Disclaimer: the claims shared in this blog post are not my own, nor my opinion. They are science, research, evidence-based facts. I share them here since they are essential to understanding pain, and thus to treating it fully. 

Learning about the existence of this model was a revelation and a validation to me, and I hope it will be for you too. I hope I can share it with you in a way that gives it sense, and is easy to comprehend. You will find references at the bottom.




Simply put, pain is a warning system. When it works well, it is an adaptative response that allows us to avoid harm.
For example, if we know putting our hand in the fire will burn, we won’t do it again. If we put it on the hot stove, our body will retract our hand automatically, without even being conscious of it: our response to pain can completely bypass our conscious understanding of it.
In the same way, if you sprain your ankle while running away from a predator, your brain will conveniently skip the part where it tells you that you are in pain. You will not experience pain, and with the help of adrenaline hormones sent by your amygdala (your danger center), you will be able to keep running towards safety.
Unfortunately, sometimes the system misfires. To no fault of our own. And then pain lasts longer than it needs to.
When it lasts past 3 months or past the time needed for the recovery of the tissue damage, we then call it “chronic pain“.
“If you are someone living with pain and have only attempted to treat pain by targeting the body with pills and procedures, then you have NOT adequately treated your pain.” – Dr R. Zoffness



🥊 We are mistreating pain because we do not understand it. In our culture, the common model of treatment for pain is the bio-medical model: have pain? Here is a product or procedure that will fix it.
Unfortunately this model means chronic pain sufferers are made to feel like something is wrong with them. They are made to believe that their pain “is all in their brain“. We thereby increase the psychological suffering of chronic pain sufferers, making them feel unseen, unvalidated, and gaslighted.
And it is time we stop doing that! Because pain is never just bio-medical. Science tells us pain is bio-psychosocial, meaning it has a biological component, a psychological component AND a social/societal component. 
This is nothing new; this model has been known for years!
Let me show you how, and why that is important for your own recovery journey.
the bio-spychosocial model of pain



There are 3 important components of pain. Treating one without the other, is just addressing only 1 part of the problem.

This is why in conditions like endometriosis, surgery alone will often lead to more pain.

I take this example in particular not only because it is a disease I know personally, but also because it is a condition that truly is visible in the body. There is tissue damage, visible by ultrasounds or MRI.

Yet, different women experience it very differently. For women that have suffered from pains for years before being diagnosed and finding validation, surgery alone is often not enough to get rid of all the pain.


That is the model that most of us experience when we seek help for chronic pain. The components of this model are:

  • genetics,
  • sleep,
  • diet,
  • exercise,
  • tissue damage,
  • system dysfunction

This is what our view of pain is reduced to. We are prescribed medications, or surgical procedures in order to fix this part, completely forgetting the other components of pain. We thus only treat ⅓ of the problem!

So what are the two other thirds?





“Psychological” does not mean that you made it up. “Psychological” means that it affects, and is affected in return, by thoughts and emotions.
As adults, we have been told that any kind of pain must be dealt with through a biomedical approach, like first aid and medicine. Even in the mental health field the first reflex is too often to prescribe meds for anxiety, burnout, or depression.
So here I want you to remember how a mother’s kiss on a bruised knee can take a child’s pain away…
Proof that pain is linked to our thoughts and emotions are present all around us, and have been demonstrated by neuroscience. Here is what studies teach us:
✨Neurosciences tells us that the things we think influence the way we feel pain.
ex.: Negative thoughts and beliefs increase anxiety; anxiety tells our brain to increase Blood Pressure, muscle tension and body temperature to “get ready” to fight => thus, your pain is amplified.
✨ Pain is adaptative. Memories of past pain experiences processed through our hippocampus help us learn.
ex.: When you burn your hand on the stove, you take your hand off and learn not to do it again. Your pain warning system is what keeps you alive.
✨ The way we behave changes the way we feel, and changes in coping behaviours can change the pain.
ex.: Avoidance behaviours, such as staying inside, not moving, will perpetuate the pain cycle in the long term. Gentle movement however can reduce pain in the long run.
✨ Trauma and cognitive processing affect our likelihood of experiencing chronic pain.
ex.: Early childhood trauma and pain have a 50% co-occurence. Developmental trauma makes the brain on high alert and more sensitive, thus more likely to have chronic pain. A High ACE (Adverse Childhood Experiences) score is associated to chronic pain and illness later in life.


A good example of this is the fantom limb, where people who had a limb amputated can still feel the pain “in” it. This disturbing phenomenon shows that pain lives in the brain, and not anywhere else in the body! In fact, to his day, the best known treatment for fantom limb is to use a mirror between the amputee’s legs so that they can “see” two healthy legs, and “show” their brain that the leg is fine, thereby reprocessing the pain.

All pain is processed in the brain. Pain is constructed by the brain and the body.


There is not one single pain center in the brain; it is a diffuse neurological process, meaning many parts of the brain process this experience we call “pain” – Rachel Zoffness, PhD


There is a real biological connection between pain and emotion (Melzack & Wall, 1965):

Multiple parts of the brain are at play to process pain: the cerebral cortex, responsible for thoughts, the prefrontal cortex, responsible for attention and executive processing, and the limbic system, which is the emotion center. Together they produce this experience we call “pain”.

So pain is always informed by sensations and emotions; it is always emotional and physical at the same time, thus both the physical and the emotional must be dealt with in order to fully treat chronic pain.


This means we must target the brain in order to relieve the body!



✨Did you know that the worst punishment you can give a human being is solitary confinement?
Why? Because humans are social animals.
💕 Our brain produces oxytocin (bounding hormone), serotonin (mood), dopamine (pleasure and reward), and endorphins (our endogenic natural pain killers) when we are in the contact of other people. In the absence of other people those chemicals crash, so physically and emotionally we feel worse.
✨Being isolated and lonely produces cortisol (stress hormone) that is detrimental to our immune system.
ex.: Studies show that isolated elderly are more prone to illness and death.
✨The way we respond to pain is modelled by parents & society:
ex.: The more calm the parent, the less likely the child is to cry. When hurt, a child will look at his parent’s face first.





Sensitisation happens through our Central Nervous System (otherwise called CNS= brain + spinal cord).

To explain this concept, think for example of a time where you got better at something by practicing it.

Here is mine:

Last month, my 10-year old daughter told me she would never be able to learn how to play the ukulele: her fingers hurt too much and she could not move them on the strings fast enough. Then she practiced for two weeks, and to everyone’s amazement, she was able to perform her first song soon after. Even her fingers did not hurt anymore!

This is because whatever we practice, we get better, stronger, faster at doing. Repetition is the key.

And so it is with our brain: the pathways in your brain are just like the muscles in your body: the more you use them, the bigger they get. 

“Neurons that fire together wire together”, Head.

Overtime, the brain pathways that practice pain can grow bigger, more conducive and become more sensitive. They fire faster. They will overreact in a way similar to a fire alarm that is reacting to a burned casserole, or a car alarm that turns on when the wind blows. That is, the warning system is turned ON even when there is no danger.

For a complete treatment of chronic pain, you must therefore also address thoughts, emotions, relationships, environment, and context. If you persist in treating only the pain in the body, you persist in healing only a third of the problem.




In our brain is some kind of a pain dial. When stress and anxiety are UP, our brain sends a message to the pain dial to increase pain volume. Thus the pain feels worse and lasts longer.

In that way negative moods and emotions matter and affect our perception of pain by making it worse. Think of how kicking your toe on a stone would feel different at a birthday party with friends, in opposition to after a long and stressful and frustrating day at work: would your experience of pain be the same?

When stress and anxiety are low, the brain sends a message to the pain dial to lower pain volume. The same is true with mood and emotions: pleasurable activities, happy mood, a distracted prefrontal cortex will also lower pain volume. Think of how a child receiving a vaccine is distracted by a movie or the promise of a candy.

Therefor there is a “recipe” for higher pain, and a recipe for lower pain days. What this really means is that YOU have the power to lower the pain volume. You just need to find the button!

Pain takes away power. But you can regain your power, your body and your life.

By learning how to use this pain dial, and understanding the science behind pain, you can regain a sense of agency over your life and body.




They are many things that you can do to change your pain. Your pain dial is your power. 

YOU have the power to turn down the pain volume and make pain feel less bad.

And we can start today.

Because if it’s ok to go to a soccer coach to get better at soccer, surely it is ok to go to a pain coach to get better at LIVING WITH PAIN!

Living with pain is really hard and you deserve to understand it.



Stanford Medical School Pain Management Series
Zoffness, R. (2020). The Pain Management Workbook: Powerful CBT and Mindfulness Skills to Take Control of Pain and Reclaim Your Life. New Harbinger Publications.
Darnall, B. D., Mackey, S. C., Lorig, K., Kao, M. C., Mardian, A., Stieg, R., … & Cheung, M. (2020). Comparative effectiveness of cognitive behavioral therapy for chronic pain and chronic pain self-management within the context of voluntary patient-centered prescription opioid tapering: the EMPOWER study protocol. Pain Medicine21(8), 1523-1531.
Sarno, John E. The divided mind: The epidemic of mindbody disorders. Prelude Books, 2011.
Van der Kolk, Bessel A. “The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress.” Harvard review of psychiatry 1.5 (1994): 253-265.
Randy S Roth, PhD, Michael E Geisser, PhD, David A Williams, PhD, Interventional pain medicine: retreat from the biopsychosocial model of pain, Translational Behavioral Medicine, Volume 2, Issue 1, March 2012, Pages 106–116, https://doi.org/10.1007/s13142-011-0090-7
Beth D. Darnall, Daniel B. Carr, Michael E. Schatman, Pain Psychology and the Biopsychosocial Model of Pain Treatment: Ethical Imperatives and Social Responsibility, Pain Medicine, Volume 18, Issue 8, August 2017, Pages 1413–1415, https://doi.org/10.1093/pm/pnw166
Grant Duncan (2000) Mind-Body Dualism and the Biopsychosocial Model of Pain: What Did Descartes Really Say?, Journal of Medicine and Philosophy, 25:4, 485-513, DOI: 10.1076/0360-5310(200008)25:4;1-A;FT485
. (2022) A critical review of the biopsychosocial model of low back pain care: time for a new approach?Disability and Rehabilitation 44:13, pages 3270-3284.

Are you ready to take back your power?

Living with pain is hard. But you do not have to go at it alone! You deserve support.

The field of pain medicine is changing; come change it with me! Contact me today to find support and learn new ways to reduce pain volume, and feel energised to rebuild a life of joy, passion and fulfillment.