The Problem of Silos in Pain Medicine

Increasingly, chronic pain is being talked about as a brain problem.

This was the focus of my research at UCSF. I watched, in real time, as pain went from being treated primarily as a musculoskeletal issue to being reclassified as something the brain produces. I studied this shift for my PhD dissertation, and later wrote about it for a broader audience. Years later, I’m still fascinated by how medical systems make sense of pain—and how those frameworks shape the care people receive.

In many ways, I think it’s a good thing that pain is now widely understood to be shaped by the brain. It’s opened up space for new approaches: mindfulness, cognitive reframing, and nervous system regulation are increasingly seen as legitimate forms of care.

But I also worry that something important is being lost.

The body hasn’t gone anywhere. Pain is still often rooted in musculoskeletal distress—injury, compression, inflammation. To say that pain is “just in the brain” is to risk missing the full picture. In almost every case, pain is both an output of the brain and a response to input from the body.

I’m not a medical doctor. I’m a sociologist of medicine. I chose to study pain in part because I had spent years working hands-on with the musculoskeletal system as a clinical bodyworker. I could feel how often pain lived at the intersection of physiology and psychology. As the brain-based discourse gained traction, I worried that the divide between brain and body might grow deeper. In some ways, it has.

Still, I don’t think the problem is that one side is right and the other is wrong. Much has been gained from treating the brain and the body as distinct systems—new insights, new tools, new kinds of care.

But too often, pain patients are left holding the contradictions. They're told their pain is physical, but also that it’s emotional. They’re told to move more, but also to rest. To see a therapist, but also a surgeon. This kind of fragmentation can feel existential. It can amplify suffering, prolong diagnosis, and make people feel like their pain is their fault.

This isn’t the failure of any single provider. It’s the result of a system that continues to silo specialties, frameworks, and information. Pain care is fragmented, and patients are left to patch together meaning—and treatment plans—on their own.

That’s the real problem.