A young construction worker jumped off a plank and landed on a 7-inch nail. Or so he thought. The sharp end poked up through his boot, he was in agony, and an emergency department gave him powerful medicine. When the boot came off, the nail had missed his foot entirely.
Another man had the opposite luck. His nail gun misfired and a nail ended up in the wall ahead of him. He thought he had gotten away with it. A toothache sent him to a dentist six days afterward, whose x-rays found a 4-inch nail wedged in his face, just short of his right eye. Serious damage, very little pain.
Rachel Zoffness tells both stories in her new book, Tell Me Where It Hurts, and she has a plain point to make with them. Pain does not track injury the way most of us assume. Zoffness is a pain psychologist and scientist. She has studied how the brain handles pain for more than 30 years.
Why the body-only story fails
What bothers her most is the standard message. “The thing that we are told about pain that drives me crazy is that pain is a purely biological, biomedical problem,” she said on a recent mindbodygreen podcast episode, and the usual fix is “pills and procedures.”
Her counterexample is phantom limb pain. Amputees frequently go on feeling awful pain in a limb that is gone, which tells you the brain helps build the experience.
Zoffness pictures pain as a Venn diagram of three overlapping circles: biological, psychological and sociological. Genetics, tissue damage, sleep and diet sit in the first. Emotions, thoughts and beliefs fill the second. Money, access to doctors, friendships and trauma belong to the third. “If we’re only focusing on the biodomain of pain,” she said, “we are missing two-thirds of the pain problem.”
Think of it like baking. Brownies need eggs, flour, butter and cocoa, and every pain experience, she says, has its own recipe. Her own high-pain day looks like too many hours at a screen, no movement, bad sleep, poor food and high stress. A low-pain day is the reverse. The useful shift is from asking what is wrong with your body to asking which ingredients you can change. You cannot swap your genes. You can work on sleep, movement, stress and the people around you.
Fear turns the volume up
Early in her career, a physician wired her to sensors that tracked pulse, skin temperature and muscle tightness, then told her to dwell on the stressful items on her to-do list. Her pulse climbed, her muscles tightened and her hands got colder. A short guided relaxation reversed every reading. After two sessions she could push her hand temperature to 90 degrees using only her thoughts.
One patient in the book, still grieving her father’s death from pancreatic cancer, had pain she took for a kidney stone and scored at six or seven on a 10-point scale. Then her husband pointed out it had lasted a month, and she became sure she had cancer. Her score leapt to 11. She was screaming, and he called 911. At the hospital a scan showed a kidney stone. Her pain fell to a two.
Words do similar work. A doctor who says there is no treatment and the pain is for life can trigger what Zoffness calls the nocebo effect. “Every patient who comes to my office has a nocebo story,” she said.
What she suggests first
Move, even for 60 seconds. Protect sleep, starting with no screens for two hours before bed. Blue light is not the reason. Doom scrolling and upsetting TV keep the nervous system buzzing. Track how stress feeds your pain.
Science News, which reviewed the book on February 10, 2026, flagged one line aimed at clinicians: “Never tell patients their pain is incurable.” A disease may be, the reviewer wrote, but a person’s pain may ebb.
Sources
- What's Actually Driving Your Chronic Pain, From A Pain Psychologist (mindbodygreen podcast write-up, via Yahoo Health), part 1
- What's Actually Driving Your Chronic Pain, From A Pain Psychologist (mindbodygreen podcast write-up, via Yahoo Health), part 2
- 'Tell Me Where It Hurts' sets the record straight on pain, and how to treat it (Science News)
