NEW YORK, June 28 — For nearly two decades, a psychologist who specializes in pain has been living with a reminder that the line between physical and emotional pain is thinner than most people realize. About 16 years ago, an old basketball injury from her days at Columbia flared up. Two extruded discs were pressing on her sciatic nerve, and she could barely walk.
Both doctors who looked at her MRI recoiled. The experience set her on a path that would reshape how she — and eventually her patients — understand chronic pain.
Her core argument, built on years of clinical work and personal experience, is that pain is not simply a message from damaged tissue. It is a threat signal produced by the brain, and the brain can learn to turn up that signal even when the original injury has healed. Think of it like a home security system.
A broken window triggers the alarm. That is acute pain.
But if the alarm keeps blaring long after the window is fixed, the problem is no longer the window. The problem is the alarm system itself. Chronic pain, in this analogy, is a hypersensitive alarm.
The practical upshot for the estimated tens of millions of Americans living with persistent pain is this: the brain can be retrained. The psychologist uses a set of techniques drawn from pain neuroscience education and cognitive behavioral therapy. Patients learn to identify the thoughts, emotions and behaviors that keep the threat system on high alert.
Fear of movement, catastrophizing about the future, and avoidance of activity all feed the cycle. She has seen patients who spent years bouncing between specialists, getting injections and undergoing surgeries, find relief through what she calls “brain-based” approaches.
One patient had been told by multiple surgeons that nothing more could be done for her back. After working through the psychological components of her pain, she was able to return to activities she had abandoned for years. None of this means the pain is “all in your head” in the dismissive sense.
The pain is real. The brain produces real pain signals.
But the source of those signals may not be structural damage. It may be a central nervous system that has learned to be overprotective. The psychologist herself still manages her own pain.
She does not claim to have cured it. But she has learned to dial down the alarm. She walks, she works, she lives with a level of function that seemed impossible in those early days after the basketball injury resurfaced.
For the medical establishment, this represents a shift in thinking. Pain clinics have long focused on the spine, the joints, the nerves.
The emerging model looks at the brain as the central player. The psychologist argues that ignoring the psychological dimension of chronic pain is not just incomplete — it is a disservice to patients who could be helped without more procedures or pills. What to watch next: whether mainstream insurance coverage will catch up with the evidence.
Many patients still find that cognitive behavioral therapy for pain is not covered, while MRIs and injections are. If the brain is the organ driving chronic pain, the psychologist suggests, treatment should reflect that.
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