How Chronic Pain Works from Seattle’s top chronic pain PTs

How RISE Performance & Health Treats Chronic Pain: Rewiring Your Brain for true freedom from pain.

If you've been living with chronic pain, you've probably heard it all. "It's all in your head." "Learn to live with it." But here's what we know as chronic pain specialists at RISE Performance & Health in Seattle: your pain is absolutely real—and the very fact that it involves your brain is exactly why we can change it.

The Science: What Happens in Your Brain with Chronic Pain

When pain persists beyond normal healing time (typically 3-6 months), something profound happens: central sensitization. Your nervous system becomes increasingly sensitive and reactive, essentially turning up the volume on pain signals. Movements that once felt normal now trigger alarm bells.

Brain imaging research shows that chronic pain literally changes the brain. Areas responsible for processing pain, emotion, and threat detection become hyperactive while regions involved in pain inhibition become less active. Your nervous system develops a hair-trigger response.

But here's the empowering part: just as the brain can change to amplify pain, it can also change to reduce it. This neuroplasticity is at the heart of everything we do at RISE.

Our Approach in the Seattle Clinic: Retraining Your Brain and Nervous System

At RISE, we don't just treat tissues—we treat the entire pain experience by addressing the nervous system directly. Our evidence-based approach combines pain neuroscience with hands-on care to help your brain learn that movement is safe again.

Belief Reframing: Changing the Story Your Brain Tells

Pain is deeply influenced by what we believe about our bodies. If you believe your back is "degenerating" or that you're "broken," your nervous system interprets movement as threatening and amplifies pain.

We help you understand the true nature of your pain through education grounded in current research. When you learn that disc bulges are normal (found in 80% of pain-free people over 50), or that "arthritis" doesn't doom you to disability, your brain begins to feel safer. This isn't positive thinking—it's accurate thinking that reduces threat perception.

Two-Point Discrimination: Sharpening Your Brain's Body Map

When pain becomes chronic, your brain's representation of that body part becomes blurred or distorted—a "smudging" of your internal body map.

Two-point discrimination training uses simple touch exercises to help your brain re-learn to accurately sense painful areas. Research shows that improving two-point discrimination correlates with decreased pain intensity. By sharpening your brain's map, we reduce the alarm signals driving chronic pain.

Visualization and Motor Imagery: Rehearsing Movement Without Pain

Your brain can't always distinguish between imagining movement and actually performing it. When you visualize moving your painful body part smoothly and confidently, you activate the same brain regions involved in actual movement—without triggering pain.

We guide you through visualization practices that help your brain remember pain-free movement, creating new neural pathways that bypass the pain response.

Regional Localization: Teaching Your Brain Where Pain Actually Lives

Many people with chronic pain struggle to pinpoint exactly where it hurts—pain feels diffuse or spread across large areas, reflecting disrupted brain processing.

Regional localization training involves exercises where you practice identifying and mapping your pain with increasing precision. As your brain becomes better at localizing sensations, pain becomes less threatening and more manageable.

Right/Left Discrimination Training: Rebuilding Body Awareness

People with chronic pain often struggle to quickly identify whether a picture shows a right or left hand, foot, or back—suggesting disrupted body representation in the brain.

Right/left discrimination training uses flashcards or apps showing body parts from different angles. By practicing quick identification, you help reorganize brain areas responsible for body perception. Studies show this can reduce pain intensity and restore normal movement patterns.

Graded Exposure Through Progressive Strength Training: Building Confidence in Movement

Perhaps the most powerful intervention we use is progressive, graded exposure to movement through strength training. When movements have been painful for a long time, your nervous system learns to fear them. This fear drives avoidance, leading to weakness and deconditioning—which ironically makes pain worse.

Graded exposure means we systematically and gradually reintroduce movements your nervous system has learned to fear. We start with modified versions your nervous system can tolerate, then progressively increase the challenge as your brain learns these movements are safe.

This isn't about "pushing through" pain. It's about carefully dosed exposure that allows your nervous system to update its threat database. Each successful repetition is evidence to your brain that movement is safe. The strength you build isn't just physical—it's neurological. You're building new movement patterns and confidence that override old pain-associated patterns.

The RISE Difference: Whole-Person Care for Lasting Change

At RISE, treating chronic pain requires more than exercise prescriptions. Every session is a full hour with your doctor of physical therapy—no assistants, no rushed appointments. As board-certified specialists and Fellows in manual therapy, we integrate these brain-based approaches with hands-on manual therapy, sleep optimization, stress and fear management, and nutrition guidance. Our trauma-informed approach also helps us navigate triggers and fears that come up during the session.

We create an environment where you feel safe to explore movement again. We don't just help you manage symptoms—we help you understand your pain, rebuild trust in your body, and return to the activities that give your life meaning.

Your Brain Can Change. Your Pain Can Too.

The same neuroplasticity that allows pain to become chronic also allows us to retrain your nervous system toward health. With the right guidance, evidence-based approaches, and consistent effort, you can teach your brain that movement is safe again.

At RISE Performance & Health, we specialize in helping active adults overcome chronic pain and return to the lives they love—stronger, more resilient, and equipped with tools that last a lifetime.

Ready to start retraining your nervous system? Contact us today to schedule your comprehensive evaluation.