Are People with Chronic Pain Overthinking the Meaning of Their Pain?

Let’s look at a new 2024 research paper that reviewed and looked at the neuroscience data on the role of the ventromedial prefrontal cortex (vmPFC) in chronic pain. The authors “suggest an updated model of what both the altered activity in and functional connectivity to the dorsal vmPFC may represent in people with chronic pain. We suggest that increased dorsal vmPFC activity may reflect a tendency to overthink the meaning of pain for oneself and one’s actions. This may in turn increase the personal threat of a given context and thereby increase the susceptibility to experience pain.”

I find this updated model interesting and helpful in understanding how the brain can be involved in the production and amplification of chronic pain. The authors mention how the connectivity of two brain prefrontal cortical areas (the ACC- anterior cingulate cortex and AIC- anterior insular cortex) may be involved in chronic pain. This brain connection may “reflect a process by which negative overthinking about the meaning of pain for oneself and one’s actions might increase the personal “threat” of a given context. This may in turn increase the likelihood of “harmless” afferent signals from the body to be interpreted as “potentially harmful”, thereby increasing the susceptibility of experiencing pain in the absence of ongoing tissue damage.”

This proposed understanding makes sense in light of what the neuroscience data shows about the cortical regions of the brain and also in light of what I see a lot on a daily basis with the people I work with. One of our big goals with neural retraining of the brain is to teach it there is no true threat or danger in the body and no true danger or threat with the pain or symptom when it is present. The brain’s negative thinking and meaning serve to amplify normal input from the body into threatening excessive output (pain/symptoms). The body is fine. It is the brain that needs to learn to think more positively and to alter its meaning of what it feels in the body.