NEW YORK — The alarm system analogy is the one that sticks. A broken window triggers the alarm. That is acute pain.
But when the window is fixed and the alarm keeps screaming, the problem is no longer the window. It is the alarm itself.
That is how a New York psychologist who has lived with chronic pain for 16 years describes the condition to her patients. She would know. She has two extruded discs pressing on her sciatic nerve from an old Columbia basketball injury.
Both doctors who looked at her MRI recoiled. She could barely walk.
Her argument is not that the pain is imaginary. It is that the brain produces pain as a threat signal. And the brain can learn to keep that signal blaring even after the original injury heals.
Chronic pain is a hypersensitive alarm. For tens of millions of Americans living with persistent pain, the practical news is this: the brain can be retrained. The psychologist uses techniques from pain neuroscience education and cognitive behavioral therapy.
Patients learn to spot the thoughts, emotions and behaviors that keep the threat system on high alert. Fear of movement.
Catastrophizing about the future. Avoidance of activity. All of it feeds the cycle.
She has seen patients who spent years bouncing between specialists. Patients who got injections.
Patients who underwent surgeries. They found relief through what she calls brain-based approaches. One patient had been told by multiple surgeons that nothing more could be done.
The core idea is not new in academic circles. But it remains radical in practice. Most pain treatment still focuses on the body.
Imaging. Injections.
Surgery. Drugs. Those tools work for acute pain.
For chronic pain, they often fail. The alarm keeps ringing.
Pain neuroscience education teaches patients how the nervous system works. It explains why a light touch can feel like a burn. Why movement can trigger agony even when no tissue is damaged.
The goal is to make the threat system less sensitive. Cognitive behavioral therapy addresses the fear and avoidance that lock the alarm in place. Patients learn to challenge catastrophic thoughts.
They learn to move again without bracing for the worst. They learn that activity is safe.
The psychologist has been living with her own alarm for 16 years. She had an old basketball injury from Columbia. It flared up.
Two extruded discs. Sciatic nerve compression.
She could barely walk. The doctors who saw her MRI recoiled. That experience set her on a path.
She now treats patients who have been told their pain is permanent. She tells them the alarm can be recalibrated. The approach works for some.
Not for all. Pain is complex.
There are conditions where tissue damage persists. There are cases where the brain-based methods are not enough. The psychologist does not claim otherwise.
But for the tens of millions of Americans whose chronic pain has no clear mechanical cause, the idea that the brain can be retrained offers something the injections and surgeries often do not: a way out.
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