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Hidden Brain
Hidden Brain

How to Combat Pain

July 20, 2026 • 50m

Summary

⏱️ 11 min read

Overview

In this episode, Hidden Brain explores how our conventional understanding of pain is fundamentally flawed. Pain psychologist Rachel Zoffness explains that pain is not simply a signal from damaged body parts, but rather a complex experience constructed by the brain using biological, psychological, and social factors. Through remarkable clinical cases and cutting-edge neuroscience, the episode reveals why traditional biomedical approaches often fail and how understanding pain's true nature opens new pathways for treatment.

The Biomedical Model's Limitations: Pills and Procedures

The antiquated biomedical model focuses primarily or exclusively on anatomy, physiology, bones, and body parts, treating pain through pills and procedures. This approach ignores two-thirds of the pain problem by never addressing the brain, emotions, or social factors. Rachel observes that someone with chronic knee pain will see numerous knee specialists without anyone discussing the brain's role in pain construction and maintenance.

  • The biomedical model is antiquated, focusing exclusively on anatomy, physiology, bones, and body parts
  • In the biomedical frame, pain treatment means primarily or exclusively pills and procedures
  • A patient with chronic knee pain will see many knee specialists but never talk about the brain

The Construction Worker and the Nail: When Perception Creates Pain

Rachel Zoffness shares two remarkable stories of construction workers and nails that illustrate how the brain constructs pain based on perceived danger rather than actual tissue damage. In one case, a worker experienced excruciating pain from a nail that appeared to pierce his boot but actually passed harmlessly between his toes. In another, a worker lived for six days with minimal discomfort despite having a four-inch nail embedded in his jaw and brain, because he believed himself to be safe.

  • First construction worker jumped onto a seven-inch nail that went through his boot, experiencing excruciating pain despite the nail passing harmlessly between his toes
  • Second construction worker had a four-inch nail embedded in his jaw and prefrontal cortex for six days with only mild toothache because he saw a nail fly into the wall
  • The brain uses all available information—including visual cues, memories, emotions, and social feedback—to decide whether to make pain and how much
" Our brain is our body's danger detector. That's our brain's job is to save our lives. And pain is our body's warning system. It's our danger detection system. "
" His brain perceived potential threat of danger, and so it made pain to protect him. "
" Credible evidence of danger will amplify the pain alarm. Credible evidence of safety will lower the pain alarm. "

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