Chronic Pain as a Brain Condition: What the Evidence Suggests

Chronic pain affects hundreds of millions of people worldwide, yet the dominant clinical model, which treats it as a signal from a damaged body part, fails to explain a large proportion of cases. Two pain specialists, Dr. Tom Walters, a board-certified orthopedic physical therapist, and Dr. Howard Schubiner, a clinical professor at Michigan State University College of Human Medicine, converge on a conclusion that remains far from mainstream: in many cases, chronic pain is a brain condition, not a structural one. Understanding this distinction has significant implications for how pain is diagnosed, communicated to patients, and treated.

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A foundational principle that both Walters and Schubiner emphasize is that pain is always created in the brain. Even when a genuine structural injury is present, the brain decides whether and how intensely to produce the pain experience. This is not a philosophical claim but a neurobiological one: the brain contains circuits specifically dedicated to generating pain as a warning signal, and those circuits can activate in the absence of any tissue damage, or fail to activate even when damage is severe.