Why Chronic Pain Persists: Two Kinds of Protection

If you live with a symptom that doesn’t behave the way an injury should — pain that moves, fatigue unrelated to exertion, dizziness or tension that comes and goes on its own schedule — you have probably already done a great deal of reading. You may know your scans better than some of the clinicians who ordered them. You may have encountered the idea that your symptom is “neuroplastic” already.

So what you won’t find here is another person telling you how your pain is just stress, or that it is in your head. We will instead track through what is happening in your brain-body connections that produce the symptoms.

The brain has multiple ways of protecting us

The simplest explanation of neuroplastic symptoms is that the brain has become accustomed to treating safe things as dangerous and it produces symptoms in response. Symptoms are the brain’s form of protection. But the brain does not run a single general-purpose danger detector. It runs several distinct protective systems that respond to different threats, produce different states, and are quieted by different things.

A note on where this comes from

The clearest map of these systems comes from the neuroscientist Jaak Panksepp, who spent his career identifying the brain’s basic emotional systems. Panksepp found that emotion is not one undifferentiated state. It is a set of distinct systems, each with its own circuitry, its own function, and its own characteristic feel.

Panksepp helps us identify which emotional system is generating a given symptom — and that points toward more targeted change and recovery.

Two of Panksepp’s systems are worth knowing by name because they are the most common generators of persistent pain.

The first: FEAR

The first is the system Panksepp named FEAR.

When the fear system is running, it feels like bracing. The body readies itself — muscles, breath, attention all narrow toward something that might harm you. There is a sense of urgency: an urge to escape, to avoid, to get away or get safe. It is sharp, mobilized, outwardly oriented against a threat.

The FEAR system is the brain’s protection against physical danger to the body. It evolved to detect threats to your physical safety and to drive the actions that get you clear of them. And it has a specific release: When the danger passes and safety is restored, the system stands down. That is the input it is built to respond to.

A neuroplastic symptom driven by FEAR has a running logic. The brain has come to read ordinary situations — a movement, a posture, a place — as physically dangerous and it produces protective symptoms accordingly.

The brain can do this in unexpected ways. For instance, one time when I was driving to the mountains for a day of leisure, I got a surge of pain that continued to persist through the day. There was something about the context of driving on the highway and seeing the mountains that activated my FEAR circuitry. It baffled me though. Why would my brain interpret the beautiful mountains as a threat? After a few days I put the pieces together. In childhood I spent a great many days travelling to the mountains to ski race. My brain had remembered the feeling of fear and pressure that accompanied those morning drives to the mountains: the pre-race anxiety. Seeing the mountains as an adult while in the context of driving was enough to remind my brain’s older protective system of the fear it had felt, and this activated pain at a pre-conscious level.

The second: PANIC/GRIEF

The second system can often be overlooked because the felt sense it produces is similar to what FEAR produces. Panksepp named it PANIC/GRIEF. It is also called the separation-distress system or attachment system.

The felt sense of PANIC/GRIEF is similar to FEAR, but different. Rather than a bracing feeling, it produces a sensation felt as closer to an ache or longing: first a surprise and/or shock experienced in separation, and then the sadness and ache associated with being separated. It signals a distress that is about disconnection — about not being wanted, not being held, or being alone. Where FEAR is sharp and mobilizes flight away from a threat, PANIC/GRIEF is heavier — it feels like a pull toward someone, a call for connection in the absence of that connection.

This system has nothing to do with physical harm. It is the brain’s way of protecting and/or securing a bond with another person or persons. It is a call to connect, belong, and feel held and included. It can be experienced as a threat of abandonment and signals our shared human vulnerability. Because of this, establishing mere physical safety does not quiet the PANIC/GRIEF system; rather, the felt sense of connection relieves it through contact, closeness, and restoration of a loving bond.

When a neuroplastic symptom is driven by PANIC/GRIEF, the logic is different from when it is driven more by FEAR: the brain has come to treat some situation as a threat to connection, to belonging, to being held — and produces a protective symptom in response to that.

Why knowing the difference makes a difference

Here is why knowing this distinction makes a difference.

In the body, FEAR and PANIC/GRIEF can feel remarkably alike. Both produce activation, disturbed sleep, a pervasive sense that something is wrong. A symptom driven by either one can look identical from the outside and feel similar from the inside.

But they are fed by different appraisals, and ultimately relieved by different inputs. And that means a treatment aimed at the wrong system will tend not to hold.

If a symptom is driven by PANIC/GRIEF, but the work is built around FEAR — establish safety, calm the danger, reassure the body it is not under threat — the relief is less likely to last. Not because the work was done poorly, but because when the PANIC/GRIEF system again gets activated it is calling for a relational restoration that mere physical safety does not reach.

This is worth saying plainly to anyone who has worked hard at recovery and found it didn’t hold: the result may mean the work was calibrated to one system while your symptom was being driven by another.

Overlapping systems

There are two things to keep in mind when considering Panksepp’s framework.

The first: in most people, the two systems are braided together. A situation can carry both a threat of harm and a threat to connection at once, and most stubborn symptoms have something of both behind them. The useful question is rarely “which one is it.” It is “which thread is louder — here, in this symptom, in this situation.”

The second: not every symptom traces back to a deep source. Some have short, ordinary histories — a plain learned association, a simple habit of bracing. This framework is a lens for inquiry — a compass that can tell you what to look for in how your symptoms present, and what they may be protecting.

A symptom is something the brain is running

One last point, because it changes what you do with all of this.

A neuroplastic symptom is not stored damage you are carrying. It is something the brain is actively running, moment to moment, now — which is why it can move, vary, intensify and recede in ways an injury never would. It is less like a wound and more like a current: ongoing, live, and fed from somewhere upstream of where you feel it.

That is the hopeful part. A protective system is not an adversary. When it comes to chronic symptoms it is often the brain’s miscalibrated strategy at maintaining the integrity of the whole person. It just needs recalibrating. It needs to learn where the judgment to protect stems from and be reassured that the situation it has been protecting against is not, in fact, a threat of either kind. As that happens, the protective output settles. The symptom does not have to be fought. It calms down as the system it belongs to stands down.

Where this leads

So often clients wonder “What is wrong with me?” Panksepp helps shift this question to “How is my symptom a form of miscalibrated protection?” And “What is this symptom reaching for: safety and/or connection?”

These are questions that can be answered. And they can be acted on. There is often a sense of relief that comes with knowing how these emotional neural circuits work, to then find ways of working with them rather than against them.