Chronic Pain Therapy with Dr. Rachel Zoffness

Here’s a summary of the podcast episode Dolorology (PAIN) with Dr. Rachel Zoffness (from the series Ologies with Alie Ward) featuring pain-psychologist Rachel Zoffness, including its key ideas and implications.

• In the episode, Dr. Zoffness asks: What is pain? Where does it come from? And how can we hurt less?

• She explains that pain is not simply a signal of damage in the body — it’s a complex brain-based construction, shaped by biology, psychology and social factors.

• The term “dolorology” (from Latin dolor = pain) is used to describe the study of pain: its nature, experience, and management.

Key Concepts & Insights

Pain is constructed in the brain rather than being purely a literal measure of tissue damage. For example, someone may perceive pain (like phantom limb pain) even when the limb is absent — indicating the brain’s “danger alarm” is at work.

Pain is Biopsychosocial:

• Bio = tissue status, genetics, injury, sleep, exercise, physical health
• Psycho = attention, emotion, cognition, beliefs about pain
• Social = context, support, work environment, stress, trauma
• Dr. Zoffness emphasizes that all three domains matter in how pain is experienced and maintained

“Pain recipes” and amplifiers: She describes that pain is often the result of a “recipe” of factors, not just one thing. For example: stress, sleep loss, injury, anxiety, social isolation might all amplify the “pain dial” in the brain.

Context, attention, and emotion matter:

1. 1. If you’re in a painful injury but surrounded by distractions, positive context, or focusing elsewhere, pain may be less intense.

   2. If you’re immobilized, anxious, depressed, isolated, or ruminating — pain gets amplified.
      She gives the “tale of two nails” example: one person experienced intense pain for a nail through a boot, another person had a nail embedded in his face/brain for days with much less pain. The difference: context, brain interpretation, expectation.

Chronic pain = sensitization: When pain lasts for weeks/months, the nervous system becomes more sensitive — smaller triggers lead to larger pain responses. This is central to chronic pain conditions.

Treatment implications:

• • Understanding pain neuroscience is key (“pain education”) so patients and clinicians stop treating pain as purely structural/damage-based.

  • Cognitive-behavioural and mindfulness-based strategies help patients hack their pain recipe — reduce the amplifiers.

  • Simply pursuing structural fixes (scans, surgeries) may miss the bigger picture of the pain system.

Practical Takeaways

• If you’re working with someone (or yourself) with pain: ask about sleep, mood, stress, attention, social environment, expectations — not just “what’s wrong physically?”

• Use language that helps someone understand pain is real, but also modifiable — the brain can turn things down.

• Encourage activities/contexts that shift attention away from pain, increase positive/social engagement, improve movement and function rather than only focusing on reducing pain intensity.

• Be cautious: scans/imaging may show “damage,” but that doesn’t always correlate with pain severity or future risk.

• For clinicians: include pain neuroscience education in treatment plans; consider behavioural/psychological interventions earlier rather than only after structural treatments fail.

Misc Notes

Central desensitization is helping someone’s brain and body desensitize to little bits of stimulation, a little bit at a time, until, like someone who’s in a dark room, suddenly you’re in a room full of light, gradually little bits at a time, and your brain and body are okay. So, that’s the treatment.

100% of the sensory signals from your body filter through your limbic system emotion center before they become this experience we call pain.

Cognitive therapy teaches us that how you think affects how you feel emotionally, affects how you feel physically, affects how you behave or act. So, round and round in a circle: what you think affects how you feel, affects how your body feels, affects how you act

So, it’s like, what is your cycle? How do I help you break it? You can break it by going after the thoughts, and you can break it by going after the emotions, and you can break it by going after the behaviors. Change behaviors first.

Trauma makes your brain more sensitive. Why? Because having trauma as a child… your brain needs to be sensitive, it’s adaptive. If something terrible has happened to you, your brain is always scanning the environment, your internal and external environment. Like, “Is a bad thing happening? What about now? What about now? Is there danger? Is there danger?”

Neuroplasticity – “The fact that the brain is always changing means that the brain can change. And if the brain can change, pain can change.