Dr. Uri Hochberg Explains Why Pain Feels Different for the Same Injury

Dr. Uri Hochberg, a specialist in family medicine and pain management, clarifies the complex nature of pain and its treatment. He explains that pain is not simply felt where the injury occurs but is a sensory and emotional experience created by the brain. The brain processes signals from the nervous system and assigns meaning to them, which is why two people with the same injury can experience very different levels of pain.

The brain itself lacks pain receptors, which is why brain surgery can be performed while the patient is awake without causing pain. Pain perception is influenced by emotions, memories, expectations, and context. For example, the placebo effect can reduce pain when a person believes a treatment will help, while anxiety and fear can amplify pain through the nocebo effect. Attention to pain also plays a role, with those who catastrophize pain often experiencing more intense suffering.

One striking phenomenon illustrating the brain's role in pain is phantom limb pain, where amputees feel pain in limbs that no longer exist. This occurs because the brain's neural networks continue to represent the missing limb. Treatments like mirror therapy can help "update" the brain’s body map and reduce this pain.

Dr. Hochberg distinguishes between pain and suffering, noting that suffering involves the interpretation and emotional response to pain. Modern pain treatment integrates medication, physical therapy, cognitive-behavioral therapy, and other methods to reduce nervous system sensitivity and alter brain processing of pain. He emphasizes that all pain is real, even if it persists after the original injury has healed.

Chronic pain can result from the protective pain mechanism continuing without actual danger. Effective treatment often requires a personalized combination of approaches to reduce pain, improve function, and restore quality of life, giving patients a sense of control over their condition.