Chronic Pain Reset: Unmasking the Brain's Role in Processing Pain with Dr. Afton L. Hassett

So the way that we kind of talk about it more colloquially is that we'll say that there is bottom-up pain. So bottom-up pain just means somewhere in the body there's some disturbance. There's an injury or a pain signal coming from somewhere else in the body. And then there's top-down pain. There's the pain that really truly is generated by the brain. So this evolution of the pain signal has taken place. It's gone from a back injury that may have healed reasonably well and now become this very amplified. So maybe there's some— stimuli coming from that lower back injury, but most of it is just the brain's overreaction. Now it's learned this signal too well and now emits pain quite on its own. And it can be exacerbated by stress, anxiety, fear, tiredness, lack of exercise. I mean, all these things can make the pain experience worse.