Cracking the Code: Exploring How Emotions Shape Our Perception of Pain

If you’re living with chronic pain, you might have encountered well-intentioned yet poorly timed comments suggesting your pain is “all in your head.” No need to elaborate on how dismissive and insensitive this can feel, but let’s delve into it further, if you’re open to it.

image of two light drawings of faces one with light and space in the brain

Pain is intriguing because it’s unique to each individual, influenced by various factors. A recent study examined pain tolerance disparities between men and women, revealing that women actually possess a higher pain threshold than men. The reasons behind this difference are quite captivating. It’s not solely linked to menstrual discomfort or childbirth; rather, it stems from women’s tendency to recall painful experiences, shaping their reactions to pain (Martin LJ, Acland EL, Cho C, et al. (2020). This contrast with men, who tend to forget pain episodes, demonstrates the intricate interplay between memory and pain perception. This connection becomes even more remarkable when considering the impact of our diverse experiences on how we process pain.

So How Much of Your Pain is in Your Head?

The answer varies, and there isn’t a universally agreed-upon percentage. In a certain light, though, technically all pain originates in the mind. This is because when the body experiences a wound or painful stimulus, the brain processes it, resulting in the sensation of pain. However, beyond this basic brain function, the extent to which our minds influence our perception of pain depends on factors such as the specific type of pain, our pain history, and the context in which the pain arises. It’s crucial to recognize that pain isn’t solely a physiological response—it incorporates a psychological dimension. This psychological aspect is pertinent when undergoing treatments for any pain and, of course, when living with chronic pain.

Both research and clinical experience highlight the significant role psychological and emotional factors play in shaping pain perception and experiences. Let’s delve into this further.

Placebo, Nocebo and Cognitive Appraisals 

image of happy and sad face drawings with pills

The placebo effect showcases the impact of positive expectations and beliefs on pain relief, while the nocebo effect reveals how negative expectations can worsen pain. These effects underscore the significant role of the mind in shaping pain perception. In simpler terms, if you anticipate a treatment being painful or ineffective, you’re more likely to experience it that way. Being hopeful or expecting positive outcomes shifts your nervous system, making you more receptive to positive results. Conversely, harboring doubts or expecting negative outcomes triggers the sympathetic nervous system response, potentially affecting treatment experience. How individuals interpret and evaluate pain significantly influences their experience. Negative appraisals and catastrophic thinking can amplify pain, while positive coping strategies and cognitive reframing can alleviate it. (Benedetti, F. (2014).

The Solution: Though it might sound unconventional, adopting a “fake it till you make it” approach can foster a positive outlook. Our brain doesn’t distinguish between actual experiences and imagined ones. So, envisioning successful treatments or consultations can alter your perspective. This practice not only cultivates a more positive mental state but also positively impacts your physical and spiritual well-being, far more than expecting failure at every turn.

Fear, Anxiety & Expectations

There’s a saying that “the fear of pain is always greater than pain itself,” a thought I ponder daily. It’s human nature to dislike pain and seek comfort, yet paradoxically, the avoidance of pain through excessive treatments and lifestyle changes is driven by fear. Anxiety and fear can magnify pain perception and contribute to pain-related impairment. Anticipating pain intensifies its sensation, whereas expecting relief can alleviate it. This illustrates how cognitive factors shape pain experiences (Eccleston, C., & Crombez, G. (2007), Kaptchuk, T. J., & Miller, F. G. (2015). Fear triggers heightened pain sensations; indeed, any negative emotion can amplify pain perception. In my acupuncture practice, I often witness this with pediatric patients. Those whose parents prepare them for acupuncture with positivity experience less anxiety and pain during needle insertion. Conversely, those prepped with negative comparisons to other unpleasant treatments exhibit higher anxiety and pain sensitivity.

The Solution: Nurture fear resilience – essentially, confront your fears. Opt for ripping off the bandage rather than peeling it slowly. Fear is natural, and acknowledging it while facing it, often with assistance from friends, mentors, coaches, or therapists, can be transformative. Begin by assessing your strategies for addressing or avoiding pain. Recognize instances of avoidance or fear, and be kind and patient with yourself. Acknowledge your efforts and obstacles without self-criticism. Fostering self-compassion can mitigate fear’s emotional impact.

Emotional Distress & Emotional Regulation

Image of calm face

Emotional distress, encompassing anger, depression, and anxiety, can diminish pain thresholds and heighten pain sensitivity. Conversely, enhancing emotional well-being can positively influence pain perception (Eccleston, C., & Crombez, G. (2007). Imagine your absolute worst day: job loss, chaotic home, dog mishap, relationship tension, shattered window, financial trouble—then you stub your toe on a coffee table. Your reaction? Likely frustration and pain, surpassing your emotional threshold. In contrast, envision a day filled with achievements and positivity: raises, published commendations, delightful dinners, unexpected funds, adorable puppies, and sunsets. Stubbing your toe in this context still brings pain, but the impact is notably lesser than in the first scenario. 

When content or joyful, our regulated nervous system equips us to handle challenges with more grace due to our heightened emotional bandwidth. Conversely, during times of upheaval, the limited bandwidth intensifies pain, discomfort, and distress.

The Solution: Broaden your focus to embrace mental and emotional well-being within your treatment plan. Some might delve into dedicated literature, while others may collaborate with coaches or therapists specializing in chronic pain and illness. The approach may vary, but the essence lies in elevating mental and emotional health to a top healing priority, transcending mere checklist tasks.

Attention & Distraction

Do you feel overwhelmed by pain and illness, reshaping your life? Doctor visits can become a full-time commitment, a constant pursuit of betterment. Where focus lands can alter pain perception. If pain tops your to-do list, it becomes the center of attention, magnifying its prominence (Crombez, G., Eccleston, C., Van Damme, S., Vlaeyen, J. W., & Karoly, P. (2012). Similar to how a new haircut dominates your awareness initially but fades over time, persistently prioritizing pain magnifies its presence, unlike a sporadic haircut.

The Solution: Developing discomfort tolerance and embracing engaging diversions can diminish pain perception. While these notions seem opposing, they share a core essence. For those feeling controlled by illness, briefly shifting it to the background can be beneficial. Carve moments for self-care, pace activities, and consider that relentless pursuit of solutions might not always be the answer. This approach entails confronting the discomfort of potential stagnation. A question I often ask clients is, “After years of unchanged treatments, could alternatives be worth exploring?” (Considering life-saving treatments as exceptions). Sometimes, embracing novel approaches or taking breaks becomes essential. As always self compassion rings paramount here as well, acknowledging that any of your choices are the best choices for you, no matter what. 

Central Sensitization

Image of close up neurons

Central sensitization plays a pivotal role in numerous chronic pain conditions, including fibromyalgia, migraines, irritable bowel syndrome (IBS), and certain back pain types. This neurological phenomenon entails the nervous system becoming highly sensitive to pain signals. This intricate process involves central nervous system (CNS) changes, mainly within the spinal cord and brain. Central sensitization significantly contributes to the development and persistence of chronic pain conditions, amplifying pain perception beyond the initial injury’s presence (Woolf, C. J. (2011).

Central sensitization generally initiates due to tissue damage, inflammation, or injury. Continuous transmission of pain signals from the body’s periphery to the CNS can induce neuroplastic adjustments. Neuroplasticity pertains to the brain’s capacity to restructure and function based on experiences. Essentially, the body rewires its pain processing mechanisms. Neurons become more receptive to pain signals, firing more readily and at lower thresholds. Consequently, stimuli that would usually be mildly painful or non-painful trigger exaggerated and prolonged pain responses. Once central sensitization sets in, it can persist post-injury or inflammation healing, contributing to the shift from acute to chronic pain and complicating pain management.

The Solution: Effectively addressing central sensitization necessitates a comprehensive approach that melds medical interventions, physical therapy, cognitive-behavioral therapy, and various pain management techniques. This underscores the interplay between emotional states and neuroplastic changes. It’s vital to recognize that central sensitization is intricate and varies among individuals and different pain conditions. As our comprehension of pain mechanisms advances, researchers and clinicians strive to develop targeted interventions, improving the lives of those with chronic pain.

Healing the Mind-Body-Spirit Connection with Chronic Pain 

Healing with chronic pain can be difficult, but healing is always available even when a cure may not be. I define healing as learning how to be with yourself, be present and engaged regardless of the intensity of the situation at hand, it means being your true self no matter what and developing resiliency and abilities to return to that self when the going gets tough, because it always does. When we shift to this definition of healing it means it’s always available for us even when pain reduction or a cure is not and this can be incredibly empowering. 

It’s important to recognize that the mind’s influence on pain perception is not a separate entity from the physiological processes of pain. The brain processes pain signals and emotions in a closely interconnected manner. The biopsychosocial model of pain management acknowledges the interplay between biological, psychological, and social factors in pain perception.

In summary, while it’s challenging to assign a specific percentage, there is a consensus that the mind and emotions play a significant role in how we experience pain. A holistic approach to pain management often considers both the physical and psychological aspects to provide comprehensive care. Working with a trauma informed coach or therapist who has experience in working with chronic pain, illness and terminal support can be profound in addressing the mental, emotional and spiritual aspects of healing. 

Are you living with chronic pain or illness and are ready to experience a shift in your reality? To build resilience to fear and pain? To reconnect with yourself on a deep level that promotes authenticity and connection? Kim is currently accepting new clients, click the button below to apply for coaching and book a discovery call!


  1. Martin LJ, Acland EL, Cho C, et al. (2020) Male-Specific Conditioned Pain Hypersensitivity in Mice and Humans. Curr Biology; 30(3):556-559. doi:10.1016/j.cub.2020.01.022
  2. Benedetti, F. (2014). Placebo Effects: Understanding the Mechanisms in Health and Disease. Oxford University Press. DOI:10.1093/acprof:oso/9780199559121.001.0001
  3. Eccleston, C., & Crombez, G. (2007). Pain demands attention: a cognitive–affective model of the interruptive function of pain. Psychological Bulletin, 133(3), 356-376. DOI: 10.1037/0033-2909.125.3.356
  4. Kaptchuk, T. J., & Miller, F. G. (2015). Placebo Effects in Medicine. New England Journal of Medicine, 373(1), 8-9.  DOI: 10.1056/NEJMp1504023
  5. Crombez, G., Eccleston, C., Van Damme, S., Vlaeyen, J. W., & Karoly, P. (2012). Fear‐avoidance model of chronic pain: The next generation. The Clinical Journal of Pain, 28(6), 475-483. DOI: 10.1097/AJP.0b013e3182385392
  6. Woolf, C. J. (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2-S15. DOI: 10.1016/j.pain.2010.09.030

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