Chronic Pain Maps in the Brain – Implications for Pain Medication Addiction

Chronic Pain Maps in the Brain – Implications for Pain Medication Addiction

One of the most surprising, “ah-ha,” “no wonder this happened” findings of my 12+ years research has been the fact that the brain controls EVERYTHING we think, feel, say and do – everything! This means chronic pain is “felt” in the brain.

I wrote about this concept in my August 29, 2014 article, “Chronic Pain and Opioid Addiction,” in which I covered the following key concepts:

  • The brain controls everything we think, feel, say and do through neural networks and brain maps.
  • Pain is in the brain.
  • Pain meds don’t just block opioid receptors – they also trigger massive releases of dopamine neurotransmitters.
  • A person can be physically dependent and not addicted to a pain med, yet the withdrawal symptoms can be the same.

How the Brain Maps Chronic Pain

When you injure yourself, pain receptors in the peripheral nervous system send pain signals to the spinal cord. At the spinal cord, bundles of sensory neurons in the dorsal horn act as a hub and send reflex messages to the injury site (take your hand off the burner, for example) and pain messages to the brain. These pain messages to the brain run throughout, triggering neural networks ranging from those involved with fight-or-flight, to those responsible to assessing this pain in context of similar pain, to so many more too numerous to count.

And this is where it can get “complicated.” If the brain attaches fear to the event – say fear about what you’ll be able to do now that you’ve broken your foot, or it attaches anxiety to the injury event – say anxiety about doing something, like exercise, that might make the pain worse, or it attaches worry about the prognosis for a full recovery, the brain starts to get the pain messages linked up with the emotions. So that if a person feels that twinge of fear when they move their foot, the brain “reads” it as pain. Additionally, if the brain is under major emotional stress around other things going on at the time of injury, say loss of a job, it can attach those stress-related feelings to the feeling of pain, as well. Thus when another job application they’ve submitted is declined, for example, their brain “feels” that old “pain.”

Not only this but pain often interrupts sleep and gets in the way of wanting to exercise. Both lack of sleep and lack of exercise in turn change brain chemistry, which in turn can lead to depression or a brain mapping that further inhibits sleep and exercise. And why would this be such a problem? When the brain does not get the powerful brain benefits of restful sleep and exercise (these actually “do things” to various parts of those strands of holiday lights), it interrupts normal neural network activity, which then exacerbates the problem.

Not only are there all of these sorts of emotion / thought-related mappings going on, BUT there are the brain maps around the chemical interruptions to the neurotransmitters and receptors’ portions of various neural networks. These interruptions are caused by the chemicals in the drug compound, itself.

Implications for Pain Medication Addiction

Opioid pain medications work in the brain in ways similar to other addictive drugs, including heroin.

Opioid pain medications work in the brain in ways similar to other addictive drugs, including heroin.

To explain this is to explain how opioid pain meds work in the brain | body.

A portion of the pain med compound binds to receptors at the injury site. A portion of the pain med compound binds to opioid receptors found throughout the brain and nervous system – the receptors on neural networks involved with the “complicated” bit above. And a portion trigger massive releases of dopamine neurotransmitters – the neurotransmitters responsible for the brain’s pleasure/reward neural networks.

With the surge of dopamine component of an opioid pain medication, the pain is not being “killed,” per se – rather it’s being overwhelmed by the content, euphoric, satisfied feelings that dopamine neural networks provide. And, of course, the brain likes that feeling, so it maps the desire for pleasure (which comes with the pain meds), in addition to all of the other brain mapping going on.

This is where the strand of holiday lights analogy described in my original post comes into play, again. Between the “complicated” stuff described above and the brain / body pain med interactions, there are so many strands (neural networks) with frayed wires, loose bulbs and power surges, that a person’s thoughts and behaviors and what they feel and how they react / respond is out of whack.

In the case of acute pain, which is normal, and lasts anywhere from a week or two to a few months, pain medications help calm all of the opioid reliant neural networks involved with injury pain. Once the injury site is healed, the brain no longer feels pain and the person is weened off their pain medication.

BUT, in the case of chronic pain, the continued feeling of pain MAY be being triggered by the “complicated”-related brain mapping around fear, anxiety, emotions related to other events going on at the time and the “ah” feeling mapped around dopamine described above. The brain can actually be hijacked, if you will, because it has maps that “tell it” that pain meds are the answer to “pain” – pain which is now triggered by emotions, memories and the drive to feel good – all of the cues it has mapped to be “answered” by the pain med.

For the Rest of the Story


  • neural networks, brain maps and pain,
  • acute vs chronic pain,
  • opioid pain medication withdrawal, and
  • what to do

check out my original article, “Chronic Pain and Opioid Pain Addiction.”

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Lisa Frederiksen

Lisa Frederiksen

Author | Speaker | Consultant | Founder at
Lisa is the author of hundreds of articles and 11 books, including "If You Loved Me, You'd Stop!," "Addiction Recovery: What Helps, What Doesn't," and "Secondhand Drinking: the Phenomenon That Affects Millions." She is a national keynote speaker with over 25 years speaking experience, consultant, and founder of She has spent more than 14 years studying 21st century brain research in order to write, speak, and consult on substance use disorders prevention, intervention and treatment; mental disorders; addiction (aka substance use disorders) as a brain disease; adolescent addiction treatment vs adult addiction treatment; effective treatment for co-occurring disorders (having both a substance use and mental disorder); secondhand drinking | drugging; help for the family; and related subjects. In 2015, she founded SHD Prevention, providing training and consulting to companies, public agencies, unions, nonprofits and other entities to address the workplace impacts of employee secondhand drinking and alcohol misuse.

2 Responses to Chronic Pain Maps in the Brain – Implications for Pain Medication Addiction

  1. Hello Lisa,

    I came across this article in Content Gems as a result of my filtered searches for autoimmune, chronic pain and Multiple Sclerosis.
    I work as the chronic pain detective and have had great success with getting to the emotional cause(s) of my clients’ chronic conditions. There is often that aha moment when all the “holiday lights” come back on, and the pain or condition quickly eases or disappears.
    But I’ve got a client for over a year now, and despite both our best efforts his all over pain, but particularly in the buttocks, remains, and actually now that he’s reducing his pain meds by his own decision, getting worse.
    I know you specialise in alcohol use, but paradoxically he does not drink at all, but is part of al anon as a secondary victim of his father’s alcohol abuse and also sexual abuse from him at an early age.
    Your brain mapping idea is most helpful and makes perfect sense, but how to undo the enormous habit of negative self talk that is of course maintaining his physical pain, as there’s nothing wrong with his body to keep causing it.
    He is understandibly fed up of all this psychological and emotional cause seeking work as he’s still in pain, but I wondered if you had an angle that might help him if you talked with him?
    Our time zone for talking is Dublin Ireland.
    He’s in his early sixties, like myself.

    • Hi John,
      I’m glad you found my article and found it helpful. I think I do have an angle that would help your client. I can set up an online Go To Meeting session, whereby the three of us could all be on the same conference call from three different locations and see and hear one another. There’s an 8 hour time difference so scheduling shouldn’t be too difficult. My personal email is – contact me there, and we can make the necessary arrangements.
      Thanks for writing,

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