How to Combat Pain

**Shankar Vedantam** (0:00)
This is Hidden Brain, I'm Shankar Vedantam. It happens in an instant. You move too fast, and you feel a wrench in your back.
That first sharp pain is followed by a persistent ache, bothersome enough to send you to the doctor.
A scan reveals a problem, a specialist recommends surgery. You go on to the knife, trusting that once the damaged tissue is repaired, the pain will disappear.
The story makes intuitive sense. Diagnose the problem, fix the bone or ligament or tendon that is not working properly, and you'll make the pain go away.
But for many of us, that's not how pain unfolds. Aches persist, even when scans look normal, or they vanish without any medical intervention. Treatments that promise relief fail to deliver. We also notice something puzzling. The pain we feel changes with other things happening in our lives. When we're feeling calm or absorbed in something else, the pain subsides. When we feel isolated or sad, the pain gets worse.
Today on the show, and in a companion episode on Hidden Brain Plus, we examine why our culture gets so many things wrong when it comes to understanding the true nature of pain. What's really happening when we experience pain, and how to address it? This week, on Hidden Brain.
Support for Hidden Brain comes from TikTok. On TikTok, people are breaking down physics, exploring geology, and explaining why the world works the way it does. You'll see impressive experiments, explanations that finally make sense, and connections you didn't expect. It's like having a lab, a lecture hall, and a science museum in your pocket. TikTok is where wonder is shared, where curiosity turns into discovery, and where millions learn something new every day.
Support for Hidden Brain comes from LinkedIn. Running a small business means every hire matters. A bad hire can cost you time, money and momentum. A good hire, they can help grow your business. LinkedIn's new hiring pros screens candidates for you, so instead of sorting through applicants, you spend time talking to only the right ones. Get started by posting your job for free at linkedin.com/hb. Terms and conditions apply. Support for Hidden Brain comes from Defender. Even the boldest journey starts small, with a single decision to go somewhere new. The Defender 110 is a vehicle built for those moments, for drivers capable of great things, whether they're headed toward unchartered territory, or just a weekend away. The Defender 110 combines on-road presence with off-road capability. It looks tough because it is, with an exterior engineered for durability. Inside, capability meets comfort, with seating for five and the option for seven, plus refined finishes and thoughtful design. It's also packed with intuitive tech, like 3D surround cameras with clear side ground view to help you navigate rough terrain, and the next generation PIVI Pro infotainment system, designed to keep you informed, connected and in control, no matter the path. The Defender 110 is naturally capable, expedition ready, and built for those ready to move forward. Explore the Defender 110 at landroverusa.com.
Pain feels like a simple message from the body. If your elbow hurts, there must be something wrong with your elbow. If your back is painfully stiff, you need some work done on your back. The brain in this model is an observer. It registers signals of pain sent in by nerves from the far reaches of the body. But is that really all there is to it? At the University of California, San Francisco, psychologist Rachel Zoffness studies the nature of pain. She has found that our minds play a much larger role in our experience of pain than many of us realize. And they also play a much larger role in how we need to deal with pain. Rachel Zoffness, welcome to Hidden Brain.

**Rachel Zoffness** (4:39)
One of my favorite ever podcasts. I'm so honored to be here.

**Shankar Vedantam** (4:44)
Rachel, as you began your own research training, you were taught a one-dimensional biomedical model of pain. Can you describe that model for me?

**Rachel Zoffness** (4:54)
Absolutely. The biomedical model is an antiquated way of looking at disease and pain that focuses primarily, if not exclusively, on anatomy and physiology and bones and body parts. And what that means in the biomedical frame of things is that when we talk about treating pain, we also talk primarily, if not exclusively, about biomedical solutions. And that takes the form of pills and procedures.
So here's what I observe as a clinician and pain researcher. What I observe is that if you have chronic knee pain, you will be sent to 762 knee specialists, but we never talk about your brain at all.

**Shankar Vedantam** (5:48)
So early on in your own training, Rachel, you encountered a pair of clinical cases documented in the medical literature, which got you thinking about pain in a different way.