Tag: pain

How Chronic Pain Changes the Brain



September is Pain Awareness Month.

Paula* started feeling pain in her shoulder late last year. It started as an ache, but it wasn’t long until routine things like waving to a friend or putting on a sports bra were too painful to do.

She started having problems sleeping and paying attention at work because of the pain.

Paula was eventually diagnosed with a shoulder tear and said some days are worse than others — but the pain is always there. “I don’t remember what it’s like not to have the pain,” she said.

Paula is not alone: About 1 in 5 people living in the U.S. have experienced chronic pain. Research shows women and people assigned female at birth are more likely to have chronic pain than men, and women of color are less likely to be treated for pain compared to white people.

Living with chronic pain can affect all aspects of life and even change the way your brain works.

What is chronic pain?

By definition, chronic pain is pain that lasts for more than three months. It can be constant — like Paula’s — or it can come and go.

There are many causes of chronic pain, including a past illness or injury that’s recovered from but the pain stays. Health conditions like rheumatoid arthritis, osteoarthritis, chronic migraine disease and temporomandibular disorders can be a cause of chronic pain. And some people have chronic pain for unknown reasons without any injuries or past illness.

Regardless of the cause, a growing body of research is showing how chronic pain affects the brain.

Read: After 14 Years of Chronic Pain, I’m Finally Embracing Pain Management >>

How chronic pain changes the brain

“Studies have shown that chronic pain can actually decrease gray matter in the brain,” said Puja Shah, M.D., an interventional pain management specialist and member of HealthyWomen’s Women’s Health Advisory Council.

Gray matter is the tissue in your brain and spinal cord that helps with important things such as learning, memory, emotions and movement — pretty much everything you need to perform everyday activities. So, a decrease in gray matter can lead to problems in related areas.

For example, one study found chronic pain led to a reduction in size and activity in the hippocampus — the part of your brain that is responsible for short- and long- term memory among other other things. Other research shows that chronic pain has a negative effect on the regions responsible for emotions and motivation. These changes can lead to personality shifts and feelings of anger and anxiety.

Chronic pain has also been linked to various health conditions dealing with the brain including:

Chronic pain can also alter areas in the brain responsible for cognitive function. “These alterations can cause difficulties with focus, learning and problem-solving, even when the pain is not at the forefront of that person’s experience,” said Jane Wigginton, M.D., medical science research director at the Center for Brain Health.

The presence of constant pain also has a big impact on mental and emotional health. “The emotional centers of the brain, like the amygdala and regions involved in emotional regulation, become more reactive under the constant pressure of pain,” Wiggington said. “This can lead to increased anxiety, frustration and feelings of hopelessness.”

Over time, chronic pain can reduce the brain’s ability to experience joy and pleasure, which can add to emotional problems.

Chronic pain and depression

The emotional wear paired with constant pain may make people living with chronic pain more vulnerable to mental health conditions like depression.

Chronic pain shares neural pathways with mood and reward systems in the brain, which explains why chronic pain has been linked to depression and substance use disorders.

“Persistent pain can disrupt the balance of neurotransmitters like serotonin and dopamine, which regulate mood, pleasure and motivation. This disruption can lead to feelings of depression, anxiety and a diminished sense of reward, making it more challenging for individuals to find relief or experience joy,” she said.

The fact that chronic pain is an invisible illness can also lend to feelings of loneliness, which can lead to social isolation and depression. Studies show that people living with chronic pain are more vulnerable to social isolation and, in turn, isolation can make symptoms of chronic pain worse.

Stress is another factor that can make chronic pain worse because it accelerates changes in brain function. Basically, the body releases cortisol, also called the “flight or flight” hormone, which can decrease the brain’s ability to manage emotions and pain. “Chronic stress may also make the brain more sensitive to pain signals, increasing both discomfort and emotional strain,” Wigginton said.

Shah said recent studies and advancements in medical imaging have helped put the spotlight on how chronic pain changes the brain. “It also shows that pain in and of itself is a true mind/body disease,” Shah said. “It’s validation that suffering is causing long-term damage.”

Read: Tech Solutions for Chronic Pain >>

Chronic pain in women

There’s still a lot about chronic pain that we don’t know. But, we do know that women and men experience pain differently and women are more sensitive to pain overall compared to men. Wigginton said this is due, in part, to hormonal fluctuations. “These fluctuations, particularly during menstruation, pregnancy and menopause, can heighten pain sensitivity and alter the way the brain processes pain signals,” she said.

Shah noted that chronic pain isn’t necessarily about tolerance — chronic pain is a complex interconnected disease that feels different depending on the person. And there can be stigma surrounding chronic pain that can keep people from getting the help they need.

Read: Breaking Barriers to Pain Treatment >>

“Women are less likely to speak up when experiencing a chronic pain condition,” Shah said. “This is for many reasons, including cultural norms, difficulty in finding the space and time for women to prioritize their self-care and bias in the medical community regarding treatment for men versus women.”

Historically, women have been left out of clinical trials and the conversation surrounding chronic pain despite being more likely to be diagnosed with pain conditions compared to men.

The issue of chronic pain and treatment for chronic pain is personal to Shah. She had migraine attacks for years but said a mind/body approach including medication and aligning her posture has helped her have better control over her migraine attacks.

The first step, she said, is awareness. “Too often we diminish things to be normal when they’re not.”

Both Shah and Wigginton said brain-healthy habits such as reducing stress, practicing mindfulness and getting enough sleep and physical activity can help with the symptoms of chronic pain.

“It’s essential for women to know that they are not powerless in this process,” Wigginton said. “There are multiple pathways to improving brain health and well-being, and by understanding and addressing the brain’s role in pain, women can feel empowered to thrive in their lives, despite the challenges chronic pain may bring.”

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The Pain in My Neck Turned Out to Be Fibromyalgia


As told to Jacquelyne Froeber

I was lifting weights at the gym when I felt something rip in my neck. I wanted to scream, but the sudden burst of fiery pain took my breath away. “Don’t panic,” I told myself. It was probably just a neck strain or a pinched nerve.

I went home and put ice on it.

The fire continued to burn.

The year was 2000. We’d all survived Y2K. I was 26 years old and two finals away from surviving my first year of medical school.

I expected the pain in my neck to get better as finals week went on — but it got worse. I studied human anatomy with a ring of fire supporting my head. Then the flames started to spread down my back and continued moving south.

Somehow, I made it through finals, but there was no relief from the burning pain. It was officially time to panic.

What the hell was wrong with me?

I went to medical school in Boston so there were a lot of fancy healthcare providers and specialists to choose from. One by one, appointment after appointment, everyone said the same thing: “We don’t know what’s wrong with you.” There was nothing to see on my scans. No neck injury to speak of.

To add insult, some providers said I was imagining the pain. Others said depression was the problem. Everyone said I needed to exercise more.

I was already exercising — hence the gym injury — and I tried to do more. But fatigue had set in, and I was so tired all the time. I woke up exhausted as if I didn’t sleep at all during the night. I was also stiff and sore — like I’d run a marathon and then gotten hit by a truck on repeat.

I was running on fumes by the time school started again. I had just enough in me to study. I knew I couldn’t go into a hospital environment and work with patients when I felt so bad. So I took a medical leave of absence my third year — which was basically unheard of — but I knew I didn’t have a choice. I had to get better or give up on my dream of being a doctor.

By this time, I was desperate. I’d spent every penny I had on alternative medicine, specialists, acupuncture and herbs. Nothing helped.

Someone along the way suggested I see a chiropractor so I made a half-hearted appointment. During the exam, he pressed on a spot in my upper body and I almost fainted. “That’s so painful,” I cried out. He pressed on other areas with the same result. “I think you have fibromyalgia,” he said.

“Fibro-what?” I asked. I’d never heard that term before in medical school — or ever. It was the first time someone gave a name to the pain. It was the first time in years I had hope.

I practically sprinted to the bookstore and headed to the health section. I made my way to “F” and found one copy of “Fibromyalgia and Chronic Myofascial Pain: A Survival Manual.” I clutched the book in my hot little hands and spent the next 24 hours reading about fibromyalgia.

Everything in the book described me. I was nodding along with every line. The burning, the pain, the brain fog — it was all me. It was exciting — thrilling — to finally have some answers. It was devastating, however, when I learned that medical treatments were basically nonexistent at the time.

Back then, fibromyalgia was considered a “wastebasket diagnosis,” which meant that healthcare providers thought the symptoms were either fake or all in your head. And there wasn’t much doctors could offer as far as treatments.

Learning what the medical community thought of my condition lit a new — different — fire within me. I knew I had to get better enough so I could help other people find a better way to live.

Over the next few months, I used myself as a guinea pig and tracked the things that made me feel better. I was sensitive to dairy, so I changed my diet. I prioritized stress management and sleep hygiene.

A type of therapy called myofascial release was the pain changer for me. The technique involves stretching the tissues around the muscles that can be inflamed for people with fibromyalgia. After the first treatment, I felt a small amount of pain relief in my neck. I knew I was on to something big.

The combination of lifestyle changes and myofascial release therapy brought my pain down from a 7 to a 3. I felt good enough to go back to med school.

Even though I had an idea what the medical community thought about fibromyalgia, hearing it in person almost broke me. Early on in the school year, a teaching physician announced that fibromyalgia didn’t exist. Other colleagues said people with fibromyalgia were making it up to get disability benefits. The consensus was that people with fibromyalgia were lazy. Hopeless. A waste of “our” time.

I wanted to yell at the top of my lungs that no one had a clue what it was like to live with fibromyalgia. But I kept to myself. If this is what my colleagues thought about my condition, what would they think about me?

At the end of school, I had to do a presentation in front of all my peers, physicians and teachers. I presented a case study on fibromyalgia and revealed, at the end, that it was about me. I started weeping right there at the podium. I sobbed uncontrollably in front of hundreds of people and I couldn’t stop. For so long I’d been hiding this secret. I looked fine on the outside, but on the inside, I was going through hell.

Most importantly, I wasn’t making it up. And I wasn’t alone.

After the presentation, I was shocked at the amount of people who lined up to thank me for talking about fibromyalgia. So many people said they had family, friends or patients going through a similar situation. The reaction was so positive — it gave me hope that things could change.

Ginevra Liptan, M.D. 2023

After school, I dedicated my career to fibromyalgia and pain conditions. Thankfully, the medical community changed and fibromyalgia is a recognized chronic condition and there are FDA-approved medications available to help treat it, along with a variety of alternative treatments that can be helpful.

The problem is that fibromyalgia is far more complex than just taking medication. Each person is different and some people really struggle to find any relief. I’m lucky in the sense that medication and lifestyle help me stay around a 2 or 3 on the pain scale. It’s manageable. And in the absence of a cure, that’s all anyone with chronic pain wants — to feel good enough to do the everyday things you have to do.

In 2016, I published the book, “The Fibromanual: A Complete Fibromyalgia Treatment Guide for You and Your Doctor,” inspired by that desperate trip to the bookstore so many years ago. The information still holds up today, but there’s also so much new research and insight into fibromyalgia out there. It gives me hope that one day soon all of us with fibromyalgia can defeat it.

Have a Real Women, Real Stories of your own you want to share? Let us know.

Our Real Women, Real Stories are the authentic experiences of real-life women. The views, opinions and experiences shared in these stories are not endorsed by HealthyWomen and do not necessarily reflect the official policy or position of HealthyWomen.

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The Facts About Redheads and Pain


Rebecca Sager, senior vice president of development for HealthyWomen, was in the prep room at the hospital getting ready to deliver her first child when the nurse came in and asked her an odd question. “Are you a real redhead?”

“You’re going to find out in a minute,” Sager quipped, knowing the nurse was there to see how dilated she was. Sager is, in fact, a real redhead. Or as she put it, the carpet matches the drapes.

Natural redheads are rare — less than 2% of the population. Was the nurse so taken by Sager’s firey mane that she had to know if it was real? Probably. But she also asked because, if Sager’s hair color was natural, it meant she may need more pain management during labor.

“I’d never heard that before,” Sager said.

Do redheads have a higher pain tolerance?

There’s a growing body of research that shows that people with red hair experience pain differently compared to people of other hair colors. The jury’s still out as to why this may be, but one theory has to do with the melanocortin-1 receptor (MC1R) gene.

All people with red hair are born with a mutation of the MC1R gene. That’s not only what gives them flaming locks of auburn hair, but, according to a 2021 study, it also reduces the function of the gene. And those changes affect the balance between pain sensitivity and tolerance.

Overall, research on redheads supports the seeming contradiction that they have a higher tolerance for pain in general, but they have increased sensitivity to certain types of pain.

For example, one study found women with red hair were more sensitive to temperature-related pain compared to women with dark hair. But another study found that people with red hair were less sensitive to pain by electric shocks.

The differences don’t stop at the way redheads perceive pain. They also respond to pain medication differently. Given the range of pain sensitivity and different types of pain, pain management can present challenges for people with red hair. Studies show redheads may require higher doses of some types of non-opioid pain relievers. But, the 2021 study mentioned above found that redheads may be more sensitive to opioids and need less medication to stop pain.

The sensitivity to opioids may be even more pronounced in women. One study found that women with two parents who have read hair — meaning they have two variant MC1R genes — had significantly higher pain tolerance and significantly higher sensitivity to opioids.

Rebecca Sager, rocking her red locks, 2023

Rebecca Sager, rocking her red locks, 2023

Do redheads need more anesthesia?

The research on whether redheads need more anesthesia is limited, but if you talk to women with red hair, you may hear anecdotal evidence that they require more anesthesia. Why? The theory is back to the MC1R gene mutation, which leads to a reduced response to anesthesia, so more is needed. One study found that women with red hair required almost 20% more anesthesia for sedation compared to women with dark hair.

Della Lin, M.D., an anesthesiologist and secretary of the Anesthesia Patient Safety Foundation, noted that the research regarding redheads and more anesthesia comes from smaller studies, so it may not be something your healthcare provider (HCP) thinks about right away.

Lin encourages people with red hair — and everyone else — to bring up any concerns about anesthesia or pain management before the procedure. “I might keep that thought in the way back of my mind [that you have red hair], but I’m not going to increase anything by default,” Lin said. “So it’s nice to know if you’ve noticed that you’re sensitive to opioids … because everyone is a little bit different.”

Jackie Wexler, a middle school teacher with curly scarlet-red hair, said she had no clue her hair color was tied to her reaction to medicine. But looking back, regular OTC pain medications haven’t done much for her menstrual cramps or her headache attacks. “Now I have the worst migraine attacks and nothing helps,” she said.

Read: 8 Types of Migraine Attacks >>

It makes sense to her that the high pain tolerance and high tolerance to certain painkillers is genetic. She said her sister, who also has red hair, needed more pain medication than they would give her when she gave birth.

Sager is now mindful of her real redhead status and tries to get her HCPs on the same page regarding any pain medication or anesthesia she may need. Still, some providers don’t think the connection between redheads and pain is true. When Sager went in for a colonoscopy, she told her anesthesiologist that she needed a higher dose. She pointed to her head. He said she didn’t. So when the nurse came in and asked why she was still coherent and sitting up, Sager didn’t mince words. “I’m a redhead. I’m different.”

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