Pain Hypnotherapy Training: Why Does the Brain Hold Onto Pain?
Over the years, I've worked with a lot of people who experience chronic pain. But something I've increasingly realised is that many of them didn't actually come to see me because of their pain. They might have wanted help with anxiety, sleep, stress, weight, IBS or simply feeling overwhelmed. Chronic pain was something else they lived with. Sometimes it had been there for years. They had often been through investigations, tried different medications and treatments and, in many cases, had reached the point where pain had simply become part of everyday life.
I think this is important for hypnotherapists. You don't necessarily have to market yourself as a chronic pain specialist to find yourself working with people who live with persistent pain. Pain hypnotherapy training isn't only relevant if you intend to specialise in pain. It can help us understand something which is likely to be present in many of the clients who come through our doors for other reasons.
A client who changed the way I thought about chronic pain
One client I worked with had lived with pain for years. It wasn't actually the main reason she initially came to see me, but as we worked together, pain kept appearing in our conversations. It affected what she did, how much she moved and what she expected from her body. She had become very aware of movements and situations that might aggravate it.
What interested me was that the original physical problem and her current experience of pain no longer seemed to have a simple relationship. There were things she avoided because experience had taught her that they hurt. There were movements she approached already expecting pain, and her body could become tense before she had really done anything at all.
None of this meant her pain wasn't real. Quite the opposite. It made me increasingly interested in a question that has become central to the way I think about chronic pain: why can the brain and nervous system continue producing pain long after the original circumstances have changed? Or, to put it more simply, why does the brain sometimes seem to hold onto pain?
Pain isn't simply a message from an injured body part
The traditional explanation of pain is very appealing because it's so straightforward. Something is damaged, receptors detect it, a signal travels to the brain and we feel pain. Except that's not really how pain works.
The International Association for the Study of Pain distinguishes between nociception and pain. Nociception is the neural process involved in detecting potentially damaging stimuli, whereas pain is a sensory and emotional experience. Pain cannot simply be inferred from activity in sensory neurons (IASP, 2021; Raja et al., 2020).
This becomes particularly important when we're thinking about persistent pain because the amount of pain somebody experiences isn't necessarily a straightforward measure of the amount of physical damage occurring in their body. This certainly doesn't mean that physical causes should be ignored. Chronic pain can involve ongoing tissue problems, inflammatory processes, nerve damage and disease, and different pain mechanisms can coexist.
But it does mean that pain is more complicated than damage equals pain.
So what is the brain doing?
One useful way of thinking about pain is as protection. If you badly injure your ankle, pain makes perfect sense. It changes your behaviour. You stop putting weight on it, protect it and give damaged tissues an opportunity to heal.
But the nervous system itself is capable of changing. Repeated pain can alter the way sensory information is processed, and in some chronic pain conditions the system can become increasingly responsive. This is particularly relevant to the concept of nociplastic pain.
Nociplastic pain refers to pain arising from altered nociception where there isn't clear evidence of actual or threatened tissue damage, or a disease or lesion of the somatosensory system, that sufficiently explains the pain. Research into nociplastic pain points towards changes in pain modulation, hypersensitivity and altered processing within the nervous system, while also recognising a complicated interaction between central, peripheral and immune mechanisms (Choi, 2024; Kaplan et al., 2024).
This isn't about somebody imagining pain. The pain is real. What has changed is our understanding of where that experience comes from and why it might persist.
But the brain also learns
This is the part I find particularly interesting from a hypnotherapy perspective. The brain doesn't encounter every experience as though it has never happened before. It learns from what has happened previously and uses that information when dealing with what happens next.
If bending over has resulted in severe pain again and again, the brain has information about bending over. If walking has repeatedly hurt, it has information about walking. If somebody has experienced a terrible flare after doing too much, their nervous system has information about what happened last time.
Research has increasingly looked at how learning, previous experience, instructions and expectations can influence both the experience of pain and the neurobiological processes associated with it (Atlas, 2023). This doesn't mean that expecting pain causes someone's pain. It means that previous experience and expectations are amongst the information the brain has available when interpreting what is happening now.
This is one of the reasons I think we need to be careful about the language we use. Saying that the brain can learn pain isn't the same as saying that somebody has learned to be in pain or is somehow responsible for continuing it.
When protection becomes overprotection
Perhaps this gives us a better way of thinking about the idea that the brain “holds onto” pain. The brain isn't stubbornly refusing to let pain go. In some cases, the nervous system may have become very good at protecting us on the basis of what it has previously learned.
A movement hurt before. A sensation meant danger before. An activity resulted in a flare before. Avoiding that activity or responding rapidly to that sensation may therefore have made perfect sense at one point.
Research into associative learning and chronic pain has found evidence that pain-related learning and generalisation may differ in people experiencing chronic pain, although researchers have rightly been cautious about claiming that these processes themselves maintain chronic pain (Harvie et al., 2017).
That caution matters. There can be a tendency within mind-body approaches to take interesting neuroscience and turn it into a very definite explanation of why an individual is experiencing pain. We can't assume that someone's pain is being maintained by learning simply because they have experienced it for a long time.
What we can say is that pain can be influenced by learning, attention, expectation, emotional state and previous experience. For a hypnotherapist, that gives us considerably more to think about than simply trying to make pain disappear.
Can the brain learn something new?
This is where things become particularly interesting therapeutically. If previous experiences can influence the way the nervous system responds now, can we also help someone accumulate different experiences?
That doesn't mean telling somebody there is definitely nothing wrong with them, that their pain is “all in their brain”, or that they simply need to think differently. It means becoming interested in what happens when the nervous system receives new information.
Perhaps a movement can be approached differently. A sensation might be noticed without immediately becoming the sole focus of attention. Someone might discover that their pain varies more than they had realised, or that there are movements they can make more comfortably than they expected. They might begin to experience their body as more capable and less fragile, or discover that they have some influence over aspects of an experience which previously felt completely outside their control.
One experience isn't necessarily going to undo years of pain. But it can provide something different for the nervous system to learn from.
What does this mean for pain hypnotherapy training?
This is one of the reasons I don't think pain hypnotherapy training should simply consist of teaching people suggestions for turning pain down. There is certainly a place for analgesic suggestions, and there is a substantial body of research investigating hypnosis for pain. A recent systematic review and meta-analysis involving 88 randomised controlled trials found evidence of an additional analgesic effect when hypnosis was added to usual care for chronic pain, although there was considerable variation between studies and limitations in the certainty of the evidence (Thompson et al., 2024).
For me, though, one of the most useful questions isn't simply whether hypnosis can reduce pain. It's what we are actually trying to influence when we use hypnosis with somebody who has persistent pain.
Depending on the individual client, we might be working with attention, expectation, perception, stress, emotional responses, body awareness, learned associations, fear of movement, sleep, confidence, lifestyle or the person's beliefs about what their pain means. Direct pain relief can be part of the work, but it doesn't have to be the whole of the work.
Chronic pain clients may already be in your therapy room
This is perhaps the most practical reason I think hypnotherapists should understand chronic pain. Many people who live with chronic pain aren't necessarily searching for chronic pain treatment.
They may come to see us because they can't sleep. They may be experiencing anxiety or high levels of stress. They may be menopausal and dealing with several issues at once. They may have IBS. They might want help with weight but find that pain has affected how active they are. Or chronic pain may simply appear on an intake form alongside the issue they actually want help with.
Pain isn't always the presenting problem, but it can be an important part of the person sitting in front of us. And that means we need to know enough about pain not to make assumptions about it. We need to understand why somebody can be in very real pain even when there isn't a straightforward relationship between their current pain and tissue damage, why appropriate medical assessment remains important, and why psychological and neurological processes influencing pain don't make the experience any less real.
A holistic approach to pain hypnotherapy training
This is very much the thinking behind Pain Rewired. Although understanding pain neuroscience is an important part of the training, I don't think we can work effectively with chronic pain by focusing on the pain mechanism alone.
Living with pain can affect someone's sleep, stress levels, movement, confidence, relationships, mood, identity, lifestyle and expectations for the future. Past experiences and emotional difficulties can also affect how someone copes with pain and how their nervous system responds to stress. Sometimes pain becomes just one part of a much bigger picture.
Pain Rewired therefore takes a holistic approach. We look at the neuroscience of chronic pain and nociplastic pain, but we also explore pain-management techniques, self-hypnosis, nervous-system regulation, the language people use around pain, mind–body approaches, lifestyle changes, emotional factors, learned patterns and ways of helping clients regain a greater sense of agency.
The aim isn't to decide that somebody's pain comes from one particular source. It's to look at the whole person and ask where we might be able to make a useful difference.
The next live Pain Rewired: Hypnotherapy for Chronic Pain training takes place on Saturday 26 September 2026, from 9.30am to 4.30pm on Zoom. The training is designed for practitioners who want to understand chronic pain more fully and have a clear, practical and holistic framework for working with clients, whether chronic pain is the main reason they seek therapy or simply one part of a much more complex picture.
References
Atlas, L. Y. (2023). How instructions, learning, and expectations shape pain and neurobiological responses. Annual Review of Neuroscience, 46, 167–189.https://doi.org/10.1146/annurev-neuro-101822-122427
Choi, Y. S. (2024). Current understanding of nociplastic pain. Korean Journal of Pain.https://pmc.ncbi.nlm.nih.gov/articles/PMC10985487/
Harvie, D. S., Meulders, A., Madden, V. J., et al. (2017). Classical conditioning differences associated with chronic pain: A systematic review. The Journal of Pain.https://www.sciencedirect.com/science/article/pii/S1526590017304844
International Association for the Study of Pain (IASP). (2021). IASP terminology: Pain, nociception and nociplastic pain.https://www.iasp-pain.org/resources/terminology/
Kaplan, C. M., Kelleher, E., Irani, A., Schrepf, A., Clauw, D. J., & Harte, S. E. (2024). Deciphering nociplastic pain: Clinical features, risk factors and potential mechanisms. Nature Reviews Neurology.https://www.nature.com/articles/s41582-024-00966-8
Raja, S. N., Carr, D. B., Cohen, M., et al. (2020). The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain, 161(9), 1976–1982.https://pmc.ncbi.nlm.nih.gov/articles/PMC7680716/
Thompson, T., et al. (2024). Adjunctive use of hypnosis for clinical pain: A systematic review and meta-analysis. Pain Reports.https://pmc.ncbi.nlm.nih.gov/articles/PMC11390056/
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