Is chronic pain 'all in people's heads'?

Is chronic pain 'all in people's heads'?

No - chronic pain is not “in people’s heads”. It is a genuine medical condition caused by changes in the nerves, spinal cord, and brain that make the pain system overactive and hard to switch off. Research shows that chronic pain is linked to measurable biological changes, including sensitised nerve pathways, altered pain processing in the spinal cord, and long‑lasting changes in brain structure and function, which can cause severe disability and major impacts on mood, sleep, work, and quality of life. Because of this, major health organisations now recognise chronic pain as a disease in its own right that must be taken seriously and treated actively, not dismissed or ignored*.

Pain is always produced and processed in the brain, but that does not make it imaginary or “made up”. When someone lives with chronic pain, their brain has learned to predict and generate pain signals more easily, often from much smaller triggers or even in the absence of ongoing tissue damage, in a similar way that the brain can learn and change in other conditions such as stroke or epilepsy. The pain they feel is absolutely real: the same brain networks that respond to acute tissue damage are active and can become overactive in chronic pain, which is why the sensations, suffering, and disability are as real and significant as in any other long‑term illness.

* Stretanski MF, Kopitnik NL, Matha A, et al. Chronic Pain. [Updated 2025 Sep 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553030/

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