AREAS OF FOCUS
Pain Science
Pain science studies how the body and brain produce pain. It asks why pain sometimes outlasts the injury that caused it and why pain can be real and severe even when every test comes back normal. These questions sit at the center of chronic pain, and the answers have reshaped how it is understood and treated. Pain is one of the most common reasons families seek medical care and one of the hardest experiences to measure, which is why understanding how it works matters so much.
How pain signals travel
When the body is injured, nerves carry signals to the spinal cord and brain, and the brain interprets them as pain. In most cases, this system functions like an alarm that quiets once the injury heals. Sometimes the alarm stays on. The nervous system can become oversensitive, so that ordinary input, such as a light touch or normal movement, is perceived as significant pain. This process, known as amplified pain, explains how pain can persist long after the tissue has healed.
Why pain can be real when the tests are normal
Standard tests such as X-rays, MRIs, and bloodwork assess the body’s structure: bones, joints, tissues, and inflammation. When the problem lies in how the nervous system processes pain signals, those tests are usually normal because they cannot detect it. This is why so many families are told nothing is wrong even though their child is clearly in pain. Both things are true at once. The tests are normal, and the pain is real.
What pain science means for treatment
Understanding pain as a signaling problem changes how it is treated. The instinct is to rest and protect a painful area, but with amplified pain, that often makes things worse. The most effective treatments retrain the nervous system toward more normal functioning through steady, graded physical activity, attention to sleep and stress, and sometimes support from a psychologist who understands pain. That support addresses a real condition because the nervous system and the mind are part of the same circuit.
How Dr. Shulman approaches it
Dr. Shulman is a physician-scientist and pediatric rheumatologist who cares for children and teens with complex pain. His work draws on the training of a physician-scientist, the daily clinical experience of a pediatric rheumatologist, and personal experience with a chronic health condition. How the body and brain produce pain, and why it can be so hard to measure, is a central theme of his forthcoming book, Cramp: A Doctor’s Notes on Pain. He helps families understand what is happening in their child’s nervous system because understanding the pain is often the first step toward treating it.
Frequently Asked Questions
What is pain science?
Pain science studies how pain is produced and perceived, from the nerves that carry pain signals to the brain that interprets them. It explains why pain can persist after an injury heals and why it can be severe even when tests are normal. For families, it offers a way to understand pain that is real yet hard to see.
Can pain be real if nothing shows up on tests?
Yes. Standard tests such as X-rays, MRIs, and bloodwork assess the body’s structure. When pain stems from how the nervous system processes and interprets signals, the structure is usually normal, and these tests cannot detect the problem. Normal results do not mean there is nothing wrong. They mean the cause lies in signaling rather than in structure.
Why does pain sometimes last after an injury heals?
In some people, the nervous system remains switched on after an injury and continues to send pain signals long after the tissue has healed. The signaling becomes oversensitive, so ordinary input is perceived as significant pain. This is the process behind amplified pain and complex regional pain syndrome.
Is chronic pain all in the mind?
No. Chronic pain involves a genuine change in how the nervous system processes signals, and the pain is experienced exactly as reported. Because the nervous system and the mind are part of the same circuit, sleep, stress, and support from a psychologist who understands pain can all affect it. That support is part of treating a real condition.
How does understanding pain change treatment?
It shifts the focus from searching for structural damage to retraining the nervous system. For amplified pain, this means steady, graded activity instead of rest, along with attention to sleep and stress. It also helps families avoid a cycle of increasingly extensive testing that yields no findings.
Who treats complex pain in children?
Complex pain in children is often managed by a clinician familiar with pediatric pain, who frequently works with physical therapists and psychologists. If a child’s pain has lasted longer than expected or does not match the test results, a pediatrician can help guide the family to the right specialist.
For appointments or clinical questions, please contact Rady Children’s Health Orange County (formerly CHOC).