The Framework That Finally Makes Sense Of Chronic Pain, According To A Psychiatrist
Ask someone what’s driving their chronic pain, and you’ll hear a familiar list: inflammation, hormones, posture, an old injury. But according to Daniel Amen, M.D., those explanations miss the full picture.
On the mindbodygreen podcast, Amen explained that physical and emotional pain don’t live in separate worlds. They overlap, reinforce each other, and often get stuck in the same cycle.
And he has a name for that cycle: PAIN HQ, a simple acronym that explains why chronic pain becomes so hard to escape—and, more importantly, how to break out of it.
Amen has seen this pattern again and again in his clinical work and in his own life. His clinics have collected nearly 300,000 brain scans, giving him a rare window into how pain and mood intertwine at the neural level.
What he’s found is that chronic pain is almost never just physical. It’s a whole-system response shaped by biology, psychology, social experiences, and even meaning or morality. Once you understand that, the picture becomes clearer and far more hopeful.
The PAIN HQ model: How pain becomes a self-perpetuating loop
PAIN HQ stands for:
Pain, Activated suffering, Increasing negative thoughts, Nervous tension, Harmful habits, and Quagmire (the stuck state).
Each stage feeds the next, creating what Amen calls the Doom Loop, a state where pain (both physical and emotional) keeps circling back on itself.
P: Pain for any reason
Pain doesn’t need to be dramatic to start the loop. It can be biological, like breaking an ankle. It can be psychological, like losing a job. It can be social, like a breakup. It can even be spiritual— when something violates your sense of right and wrong. All forms of pain activate the same brain pathways.
A: Activated suffering
Once pain hits, the brain’s “suffering pathway” lights up. This happens faster and more intensely in people with anxiety, depression, or high ACE scores (adverse childhood experiences). Early trauma primes the brain to feel pain more deeply and stay in it longer, a pattern Amen has documented in over 7,500 patients.
I: Increasing negative thoughts
This is where the mental spiral kicks in. Amen calls these ANT, automatic negative thoughts. They amplify the original pain and convince you it’s permanent, catastrophic, or entirely your fault. He often encourages patients to “name” their mind (almost like a character) so they stop believing every thought it offers.
N: Nervous tension
This stage is both psychological and physical. Muscle tension heightens pain signals. Stress hormones rise. Sleep suffers. The brain becomes more reactive, and the body misinterprets normal sensations as threats. For many people, this is when chronic pain shifts from acute to long-term.
H: Harmful habits
In an attempt to cope, many people reach for substances or behaviors that offer temporary relief but worsen pain long-term: opioids, alcohol, marijuana, compulsive distraction, and emotional suppression. These strategies numb the moment but dysregulate the brain’s natural calming pathways.
Q: Quagmire (the stuck state)
Eventually, the loop becomes self-sustaining. You feel pain, you tense up, you think more negatively, and you adopt habits that keep everything locked in place. This is the “I’ve tried everything, and nothing works” phase.
The good news? There’s an evidence-based way out.
How to interrupt the Doom Loop & support your brain
Amen describes the antidote as the Relief Loop, which uses practices that calm the nervous system, quiet rumination, and release trapped emotional energy, especially anger or resentment.
Here are accessible ways to start shifting out of PAIN HQ:
Acknowledge all sources of pain, not just physical ones
If stress, loss, or moral injury is contributing to your symptoms, calling it out is the first step. The brain can’t regulate what it doesn’t recognize.
Interrupt automatic negative thoughts
When negativity spikes, don’t run with it. Pause and question the thought. Is it true? Is it helpful? What else could be happening? This helps re-engage the frontal lobes, the brain’s center for reasoning and emotional regulation.
Release repressed emotions
Amen often uses Intensive Short-Term Dynamic Psychotherapy to help patients access buried anger or grief. Many chronic pain patients are “the goods”—kind, responsible people who swallow their frustration. Learning to name and release those emotions can be transformative.
Calm nervous system tension
Breathwork, gentle movement, somatic practices, stretching, and grounding techniques can all help reduce baseline muscular and emotional tension.
Replace harmful coping habits with supportive ones
Substances or emotional numbing short-circuit the brain’s natural regulatory system. Swapping these for healthier routines, like quality sleep, journaling, nature time, and structured movement, helps rebuild resilience.
The takeaway
Chronic pain isn’t a simple cause-and-effect issue. It’s a whole-system experience shaped by the brain, the body, and the stories you carry. The PAIN HQ model doesn’t dismiss pain; it explains why it becomes so overwhelming and why willpower alone rarely fixes it. But it also shows a path forward.
When you support your brain, acknowledge your emotional landscape, and build healthier coping patterns, the loop starts to loosen. Bit by bit, pain becomes something you can influence again rather than something that controls you.