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Summary
Pain is built by the brain, and because the brain can change, pain can change. That is the core of what pain psychologist Dr. Rachel Zoffness lays out in this episode. Pain is never all in your head, but it is never only in the body part that hurts either. It is biopsychosocial: biology, psychology, and your social world all turn the volume up or down.
Dr. Zoffness is faculty at the UCSF School of Medicine, lectures on pain science at Stanford, and is the author of Tell Me Where It Hurts: The New Science of Pain and How to Heal. She walks through her three core truths about pain, why 96% of medical schools teach no dedicated pain science, the pain dial (how stress, mood, and attention change what you feel), and the pain recipe: writing down what makes a bad pain day so you can build the opposite. She closes with the three things that matter most for a healthy life with pain: movement, social health, and balance.
Links
- Dr. Rachel Zoffness (free resources page): zoffness.com
- Tell Me Where It Hurts: The New Science of Pain and How to Heal
- Instagram: @therealdoczoff
- Fit for Task Muscle and Strength Workshop: 40plusfitness.com/muscle
Key Takeaways
Is chronic pain all in your head? No, and it is never only in the body part that hurts either. Dr. Zoffness explains that the brain constructs every pain experience (phantom limb pain proves a leg cannot make pain on its own), and that pain is the brain’s opinion of how much danger you are in. Because the brain is plastic, the pain it produces can be changed.
What does it mean that pain is biopsychosocial? Three overlapping domains feed every pain experience: bio (tissue, genetics, sleep, diet), psych (emotions, thoughts, coping), and social (support, isolation, trauma, environment). Medicine treats the bio circle and stops. Zoffness points out that 100% of sensory signals pass through the brain’s emotion machinery before they become pain, which is why stress and depression make the body hurt more.
Why does pain get worse when you are stressed or focused on it? Your nervous system has a pain dial, and three things move it: stress and anxiety, mood, and attention. Tense muscles and worried thoughts turn the volume up; a calm body, positive mood, and distraction turn it down. That is why muscle relaxants, breathing, and absorbing hobbies all reduce pain, and why lying in bed thinking about it makes it worse.
How do you find what makes your pain worse? Write out your high pain recipe: the ingredients that add up to a bad pain day, like too much screen time, no movement, poor sleep, a bad diet, and high stress. Your low pain recipe is the opposite. Sleep is the first place to look, since poor sleep amplifies pain and a sleep hygiene protocol (fixed bed and wake times, morning sunlight, no doom-scrolling in bed) reduces painsomnia.
Should you move if you have chronic pain? Yes, and movement comes before pain reduction, not after. With acute pain like a broken bone, rest makes sense. With chronic pain, the longer you sit, the stiffer and weaker you get and the more movement hurts. Start with whatever you can tolerate, even five minutes standing on the porch, and build from there.
“Pain is never, and I do mean never, all in our heads. All pain is biopsychosocial, always.” – Dr. Rachel Zoffness
Episode
Podcast: 40+ Fitness
Episode: 763
Published: 2026-09-08
Host: Allan Misner (aka Coach Allan), author of The Wellness Roadmap
Guest: Dr. Rachel Zoffness, pain psychologist and faculty at the UCSF School of Medicine, author of Tell Me Where It Hurts: The New Science of Pain and How to Heal
Listen & Subscribe: Apple Podcasts · Spotify · YouTube (audio only)