A 7-part Series on Chronic Pain

by Josh Meyers, PT, DPT, OCS

Pain is good. It helps one to avoid danger, survive an injury, and protect oneself when confronted by physical or emotional threats. The problem arises, however, when pain persists after a danger is removed, an injury heals, or a threat is no longer present. Medical providers call this persistent type of pain chronic pain, and it is the leading cause of disability in America.

Hope, however, lies in the fact that chronic pain is treatable. Through this series, readers will learn how chronic pain develops, recognize common symptoms, and understand how chronic pain is treated. Our goal is to empower readers to take action and regain control of their pain. Comments at the end of each post are welcome. Be sure to ask questions and share experience to help others with similar symptoms.

Part 4: Neuroplasticity – The Brain Changes  

The brain changes. It constantly gathers input from the body and the physical environment and makes adjustments based on interpretation of that information. This continual adjustment, known as neuroplasticity, allows the brain to adapt to new situations, compensate for an injury, and learn from situations or changes in the environment.1

Not only is this adaptation helpful, survival depends on it. Neuroplasticity allows one to learn that stoves are hot to the touch and helps people function after a body part is injured. It allows a person to get better at a task with practice. Neuroplasticity ties emotions and feelings to events, and neuroplasticity helps one learn from mistakes in order to make better choices the next time. Neuroplasticity is happening as you read this post.1

While the brain typically uses neuroplasticity to adapt in a positive manner, negative adaptation occurs as well. When injury causes the brain and nervous system become extra-sensitive, a negative bias toward interpretation of information produces a pain experience more readily. As these negative adaptations become more ingrained, one begins to associate pain with movement, fear movement, and even avoid movement altogether.

Practice Makes Perfect

Professional athletes improve the performance of a movement (i.e., golf swing, tennis serve) by repeating it thousands of times. With regular practice and repetition, one sharpens the brain’s “image” and improves the consistency of a certain movement. While this analogy typically refers to actions of professional athletes, every day movement trains the brain in the same way. The way one reaches into the cupboard for a glass, leads with a particular foot when taking the stairs, or knows how to tie shoes without looking is evidence of this brain “training” in action. As long as one performs movement regularly, those patterns stay sharp.2,3

Unfortunately, the brain learns pain and inactivity just as well. When injury restricts movement in part of the body, or the entire body for that matter, the brain’s “image” of movement becomes less defined. As inactivity continues, the brain begins to neglect or lose awareness of the affected body part. This process only takes a short time to manifest, and as it does, the brain’s “image” of movement begins to fade. As the awareness of movement continues to decline, a disparity between the brain’s ill-defined image and reality develops. This disparity causes/perpetuates chronic pain.2,3,4

Furthermore, when a person with chronic pain experiences pain with movement on a regular basis, a training effect occurs as well. Moving with pain or dwelling on pain forms connections in the brain that reinforce the presence of pain with movement. In the same way that athletes “practice” a certain movement, the brain rehearses the connection of pain and movement. Intentional or not, this process continues and causes the brain to reach a point where even the thought of a particular movement produces pain.1,2

In the next post, readers will learn how fear contributes to chronic pain and what to do to regain control.


Let’s Hear From You

What are your experiences with pain? Have you noticed that you tend to avoid movement out of fear of pain?


Need Help?

If you suffer from chronic pain, there is hope. Call us today to find out how physical therapy can help treat your chronic pain.



  1. Gifford, L.S., Pain, the tissues and the nervous system. Physiotherapy, 1998. 84: p. 27-33.
  2. Louw A. Treating the brain in chronic pain. In: C FdlP, J C, Dommerholt J, eds. Manual Therapy for Musculoskeletal Pain Syndromes. Vol 1. London: Churchill Livingston; 2015.
  3. Amit DJ, Brunel N, Tsodyks MV. Correlations of cortical Hebbian reverberations: theory versus experiment. J Neurosci. Nov 1994;14(11 Pt 1):6435-6445.
  4. Flor H. The functional organization of the brain in chronic pain. Prog Brain Res. 2000;129:313-322.