to decrease pain, we need to decrease the perception of threat and tame the metaphorical lion in our life.

3 steps to tame the lion in your life.

1. Reframe and re-write aberrant thoughts

-Throughout literature, education is a staple in management of chronic pain. That’s because understanding the pain process helps us perceive the stimulus as “less scary”. What if instead of a ravenous lion, you learned the lion was a successful and easy-going show-pet named Squeezy. He had been declawed and was as docile as a purring house cat. Would your response to the lion change? I would think so.

This is exactly how we address consistent pain. We reframe the big scary problems into less scary thoughts. “I have a BAD back due to degenerative changes in my spine”. Sounds scary. Much less scary if we reframe into “I have back pain due to normal age related changes, but I’m taking steps to improve it”. Instead of “I’ll never do XYZ activity again due to my injury” reframe to “I can’t do XYZ right now, but with time and effort I’ll get back to XYZ”. The way your brain perceives these small intricacies makes enormous differences and effects your outcome. This takes practice and consistency, but may move the needle further than you ever imagined in regards to pain.

2. Restore movement and normal perception of it

-I grew up on a farm. I learned from a very young age that touching an electric fence is painful and overall not a fun experience. After a few encounters, even getting close to the fence had me on my toes. Everywhere I went I’m thinking “where is the fence, I’ve got to stay away from it”. Your pain is the same. If our shoulder hurts when we reach overhead, we learn that association. If this goes on long enough, even getting CLOSE to that motion may trigger a pain response. Instead of lifting overhead being painful, now it’s painful when you start to move your arm in any direction. Your brain has associated your shoulder movements with painful stimuli and is yelling “STAY AWAY FROM THE FENCE”. This is why seeing a movement specialist is so crucial sooner rather than later. By restoring pain free motion, we can restore how our brain perceives said motion. If you can learn it, you can un-learn it with effort and time. The key is you have to KEEP moving in order to do so.

3. Rebuild healthy pathways through positivity and consistency

-Have you ever started looking for a new car? After deciding you want to buy a specific model of car, you start to see them everywhere. There are more of those cars than you ever realized! They’ve always been there, you just started noticing because you told your brain it was important. Again, we’re talking about frequency bias. We can use this to our advantage by up-regulating the positive aspects of our life. By purposefully focusing on things we are grateful for and seeing our world through an optimistic lens, we will gravitate toward those things. We will start to see injuries as opportunities for improvement instead of overwhelming obstacles.

- We also have to be able to set healthy boundaries and habits and stay consistent with them. Stress and environmental factors can be large triggers of pain due to the before mentioned association. Learning and minimizing specific things, people, situations that cause you stress can be a big factor in managing pain. Understanding that getting adequate sleep, nutrition, and human interaction affect pain is crucial. Taking small consistent steps to improve sleep quality, food quality, and limiting stressful stimuli (within our control) should not be overlooked.

In conclusion, I’m not saying you can simply think away all of your pain. There are likely real and significant physical factors at play. What I’m saying is that your thinking does heavily influence your physical pain and can be used to supplement your physical treatments. As a human being our minds can be our biggest asset as easily as being our biggest liability. If you’re having significant pain get checked out by a healthcare provider and consistently reframe, restore, and rebuild the narrative.

Stay Kinetic Friends.


Osterweis M, Kleinman A, Mechanic D, editors. Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives. Washington (DC): National Academies Press (US); 1987. 7, The Anatomy and Physiology of Pain. Available from: .


Dr. Levi Kerby is a physical therapist, orthopedic certified specialist, and owner of Kinetic Performance and Rehab in Winston-Salem, NC. He enjoys fly fishing, guitar, various forms of fitness, and treating active and motivated individuals.

If you're dealing with an injury or pain, you can contact Kinetic Performance and Rehab directly below.

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