Working at a trauma hospital as a therapist, one issue that I address daily with patients is pain.

A few days ago, I listened to an episode of Hidden Brain that made me reconsider something most of us take for granted: pain.

We usually think about pain as a straightforward physical process. You injure your back, so your back hurts. You twist your knee, so your knee hurts. If the pain continues, we assume there must still be something physically wrong that hasn’t been found or repaired.

Sometimes that is exactly what is happening. Pain can be an important warning that something in the body needs medical attention.

But pain is not always that simple.

Have you ever noticed that an ordinary headache feels worse after a stressful day? Or that the same aching knee that consumes your attention while sitting alone at home seems less noticeable when you are laughing with friends?

The injury may not have changed. Your experience of it did.

Pain Is Not Just About the Body

In the podcast, psychologist Rachel Zoffness describes pain as a biopsychosocial experience. That is a long clinical word for a fairly simple idea: pain is influenced by what is happening in your body, your mind, and your life.

The biological part includes things such as injury, inflammation, genetics, illness, sleep, nutrition, and physical activity.

The psychological part includes anxiety, depression, fear, memories, expectations, and the meaning we attach to what we are feeling.

The social part includes relationships, loneliness, financial stress, trauma, culture, access to healthcare, and whether we feel safe and supported.

All three interact.

This does not mean pain is imaginary or “all in your head.” It means that pain is a whole-person experience. Even the International Association for the Study of Pain recognizes that pain is influenced by biological, psychological, and social factors, and that a person’s report of pain should be respected.

If someone’s pain becomes worse during a period of depression, grief, or loneliness, the pain is still real. Emotional distress does not make someone a liar. It changes what is happening within the nervous system.

The Brain Is Constantly Asking, “Am I Safe?”

One of the most interesting ideas from the episode was that the brain does not simply receive pain like a passive alarm. It evaluates information from the body and the surrounding environment.

It considers the injury, but it also considers what we see, what we remember, what we expect, how afraid we are, and whether we believe we are in danger.

In other words, the brain is constantly trying to answer a question:

How much protection does this person need right now?

When the brain detects danger, the pain alarm may become louder. When it receives credible signals of safety, that alarm may quiet down.

This explains why fear can intensify pain. If every sensation is interpreted as evidence that the body is damaged, fragile, or getting worse, the nervous system remains on high alert.

A sore back becomes, “Something is seriously wrong.”

A headache becomes, “What if this never goes away?”

A painful day becomes, “My body is broken.”

Those thoughts are understandable, particularly when someone has been hurting for a long time. But they can also add fear to the original pain. The body hurts, the mind predicts catastrophe, the nervous system detects more danger, and the pain becomes even harder to tolerate.

The fear does not create the entire problem, but it can turn up its volume.

Loneliness Can Make Pain Heavier

Whenever I meet with a patient I always look for signs of visitors. It could be flowers, cards, the pull out sofa in the room obviously recently used. If I don’t see any signs I usually ask my patient if they have or are expecting visitors because I know the importance of not feeling alone when you’re already not feeling well.

We tend to treat loneliness as an emotional problem and pain as a physical one. The body does not separate them so neatly.

Human beings are wired for connection. Feeling supported can provide the nervous system with a sense of safety. Isolation can do the opposite.

When you are alone with pain, there is also less to interrupt it. Your attention repeatedly returns to the uncomfortable sensation. There is no conversation, laughter, touch, shared activity, or reassuring presence to help the brain widen its focus.

Loneliness can also increase stress, disturb sleep, reduce motivation, and contribute to depression. Each of those factors can make pain more difficult to manage.

This may be why physical pain often becomes heavier during divorce, grief, unemployment, family conflict, or prolonged isolation. The body is not operating separately from the life around it.

Sometimes the question is not only, “Where does it hurt?”

It may also be, “What else has been hurting lately?”

Expectations Matter Too

The podcast also discussed how expectations can shape pain.

This does not mean that positive thinking magically cures illness. It means that our predictions influence how the brain interprets incoming information.

If you expect a procedure to be unbearable, your body may begin bracing before it even starts. Your muscles tense. Your heart rate increases. Your attention narrows. Every sensation is treated as confirmation that something terrible is happening.

On the other hand, trust in a doctor, confidence in a treatment, or simply understanding what is happening can lower fear. That sense of safety may change the intensity of the experience.

Most of us have seen a small version of this with children. A child falls, looks at the adults nearby, and pauses. If everyone panics, the child may begin screaming. If a trusted adult responds calmly, checks the injury, and offers comfort, the child may recover more quickly.

The injury is not imaginary in either situation. The surrounding information helps the brain decide how threatening it is.

Adults are not as different from that child as we would like to believe.

What Is in Your Pain Recipe?

One practical idea from Zoffness is that each person has a “pain recipe.”

A high-pain day might include poor sleep, skipped meals, work stress, hours of sitting, an argument with your partner, isolation, anxiety, and very little movement. By evening, that familiar headache, backache, or joint pain may feel unbearable.

A lower-pain day might include better sleep, gentle movement, regular meals, meaningful activity, less catastrophizing, and time with someone who makes you feel safe.

That does not mean we can control every ingredient. Some medical conditions and injuries require treatment, medication, physical therapy, procedures, or long-term care. Sometimes we can do everything “right” and still hurt.

But we may have more influence than we realize.

When your pain is elevated, ask yourself:

• How did I sleep?
• How stressed or anxious have I been?
• Have I been moving my body appropriately?
• Have I eaten and hydrated?
• Am I feeling lonely or disconnected?
• What am I predicting about this pain?
• What does my healthcare provider recommend?
• What would help my nervous system feel a little safer right now?

The goal is not to blame yourself for hurting. It is to understand the entire picture.

Your Pain Is Real and It May Be Changeable

People living with pain are often caught between two frustrating messages.

The first is, “We cannot find anything wrong, so it must be in your head.”

The second is, “There is something wrong with your body, and there is nothing you can do except live with it.”

Neither message tells the whole story.

Pain is real. It deserves to be taken seriously and medically evaluated, especially when it is new, severe, worsening, or accompanied by other concerning symptoms.

But real does not always mean fixed.

Treating pain may involve caring for the injured or affected part of the body. It may also involve improving sleep, addressing anxiety or depression, gradually returning to movement, challenging catastrophic predictions, processing trauma, reducing stress, and reconnecting with other people.

None of those approaches invalidate the physical pain. They recognize the person experiencing it.

We are not a collection of separate parts. Our relationships affect our minds. Our minds affect our nervous systems. Our nervous systems affect our bodies. And our bodies influence how we experience the world.

Sometimes everything hurts more when life does.

Understanding that may not eliminate the pain overnight. But it can replace helplessness with curiosity and open more than one door toward healing.

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This post was inspired by the Hidden Brain episode “How to Combat Pain,” featuring psychologist Rachel Zoffness. Additional background: International Association for the Study of Pain.