Episode 91: The Neuroscience of Chronic Pain: How Our Brain Predicts And Creates A Biology of Pain with Dr. Howard Schubiner

Listen to Episode 91 with Dr. Howard Schubiner →

When Your Pain Has No Structural Cause

You've had every scan, every test, every specialist appointment. Doctors find no structural damage to explain your chronic pain. They suggest the pain is "in your head" or offer medications that don't address the root cause. You know the pain is real but feel dismissed and hopeless.

What if your brain is generating real pain through neural circuits rather than from tissue damage?

What two neuroscience features reinforce chronic pain and make it habitual even after tissue healing? Understanding these mechanisms changes how you approach pain that won't resolve through standard medical treatment.

Dr. Howard Schubiner joins me today as a physician board certified in pediatrics, adolescent medicine, and internal medicine who's become a leading voice in mind-body medicine. We discuss how your brain regulates and generates chronic symptoms from pain to fatigue to anxiety. His research and clinical experience led him to develop therapies that help people "unlearn" chronic symptoms by addressing the underlying neural circuits and emotional factors driving these psychophysiological conditions.

Understanding Predictive Processing

What two neuroscience features reinforce chronic pain and make it habitual beyond the original injury or trigger? These features explain why pain persists long after tissue heals and why standard medical treatment focused on structural problems fails to resolve many chronic pain conditions.

Predictive processing reveals how your brain doesn't just respond to pain signals passively. It predicts and actively creates pain based on expectations rather than just reacting to injury. Your brain generates pain experiences based on what it anticipates will hurt, not only what's actually damaged. This means pain can exist without proportional tissue damage because your brain is creating the experience.

Your brain's role in chronic pain extends to regulating a wide range of chronic symptoms beyond just physical pain. Fatigue, anxiety, digestive problems, dizziness, and numerous other symptoms can be brain-generated rather than resulting from structural pathology. When you understand these symptoms originate from neural circuits rather than damaged tissues, treatment approaches change completely from trying to fix structures to retraining neural patterns.

Understanding the Biology of Trauma® alongside Dr. Schubiner's work reveals why trauma survivors experience so much chronic pain. Your brain learned through traumatic experiences to be hypervigilant for danger and to interpret ambiguous signals as threats. That learning extends to pain where your brain predicts and generates pain as a protective mechanism even when actual tissue damage doesn't warrant the pain level you experience.

Neural Circuit Pain and Emotional Factors

Not all pain comes from tissue damage or structural problems. Neural circuit pain originates from emotional injuries and psychological stress rather than physical injury. Your brain creates real, measurable pain in response to unresolved emotions, suppressed feelings, chronic stress, or traumatic memories. This pain is just as real as pain from injury but requires different treatment approaches.

How pain becomes habitual involves neural pathways that reinforce themselves through repetition. Pain reinforces itself through creating stronger neural pathways each time you experience it. The more you experience pain, the more your brain expects it and the more readily it generates the pain response. Pain becomes a learned pattern that persists even after any original injury has healed completely.

Fear's reinforcing role in chronic pain creates vicious cycles that maintain and worsen pain. Fear of pain makes pain worse through activating your nervous system defensively. This creates a cycle where fear generates pain and pain generates more fear. Your nervous system stays activated in threat mode which itself generates pain signals and hypersensitivity to sensations.

Conditioned responses explain why certain movements, activities, or situations trigger pain reliably. Your brain learns to associate specific triggers with pain through repeated pairings. Those associations become automatic conditioned responses. The pain response becomes conditioned like Pavlov's dogs salivating to bells, where your brain generates pain automatically when it encounters learned triggers.

Retraining Your Brain

Treating your brain like a child represents Dr. Schubiner's approach to pain retraining. His method involves gentle retraining rather than forcing change. Like teaching a child something new requires patience and repetition. Your brain needs compassionate guidance and repeated experiences rather than aggressive interventions. You're essentially teaching your brain that it's safe to move without generating protective pain.

The principle of graded exposure helps retrain pain responses through gradually exposing yourself to feared activities in manageable steps. Small incremental steps build confidence and teach your nervous system that activities are safe rather than dangerous. Starting with minimal versions of feared movements and gradually increasing allows your brain to update its pain predictions based on actual experience rather than fear.

Using Internal Family Systems for pain management addresses the parts that fear pain or feel angry at your body for having sensations. Working with these parts changes your pain experience by resolving the internal conflict and fear that amplify pain signals. When protective parts learn that sensations don't always mean danger, they stop amplifying signals into intense pain experiences.

Understanding mind-body symptoms as distinct from structural problems becomes essential for proper treatment. When symptoms are mind-body related through neural circuit generation, standard medical treatment targeting structural problems won't fix them because there's no structural problem to fix. Recognizing this distinction allows you to pursue appropriate treatment that addresses neural circuits and emotional factors rather than continuing to search for structural causes.

Unlearning Chronic Pain

Dr. Schubiner's therapies help people unlearn chronic pain patterns by addressing both neural circuits and emotional factors. By working with how your brain generates and maintains pain. By processing the emotional injuries and stress that triggered neural circuit pain originally. Real lasting change becomes possible when you address the actual mechanism creating pain rather than treating symptoms.

The integration of neuroscience understanding with emotional processing creates comprehensive pain treatment. Your pain has both neurological and emotional components that need addressing simultaneously. Working with your brain's predictive processing through education and exposure while also processing underlying emotions creates synergistic healing.

Understanding that your brain creates pain through prediction and conditioning removes shame about pain that has "no cause." Your pain is real even when scans are clean. Your brain is generating genuine pain experiences through neural circuits. This isn't weakness or imagining pain but rather how your brain protects you based on learned patterns that need updating.

The practical application involves educating yourself about neural circuit pain so you understand the mechanism, identifying emotional factors or stressors that correlate with pain onset or flares, gradually exposing yourself to feared movements while reassuring your brain of safety, and processing underlying emotions that your brain might be expressing through pain.

For people with chronic pain that has no structural cause, this perspective offers hope after years of failed treatments. Your pain isn't permanent or unfixable. It's a learned neural pattern that can be unlearned through appropriate interventions that work with your brain rather than trying to fix nonexistent structural problems.

This Episode Is For:

✓ People with chronic pain that has no structural cause 

✓ Anyone whose pain persists despite medical treatment 

✓ Practitioners wanting to understand when pain is neural circuit-based versus structural 

✓ Those whose scans are clean but pain is real 

✓ Anyone with mind-body symptoms that medicine can't explain 

✓ People ready to unlearn pain patterns through brain retraining

What You'll Learn

Listen to understand the two neuroscience features that make pain habitual including predictive processing and conditioned responses. Discover why treating your brain like a child through gentle graded exposure can help you unlearn chronic pain patterns. Learn how emotional injuries create neural circuit pain and why IFS helps address the parts maintaining pain.

Your chronic pain might be your brain's learned protective response rather than structural damage.

Listen to Episode 91 with Dr. Howard Schubiner →

Disclaimer

This podcast is for educational purposes only and is not a substitute for professional medical or mental health advice, diagnosis, or treatment. The information shared reflects my clinical expertise and research, but every person's biology and healing journey is unique. Always consult with qualified healthcare providers before making changes to your treatment plan or starting new interventions. If you're experiencing a mental health crisis, please contact emergency services or a crisis helpline immediately.

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