What Neuroscience Tells Us about Chronic Pain: How it's Shaped Hypnotherapy Training

Within the western medical tradition, pain has been treated as a single phenomenon – a signal, generated by injury or disease, which was transmitted to the brain and which was experienced physically. Since the 1960s, pain has been considered at a psychological level, and modern neuroscience shows us exactly what’s happening inside the brain at an emotional level.

We can think of pain in two different ways:

• A sensory experience – this is when the body experiences something physical, such as touching a hot surface or cutting the skin, and makes sense of it, often by recognising it as a source of danger that should be avoided.

• An emotional experience – this is when decide how the pain feels. How much is it affecting us? How much does it matter? 

These two things are not necessarily the same. One person might be experiencing severe physical pain, but not feel overly affected it – their emotional response isn’t particularly strong. Another person might have a minimal physical experience, but feel that the pain is overwhelming, and affecting them greatly.

Here’s a personal example. When I turned forty, I started to get a really sore knee, and pain above my knee. I assumed it was arthritis and the pain progressively worsened over a few months. I sold my manual car and bought an automatic, due to the pain involved in gear changing. Around that time, I started working in a therapy centre next to a physiotherapist and, as we got chatting, I mentioned the knee. She told me to hop onto the table and had a quick feel, confirmed there was nothing wrong with my knee, but I had a tight ligament that was causing some pain.

I hopped and skipped out of the room – the pain suddenly disappeared – because how I felt about it (a minor physical condition that would heal itself over time, as opposed to age-related degeneration) had completely changed.  

This triggered an interest in how our perceptions of pain can significantly impact how we experience it.

The Brain Region at the Centre of Suffering

There is a small region of the brain called the anterior cingulate cortex (ACC). Its job is to take a physical sensation and decide how much it matters emotionally. In other words, it is where sensation becomes suffering.

When the ACC is surgically removed, something remarkable happens: people can still feel pain — they know it is there, they can point to it — but they are no longer troubled by it. The sensation remains. The distress disappears.

Research published in Nature (Oswell et al., 2026) confirmed this further, identifying the precise neurons in the ACC responsible for the emotional experience of chronic pain. When those neurons were quietened, suffering reduced — while the body's ability to sense and respond to harm stayed completely intact.

Pain Is a Brain State, Not Just a Body Signal

One of the most significant statements in the Oswell et al. (2026) research is this:

"Pain is not merely a sensory signal, but a dynamic brain state shaped by perception, memory and emotion."

This reframing is transformative for clinical practice. It means:

• Pain is actively constructed by the brain, not passively received

• The brain draws on memory, expectation, and emotional context when determining how much pain to generate

• The same sensory input can produce vastly different experiences depending on the individual's internal state

• Chronic pain can persist long after tissue has healed precisely because the brain has learned a pain state — and the emotional circuitry sustains it

This is why chronic pain so frequently co-exists with anxiety, low mood, and a sense of loss of control. The aversive emotional circuitry and the regions associated with those psychological states are deeply interconnected.

Why This Underpins Hypnotherapy Training for Chronic Pain

This research maps directly onto what hypnotherapy does, and why specialised hypnotherapy training needs to be clearly rooted in neuroscience.

1.     Hypnotherapy works on the emotional component of pain

When a client shifts their relationship to pain in hypnosis — experiencing sensation without distress — that is not imagination. It reflects real change in ACC activity. The aim is not to remove sensation but to reduce the emotional layer that turns a signal into suffering.

2. The brain's pain state can change

Pain is built from perception, memory, and emotion. That means it can be reorganised. Hypnotherapy works directly on those inputs — the meaning of sensation, anticipatory responses, and nervous system arousal.

3. Dissociation techniques are neurologically grounded

Creating distance from pain — observing it, imagining it as separate — mirrors the brain's own sensory/emotional split. These techniques work because they reflect how pain is actually structured.

4. Change can last

The research found that reduced pain distress persisted with continued treatment. The nervous system recalibrates when the emotional circuitry is consistently engaged differently. This supports what hypnotherapists see clinically: lasting change is possible.

Core Principles for your Hypnotherapy Practice

Here are some learnings from the research that we can take into practice.

Sensation and suffering are separate. Clients benefit from understanding that feeling something is not the same as being harmed by it. The goal is not to stop feeling — it is to change what the feeling means.

The brain learned this pain state. What is learned can shift. The nervous system that amplified and sustained the pain experience is the same nervous system that can reorganise around a different relationship to sensation.

Emotional experience drives suffering more than sensation does. Distress, fear, and anticipation are not side effects of chronic pain — they are central drivers of it. Working directly with these emotional components is not peripheral to pain management. It is the work.

The body's protective signals remain valuable. Hypnotherapy for chronic pain does not aim to produce insensitivity. It aims to reduce unnecessary suffering while preserving the body's ability to communicate genuine need. This is a distinction worth making explicit with clients.

A Note on Where the Science Is Heading

The techniques used in the Oswell et al. study — silencing specific neurons in the ACC — are not yet available in clinical settings for humans. However, the researchers note that advances in non-invasive neuromodulation and personalised approaches to the brain are progressing rapidly.

This study shows us precisely where in the brain the emotional suffering of chronic pain lives, and confirms that it can be targeted without disrupting the rest of the pain system.

Hypnotherapy is already working in that territory. This research gives us the language to describe why.

Reference: Oswell, C.S., Rogers, S.A., James, J.G. et al. Mimicking opioid analgesia in cortical pain circuits. Nature 649, 938–947 (2026). https://doi.org/10.1038/s41586-025-09908-w

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