Episode 24: High Definition Pain

Episode 24: High Definition Pain

Highly Sensitive Nervous Systems and Chronic Pain: Sensory Processing Sensitivity, Allostatic Load, and What Actually Helps

Dr. Zev Nevo explains how highly sensitive persons (HSPs)—a neurobiological trait affecting about 20–33% of people—may experience chronic pain differently due to heightened sensory processing and insula activity, leading to vivid pain descriptions often misread as catastrophizing. He describes “bidirectional sensitization,” where sensory sensitivity amplifies pain and chronic pain further sensitizes the nervous system, shaped by central sensitization, autonomic dysregulation, and allostatic load. The episode introduces the validated 27-item Highly Sensitive Person Scale (HSPS) and outlines six sensitivity patterns (introverted, extroverted, empathic, sensory, intuitive, creative). It addresses misconceptions and offers strategies: patience, titrated “microdosed” exposure, interoceptive reframing to reduce hypervigilance, addressing allostatic load, pivoting to regulation during stress, and using objective data like HRV. Guidance is included for self-advocacy, provider practice, and cultural, gender, and lifespan factors.

00:00 Vivid Pain Dismissal

01:43 HSP Pain Link

03:24 Two Patients Contrast

06:40 Bidirectional Sensitization

09:03 Allostatic Load Bucket

12:42 HSPS Assessment Tool

16:59 Interoception Trap

21:42 Six Sensitivity Faces

28:49 HSP Pain Myths

33:27 Six Core Strategies

37:19 Balanced Sensation Tracking

37:45 Reduce Allostatic Load

39:21 Pivot Toward Neutral

40:34 Objective Data Trust

42:15 Self Advocacy Scripts

47:09 Patient Recovery Story

49:57 HSP Pain Neuroscience

54:39 Provider Clinical Framework

01:00:30 Culture Gender Lifespan

01:04:35 Final Healing Roadmap

01:08:39 Closing Thanks Share

REFERENCES & RESOURCES:

Sensory Processing Sensitivity & High Sensitivity

Morese R, Palermo S, Defedele M, et al. Sensory processing sensitivity and social pain: a hypothesis and theory. Front Hum Neurosci. 2023;17:1122849. doi:10.3389/fnhum.2023.1122849 [PMC]

Lionetti F, Aron A, Aron EN, et al. Dandelions, tulips and orchids: evidence for the existence of low-sensitive, medium-sensitive and high-sensitive individuals. Transl Psychiatry. 2018;8(1):24. doi:10.1038/s41398-017-0090-6

Hochreuter J, Wehrli S, Locher C, et al. Painfully sensitive: how sensory processing sensitivity affects healthy adolescents' perception of pain. J Pain Res. 2025;18:719-733. doi:10.2147/JPR.S473575 [PubMed]

Aron EN, Aron A, Jagiellowicz J. Sensory processing sensitivity: a review in the light of the evolution of biological responsivity. Pers Soc Psychol Rev. 2012;16(3):262-282. doi:10.1177/1088868311434213 [PubMed]

Allostatic Load & Stress

Ruiz-Robledillo N, Costa-López B, Moreno O, et al. Sensory processing sensitivity as a predictor of health-related quality of

This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

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LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
• Substack

Transcript

Episode 24 | High Definition Pain

[00:00:00] Let me ask you something. Have you ever walked into a doctor's office and tried to describe your pain? Really describe it only to watch their face change? You're saying things like, it's like broken glass, grinding into my spine, or it feels electric, like my whole nervous system's on fire. And you see it that glance between the doctor and the medical assistant.

[00:00:28] The subtle shift in body language and you know exactly what they're thinking. This person is catastrophizing. But here's what I want you to consider. What if you're not catastrophizing? What if your nervous system is simply processing pain in high definition and the medical system just doesn't have the resolution to see what you're seeing?

[00:00:53] Think about it. Why do we assume that someone who describes pain vividly is exaggerating, [00:01:00] but someone who says it's a five out of ten is being accurate? Isn't a number scale just as subjective, maybe even less informative than a metaphor? Here's what nobody tells you. Between 20 and 33% of the population has a neurobiological trait that fundamentally changes how they experience pain.

[00:01:20] And if you're one of them, every doctor's appointment, every treatment protocol, every piece of advice you've received might have been designed for a nervous system that works completely differently than yours. So if you've ever been told you're too sensitive or that you're too focused on your symptoms, stick with me because what you're about to learn might just change everything.

[00:01:43] Hey everyone, and welcome back to Mind Your Body. I'm Dr. Zev Nevo. your source for pain and trauma-informed psychoeducation and the exploration of Mind Body Rehabilitation. Today we're diving into something that I think is going to fundamentally shift how you understand chronic pain, [00:02:00] especially if you've ever felt like your body came with a different instruction manual than everyone else's.

[00:02:06] We're talking about highly sensitive persons, or HSPs, and the hidden link between sensory processing sensitivity and chronic pain. And here's the thing, this isn't about being dramatic. It's not about having a low pain tolerance or being psychologically fragile. This is about a neurobiological trait that affects up to one in three people, and when it intersects with chronic pain, it creates what I call bidirectional sensitization. Think of it like this. If your nervous system is a home security system, most people have one that only goes off when someone actually breaks in.

[00:02:43] But if you're highly sensitive, your system is so finely tuned that it goes off when a squirrel runs across the lawn, not because it's broken, but because it's designed to detect more. So if you've ever felt like your nervous system is stuck in overdrive, if [00:03:00] small stressors feel catastrophic, or if your body awareness has transformed from a gift into a trap, this episode is for you.

[00:03:09] And if you're a provider working with patients who seem to experience pain differently, who describe their symptoms with emotional richness that doesn't match their imaging, this episode is going to change how you practice. Let's get into it. What makes highly sensitive people experience pain differently?

[00:03:27] I see it in my office every week. She walks in describing her back pain with a level of detail that immediately signals something different. It's like broken glass, grinding into my spine. She says her voice rises slightly. And when I move, it's not just pain, it's this electric shooting sensation that makes my whole body tense up.

[00:03:48] She pauses, noticing the fluorescent lights overhead. Even those lights make it worse somehow. Now, most providers would hear this and think, catastrophizing, amplifying, [00:04:00] psychological overlay. But I see something else entirely. I see a nervous system that processes stimuli more deeply than average. A brain that doesn't just register pain, it experiences it in high definition.

[00:04:13] Let me contrast this with another patient I saw the same week. Same diagnosis, lumbar disc herniation at L4-L5, similar findings on MRI. But when I asked him to describe his pain, he said, it's just a dull ache in my lower back. It gets worse when I sit too long. That's about it. It's the same structural problem, but a completely different experience.

[00:04:36] So what's the difference? The first patient is a highly sensitive person. The second is not. You might be wondering, Wait. Is this just a pain tolerance thing? Are highly sensitive people just weaker? No, and that's the misconception that causes so much harm. Here's what's actually happening. Highly sensitive persons have fundamental neural differences in how they process [00:05:00] environmental stimuli.

[00:05:01] Research shows that the insula, your brain's interceptive command center, the region responsible for awareness of emotional and inner states, shows heightened activity in highly sensitive people. This means HSPs process each stimulus more deeply, making comparisons with past situations. This processing is slower, more painstaking, and can be either conscious or unconscious.

[00:05:26] And here's where the numbers get really interesting. In healthy populations, about 20 to 35% fall into the high sensitivity group, but in adolescents reporting chronic pain, that proportion jumps to 45.7%, and those in the high sensitivity group reported significantly higher pain related distress. The sensitivity isn't causing the pain, but it fundamentally changes how the nervous system interprets, amplifies, and responds to it.

[00:05:57] When a highly sensitive person walks into my [00:06:00] office with chronic pain, there are typically more descriptive components to their pain, more clarity and focus on the feeling of pain, not just its existence. More references to emotions and adjectives. Language that is more dramatic with changes in vocal tone and pitch or cadence, more expressive emotionally.

[00:06:19] And here's what most providers miss, and this is crucial. These are clues that their nervous system is in an activated fight or flight state. Or if there's very low affect, and more monotone presentation, lack of eye contact. That's indicative of a nervous system state representing depletion and hopelessness.

[00:06:40] So when a highly sensitive person walks into my office with chronic pain, I'm not just treating pain, I'm addressing bidirectional sensitization, where heightened sensory processing amplifies pain signals and chronic pain further sensitizes an already sensitive nervous system.

[00:06:58] This is a double [00:07:00] down nervous system response. The HSP was already processing stimuli more deeply. Now add central sensitization, the nervous system's amplification of pain signals after repeated exposure to pain.

[00:07:14] The threshold for future neuronal activation drops. Suddenly, ostensibly innocuous stressors become sufficient to trigger a pain flare, such as a conversation with your boss, a sleepless night, an argument with your partner, things that wouldn't trigger pain in someone else become landmines for the highly sensitive person with chronic pain. How would your pain describe itself if it didn't have to use numbers?

[00:07:40] Your nervous system isn't broken. It's just processing differently. Let me be absolutely clear about something because this is where the medical system has failed you. Sensory processing sensitivity is not a disorder. It's a trait. If you're a highly sensitive person with chronic pain, you've probably been told directly or indirectly that [00:08:00] you're the problem, that you're too focused on your symptoms, that you need to toughen up, stop paying so much attention to your body or just relax. I've had patients come to me in tears because a previous provider told them, you're making this worse by being so aware of every little sensation, you need to stop thinking about it so much. And here's what I wanna say to that. Telling a highly sensitive person to stop noticing their body is like telling someone with perfect pitch to stop hearing music.

[00:08:29] It's not a switch you can flip. It's how your nervous system is wired. If someone with exceptional vision could see details that others missed, would we tell them to squint more, to see less clearly? Of course not. We'd recognize that as a perceptual gift, even if sometimes it meant seeing things that were uncomfortable.

[00:08:49] So why do we pathologize heightened interception? Your nervous system is wired to process stimuli more deeply. And when chronic pain enters the picture, it [00:09:00] doesn't just add another layer, it creates a trap.

[00:09:03] This is where the concept of allostatic load becomes essential. This is the key to understanding why you feel the way you do. Allostatic load is the physiological wear and tear from repeated adaptations to chronic stressors. It begins with prolonged activation of the hypothalamic pituitary adrenal axis, or HPA axis, and sympathetic nervous system leading to elevated stress hormones.

[00:09:30] This excessive activation accompanied by sustained pro-inflammatory states is directly related to central sensitization and alterations in pain signaling pathways. Let me give you a metaphor. Think of allostatic load like a bucket. Each stress, physical, emotional, psychological, environmental adds water to that bucket.

[00:09:52] For most people, the bucket is fairly large and it has a decent drainage system. Stressors come in, but they [00:10:00] also drain out with rest, recovery and regulation. For highly sensitive people, the bucket is smaller to begin with because their nervous systems already work harder to process everyday stimuli and the drainage system, it's slower.

[00:10:14] It takes longer to recover from stressors because the processing is deeper and more intensive. Now, add chronic pain to that equation. Chronic pain doesn't just fill the bucket. It also clogs the drain. A 2024 study identified three phenotypes of allostatic load, and participants experiencing metabolic dysregulation had twice the risk of developing high interference chronic pain, and experiencing pain at three or more body sites.

[00:10:43] For highly sensitive people, this cumulative burden accumulates differently. So when you add chronic stress, unresolved trauma, or ongoing adversity, the window of tolerance narrows dramatically. What looks like overreacting to others is actually a nervous system [00:11:00] operating at capacity. The HSPs baseline processing is already more intensive.

[00:11:06] Adding chronic pain creates blunted sympathetic reactivity, a sign of autonomic exhaustion, and you have a system that's both hypersensitive and depleted. Research shows that prolonged stress states like chronic pain reduce the dynamic flexibility of the autonomic nervous system, which results in poor adaptation to altered internal or external demands.

[00:11:30] In contrast to acute pain, which increases sympathetic reactivity, chronic musculoskeletal pain conditions are associated with autonomic dysfunction. Your nervous system isn't broken, it's stuck. And here's the validation you need to hear, and I mean, really hear. It doesn't matter how long you've had pain.

[00:11:50] For some people, even a short period of pain can set off their nervous system, depending on their reaction and response to actually having a sensation interpreted as pain and their [00:12:00] window of tolerance for pain, adversity, uncertainty, stress, and trauma. This has everything to do with your allostatic load and your coping mechanisms, your anchors of safety, your emotional regulation skills.

[00:12:13] So if you've been living with pain for three months and you feel like you're falling apart while someone else has had pain for three years and seems to be managing, that doesn't mean you're weak. It means your nervous system is processing differently. If you've struggled to find the words to describe your pain, it's not because you're failing at communication, it's because you're trying to translate a quantum experience into a material world. That's a heavy lift, and you've been doing it without a translator, but I know what you might be thinking right now.

[00:12:42] Okay, this all sounds familiar, but how do I actually know if I'm highly sensitive? Is there a way to measure this or am I just guessing based on how I feel? Well, let me show you. There's a validated assessment tool. In 1997, Dr. Elaine Aaron and her colleague Arthur Aaron, developed a highly [00:13:00] sensitive person scale or HSPS for short.

[00:13:03] It's a 27-item questionnaire that measures sensory processing sensitivity across five distinct domains. What makes it valuable is that it's not some pop psychology quiz you find on the internet. The HSPS has strong psychometric properties, which in research terms means it's highly reliable.

[00:13:23] When you take this assessment, you're getting real data about how your nervous system processes information. What are the five dimensions that measures? First is sensory processing sensitivity. This is your response for physical stimuli: lights, sounds, textures, smells with questions like: are you bothered by intense stimuli, like loud noises or chaotic scenes? Or, do you startle easily?

[00:13:48] The second dimension is emotional sensitivity. This measures the depth of your emotional response. Questions like: do you find yourself deeply moved by the arts or music? Or [00:14:00] does your mood seem to be easily influenced by the mood of others? Third is social sensitivity. This is about your awareness of others' moods and social dynamics with questions like: are you aware of subtleties in your environment? Or, do you seem to be aware of things that others miss?

[00:14:18] Fourth is thinking sensitivity. This measures the depth of information processing. Questions like: do you have a rich complex inner life? Or, when you were a child, did parents or teachers see you as sensitive or shy? And fifth is imagination sensitivity. This is about creativity and inner life. Questions like: do you have a vivid imagination?

[00:14:42] Let me give you a few additional sample questions so you can start to get a sense of where you might fall. Do you get rattled when you have a lot to do in a short amount of time? Do changes in your life shake you up? Are you made uncomfortable by loud noises? Do you make it a high priority to arrange your life to avoid upsetting or [00:15:00] overwhelming situations?

[00:15:02] When you compete or are observed while performing a task, do you become so nervous or shaky that you do much worse than you would otherwise? Does being very hungry create a strong reaction in you disrupting your concentration or mood? That last one's fascinating. Most people don't think of hunger as a sensitivity marker.

[00:15:21] But for highly sensitive people, being hungry doesn't just mean I should eat soon. It means my entire nervous system is dysregulated. I can't think clearly, and I might need to leave this meeting right now. If you're nodding along to most of these questions, there's a good chance you're highly sensitive.

[00:15:37] Now, here's what I want you to understand, though. This assessment isn't about labeling yourself or putting yourself in a box. It's about gaining clarity. It's about having language for something you've experienced your whole life but maybe didn't have words for. And for providers listening, this is a tool you can use in clinical practice.

[00:15:55] When a patient presents with chronic pain and you're seeing those patterns we talked about [00:16:00] earlier, the descriptive language, the emotional expressiveness, the sensitivity to environmental stimuli, you can administer the HSPS as part of your assessment because here's what changes when you have that data.

[00:16:12] Instead of guessing whether someone's nervous system processes differently, you know. Instead of wondering whether you need to adjust your treatment approach, you have evidence that you do. And for patients having that score, being able to say, I scored 18 on this Highly Sensitive Person Scale, that's not just information, that's validation. 

[00:16:32] That's proof that what you've been experiencing isn't in your head, it's in your neurobiology. 

[00:16:37] Here's what I want you to know. Whatever your score is, it doesn't define you, it describes you. It gives you information about how your nervous system works, so you can make choices that support it rather than fight against it. And if you do score high on sensitivity, you're not alone. You're not broken.

[00:16:55] And you're about to understand yourself in a way that changes everything. Here's a [00:17:00] clinical paradox I see constantly, and it's one of those things that sounds backwards until you really understand it. Highly sensitive people often have exceptional interoceptive awareness, which is the ability to perceive internal bodily sensations.

[00:17:16] This should be an advantage in pain management, but it often becomes a trap. Wait, how does a gift become a trap? Let me explain. Research on chronic pain patients reveals a paradoxical pattern. Compared with match controls, chronic pain participants exhibited significantly lower interoceptive accuracy and interoceptive confidence.

[00:17:38] However, within chronic pain patients, higher interoceptive accuracy correlated with enhanced perception of pain via somatosensory amplification. Let me translate that into human: Chronic pain may cause patients to suppress interoceptive accuracy to avoid pain, yet the ability to perceive bodily sensations [00:18:00] inevitably enhances pain perception.

[00:18:03] For HSPs, this paradox is amplified. Their heightened interoception means they notice every sensation, the tightness in their chest, the tension in their jaw, the subtle ache in their lower back, but without the ability to accurately appraise these sensations, interoception becomes hypervigilance. Patients with increased anxiety sensitivity report hypervigilance for somatic sensations. 

[00:18:29] A consequence of this hypervigilance is an increased self-report of somatic sensations and a dysfunctional cognitive appraisal of these sensations with a bias toward a danger-related and catastrophizing interpretation style.

[00:18:43] Let me give you a concrete example. I had a patient, let's call her Julie, who would wake up every morning and immediately scan her body.

[00:18:50] Before she even opened her eyes, she was checking: Does my back hurt? What about my neck, my shoulders, my hips? The moment she detected any sensation, even mild [00:19:00] tightness that most people wouldn't notice, her mind would immediately jump to. It's starting again. Today is going to be a bad pain day. I won't be able to do anything. That thought would trigger an emotional response.

[00:19:11] Anxiety, frustration, despair. That emotional response would activate her sympathetic nervous system, and that activation would amplify the pain signal. By the time she got out of bed, she was already in a pain flare, not because the structural problem in her back had worsened overnight, but because her interoception had become hypervigilance, and hypervigilance had become a self-fulfilling prophecy.

[00:19:35] So here's the reframe, and this is crucial. Interoception is only useful when you can appraise sensations accurately without immediately jumping to threat. The key is teaching the distinction between noticing a sensation and catastrophizing it. Interoception can work both ways. It's a good thing to be able to tap into your body sensations, however the key is appraising those sensations, [00:20:00] initially with curiosity, and then attributing an accurate threat level to a negative sensation without an emotional reaction or response, so as to mitigate catastrophizing, and minimize the influence of our negativity bias for survival and learned associations. Here's what I taught Julie. When you wake up and scan your body, 

[00:20:23] I want you to notice everything, not just the pain. Notice the parts that don't hurt. Notice the neutral sensations. Notice the temperature of your sheets, the weight of the blanket, the feeling of your head on the pillow. This means making sure to log instances, moments, periods of time when you're interocepting and not feeling pain, acknowledging your body's capacity to also feel less or no pain in certain areas.

[00:20:47] This balances out the negativity bias toward automatically attributing a highly negative or dangerous categorization to sensations that feel painful. And when you do notice pain or discomfort, [00:21:00] practice curious appraisal. Instead of, it's starting again. Try, Hmm. I'm noticing tightness in my lower back. I wonder what that's about.

[00:21:08] Is it because I slept in an awkward position? Is it because I'm stressed about today? Or is it just morning stiffness that will ease up once I move? That shift from autonomic threat detection to curious appraisal is the difference between interoception and hypervigilance. What would change if you treated your body sensations like weather reports instead of emergency alerts, partly cloudy with a chance of lower back tightness instead of Code Red! Pain Incoming!

[00:21:38] How would your morning feel different? Here's something that might surprise you. Not all highly sensitive people experience interoception the same way. In fact, high sensitivity shows up in six distinct patterns, and understanding which pattern you identify with can completely change how you work with your nervous system.

[00:21:57] There's six faces of high sensitivity. [00:22:00] Now, here's something that most people don't understand about high sensitivity, and honestly, this misconception causes a lot of confusion and self-doubt. When people hear highly sensitive person, they often picture someone who's introverted, quiet, easily overwhelmed, maybe a bit socially anxious, someone who needs a lot of alone time and avoids crowds.

[00:22:20] And yes, that does describe some highly sensitive people, but it doesn't describe all of them because high sensitivity isn't one thing. It's a spectrum with six distinct patterns. And understanding which pattern or patterns, because you can be more than one you identify with, can completely change how you work with your sensitivity.

[00:22:40] Let me walk you through the six faces of high sensitivity. Face number one is the introverted HSP. This is the stereotype. The person who needs solitude to recharge, who finds social interaction draining even when it's enjoyable. Who processes experiences internally before sharing them.

[00:22:59] If [00:23:00] you're an introverted HSP with chronic pain, you might find that social obligations during a pain flare feel impossible, not just difficult. Because your nervous system's already working overtime to process the pain

[00:23:13] and adding social stimulation on top of that exceeds your capacity. Face n umber two is the extroverted HSP. Wait! Extroverted and highly sensitive? Yes, absolutely. Extroverted HSPs enjoy social interaction and may even seek it out for energy, but, and this is the key difference: They remain vulnerable to overstimulation.

[00:23:40] They might love being at a party, but after two hours, their nervous system hits a wall and they need to leave immediately. If you're an extroverted HSP with chronic pain, you might confuse people. They see you being social and active and think, 

[00:23:53] you can't be in that much pain if you're out having fun. But what they don't see is the crash that comes afterward. The [00:24:00] three days you need to recover because you pushed past your window of tolerance. Face number three is the Empathic HSP. These are the people who absorb others' emotions like a sponge.

[00:24:12] They walk into a room and immediately sense the tension, the sadness, the unspoken conflict. They're the ones everyone comes to for support because they just get it. If you're an Empathic HSP with chronic pain, you might find that other people's stress triggers your pain flares. Your partner has a bad day at work, and suddenly your back is in spasm, not because you're weak.

[00:24:35] Because your nervous system is processing their emotional state as if it's your own, and that processing adds to your allostatic load. Face number four is the Sensory HSP. This is the person who's particularly affected by lights, sounds, textures, smells. The fluorescent lights in the grocery store give them a headache.

[00:24:55] The tag in their shirt feels like sandpaper. The smell of someone's perfume [00:25:00] three rows away on the airplane is overwhelming. If you're a Sensory HSP with chronic pain, environmental factors become massive triggers. The beeping of medical equipment during a doctor's appointment can amplify your pain. The texture of certain fabrics against your skin can make everything worse.

[00:25:18] You're not being difficult. Your nervous system is processing more sensory data than others, and when you're already in pain, that processing becomes unbearable. Face number five is the Intuitive HSP. These are the people guided by strong gut feelings. They know things without knowing how they know them.

[00:25:37] They pick up on patterns and connections that others miss. They trust their instincts because their instincts are usually right. If you're an Intuitive HSP with chronic pain, you might have known something was wrong long before any tests confirmed it.

[00:25:52] You might sense when a treatment isn't right for you before you can articulate why. And you might frustrate providers who want [00:26:00] concrete, logical explanations, and what you have is a deep knowing that something's off. Face number six is the Creative HSP. These are the people who process experiences through artistic expression.

[00:26:11] They see the world in metaphors and colors and stories. They need creative outlets, not as hobbies, but as essential nervous system regulation tools. If you're a Creative HSP with chronic pain, you might find that your pain has a shape, a color, a narrative. You might describe it in ways that sound poetic to others, but are actually the most accurate representation of your experience.

[00:26:36] And you might find that creative expression, writing, painting, music helps regulate your nervous system in ways that traditional pain management techniques don't. Now, here's what's important. You're probably not just one of these most highly sensitive people are a combination of two or three patterns.

[00:26:54] I'm an Introverted, Intuitive, Empathic HSP. I need solitude to recharge. I trust my [00:27:00] gut instincts in clinical decision making, and I absorb my patient's emotional state sometimes, which is both a gift and something I have to actively manage. You might be a Sensory, Creative, Extroverted HSP.

[00:27:12] You love being around people. You're highly attuned to environmental stimuli and you process your experiences through art. The combinations are endless, and understanding your specific pattern helps you make sense of why certain situations overwhelm you while others don't. There's no right way to be highly sensitive.

[00:27:33] There's only your way, and when it comes to chronic pain, understanding your specific sensitivity pattern helps you identify your triggers more precisely. If you're a Sensory HSP, you need to pay attention to environmental factors, lighting, noise, temperature, textures. If you're an Empathic HSP, you need to pay attention to relational factors, who you're spending time with, what emotional states you are [00:28:00] absorbing, where you need boundaries. If you're an Intuitive HSP, you need to trust your gut about treatments, providers, and pacing even when others are telling you to push harder.

[00:28:12] If you're a Creative HSP, you need to prioritize creative expression as part of your pain management, not as something you'll get to when you feel better. So here's my question for you. Which face or faces of high sensitivity do you recognize in yourself? And more importantly, how would your approach to pain management change if you honor that specific pattern instead of trying to fit into someone else's version of what sensitivity looks like.

[00:28:40] Because the goal isn't to be less sensitive, it's to be sensitive in a way that works with your nervous system, not against it. Now, even with all this understanding, even knowing you're highly sensitive, even identifying your specific pattern, you're still going to encounter misconceptions [00:29:00] from providers, from family, from yourself.

[00:29:04] So let's address them head on. What people get wrong about HSPs and pain. Before we get into solutions, I need to address some common misconceptions about highly sensitive people in chronic pain because these misconceptions aren't just wrong. They're actively harmful. Misconception number one, highly sensitive people are just anxious.

[00:29:25] No, and this is like saying people who wear glasses just have blurry vision. You're describing a symptom, but not understanding the underlying mechanism. Sensory processing sensitivity is a distinct neurobiological trait. While HSPs may be more prone to anxiety, especially when their nervous systems are overwhelmed, sensitivity and anxiety are not the same thing.

[00:29:51] You can be highly sensitive and not anxious. You can be anxious and not highly sensitive, and when you conflate the two, you [00:30:00] miss the underlying nervous system processing differences that require specific interventions. Misconception number two. If you just stopped focusing on your pain so much, it would get better.

[00:30:12] Oh, this one. This is the most damaging misconception I encounter, and I've seen it destroy people's trust in healthcare. Here's the truth. Suppressing interoception doesn't make pain go away. It just disconnects you from your body, which actually makes regulation harder. Telling someone to stop focusing on their pain is like telling someone who's drowning to stop focusing on the water.

[00:30:36] The problem isn't the focus, it's the drowning. The goal isn't to stop noticing sensations. It's to change how you appraise them. 

[00:30:45] Misconception number three, highly sensitive people have low pain tolerance because they're weak or haven't experienced enough hardship. This one makes my blood boil. I've worked with highly sensitive people who've survived unimaginable [00:31:00] trauma, who've endured chronic illness for decades, who've pushed through pain that would've broken most people. Lower pain tolerance and HSPs isn't about weakness, it's about nervous system processing.

[00:31:12] Their systems are detecting and amplifying signals that other nervous systems would filter out.It's like saying someone with exceptional hearing is weak because they can't tolerate loud noises that don't bother others. No, they're just processing more auditory information. That's not weakness, that's sensitivity.

[00:31:32] And here's the irony. The same trait that makes HSPs more vulnerable to pain also makes them more capable of profound healing when their nervous systems feel safe. Misconception number four, standard pain treatments should work the same for everyone.

[00:31:50] This is the clinical blind spot that causes so much harm. When providers apply one-size-fits-all protocols to highly sensitive people, those treatments [00:32:00] often backfire. Aggressive physical therapy that works for non HSPs can overwhelm an HSP's nervous system and cause a massive flare. Relaxation techniques that help most people can actually increase anxiety in HSPs who are in a shutdown state.

[00:32:16] Medications that provide relief for others might cause intolerable side effects in HSPs because of their heightened sensitivity to stimuli, including pharmaceutical stimuli. Misconception number five, you just need to toughen up and push through it. Pushing through pain when your nervous system is already maxed out, doesn't build resilience.

[00:32:39] It increases allostatic load and deepens sensitization. For highly sensitive people with chronic pain, the path forward isn't about pushing harder, it's about working smarter with your nervous system, not against it. Think about it this way, if your car is overheating, do you solve a problem by pressing harder on the gas [00:33:00] pedal?

[00:33:00] Of course not. You pull over, let it cool down and figure out what's causing the overheating. Your nervous system works the same way. So here's what I want you to ask yourself. Which of these misconceptions have you internalized? Which ones have you been told so many times that you started believing them about yourself?

[00:33:21] Because unlearning these misconceptions is the first step toward actual healing. So let's talk about what actually works for highly sensitive people with chronic pain, because I don't want to just tell you what's wrong. I want to give you a roadmap forward. When I work with highly sensitive people in chronic pain, the approach is fundamentally different.

[00:33:42] Standard pain management protocols often backfire because they don't account for the unique nervous system processing of HSPs. Let me walk you through the six core strategies that change everything. Strategy number one, patience is non-negotiable, and I mean patience from both you and your provider. [00:34:00] HSPs may have an initial decreased tolerance to nervous system regulation techniques. Forcing relaxation can feel threatening to a system that's been in survival mode.

[00:34:10] They need more time and patience to have the visceral buy-in and surrender to movement that has typically triggered pain in the past. Patients with HSP can often be intolerant of treatments like somatic tracking, have difficulty letting go of feelings or sensations, or be more triggered with certain therapies. 

[00:34:28] So patience on the part of both the provider and the patient is crucial, but here's what patience actually looks like because I think we made it too abstract. Patience means giving yourself permission to progress at your own pace, not the pace your physical therapist expects, or the pace your friend with back pain experienced.

[00:34:49] Patience means recognizing that slow progress is still progress. That titration isn't failure, it's precision. Strategy number two, [00:35:00] titration is everything, what I call microdosing. Starting with imagined triggers of pain, followed by actual triggers, both physical and non-physical through interventions like Pain Reprocessing Therapy.

[00:35:11] This is graded exposure, but at a pace that respects the HSP's narrower window of tolerance. Let me walk you through what this looks like in practice. I had a patient, let's call him Marcus, who had developed severe fear avoidance about bending forward. Every time he bent to tie his shoes, he'd get shooting pain down his leg.

[00:35:31] So he stopped bending. He started wearing slip-on shoes. His world was shrinking around this one movement. Here's how we approached it. Week one, we didn't touch the actual movement. Marcus would close his eyes and imagine bending forward. We noticed what sensations came up and practiced curious appraisal.

[00:35:50] Week two, he'd sit in a chair and lean forward just a few inches. Week three, we increased the range gradually. Week four, Marcus bent forward and touched [00:36:00] his toes. No shooting pain, no catastrophic flare. His nervous system had learned through tiny titrated exposures that this movement wasn't dangerous.

[00:36:10] That's microdosing. That's what graded exposure looks like when you're working with a highly sensitive nervous system. For people in a depleted shutdown state, the approach is slightly different. It's important to be able to climb back towards safety through somatic nervous system regulating exercises, reintroducing some level of activation that doesn't feel overwhelming, like sustainable turbulence until you can climb towards a safe nervous system state without crashing back towards despair and despondency.

[00:36:42] Strategy number three, reframe interoception. The goal isn't to eliminate body awareness at all. It's to teach accurate appraisal. I have patients log instances when they're interocepting and not feeling pain. This balances out the negative bias toward automatically attributing [00:37:00] danger to every sensation.

[00:37:01] I give them a simple exercise, set a timer for three random times during the day. When the timer goes off, pause and do a body scan. But here's the key. You're not just scanning for pain, you're scanning for everything. Notice what doesn't hurt. Notice neutral sensations. Notice pleasant sensations. The warmth of the sun on your skin, the comfort of your chair, the ease in your shoulders.

[00:37:26] This retrains the nervous system to collect balanced data instead of only logging threats. If your body kept a journal, what would today's entry say? Would it only mention the pain? Or would it also mention the moments of ease, the neutral sensations, the times when you moved without thinking about it.

[00:37:45] Strategy number four, address allostatic load. Understanding what factors contribute to increased sensitization of pain, even when they don't make sense from a clinical or structural standpoint, is essential. Life stressors, relationship [00:38:00] conflicts, work demand, sleep disruption.

[00:38:02] All of these narrow the window of tolerance and amplify pain. I inquire about their history with pain, this specific complaint and pain in general. I get an idea of how they've managed in the past and how their pain experience is currently influencing their lives in a negative inhibitory way.

[00:38:21] What did they think or do when they felt pain in the past? What do they think or do when they feel pain in the present? What do they think about their future? Can they imagine a life without pain or do they feel this is a life sentence and their new normal?

[00:38:36] When someone tells me, this is my life sentence, or this is my new normal, that's telling me something about their window of tolerance being completely consumed. So we work on expanding that window. Not by adding more pain management techniques, but by addressing the other sources of nervous system activation: better sleep hygiene, boundary setting at work, repairing a [00:39:00] strained relationship, processing unresolved trauma.

[00:39:03] Because here's the thing, you can't out exercise a nervous system that's drowning in allostatic load. You can't stretch your way out of chronic stress. You can't foam roll away unresolved trauma. The pain is the messenger. The allostatic load is the message.

[00:39:21] Strategy number five, pivot without direct pain focus. When HSPs are experiencing other life stressors, they may experience pain more strongly. During these periods, the goal isn't to fight the pain harder. It's to incorporate self-compassion techniques and move toward neutral sensations adjacent to the pain rather than directly confronting it.

[00:39:42] Here's what that sounds like in practice. Instead of, I need to do my exercises even though I'm exhausted and stressed, because if I don't, my pain will get worse. Try this. I'm noticing I'm exhausted in stress. My nervous system is already working hard. Today, instead of pushing through my full [00:40:00] exercise routine, I'm going to do some gentle movement that feels neutral, maybe a short walk, maybe some stretching that doesn't trigger pain.

[00:40:09] I'm going to prioritize regulation over rehabilitation today. That pivot from fighting pain to supporting your nervous system makes all the difference. And here's the beautiful irony. When you stop fighting the pain directly and start supporting your nervous system, the pain often improves anyway, not because you're ignoring it, but because you're addressing the underlying dysregulation. Strategy number six, use objective data to build trust.

[00:40:39] One of the challenges for highly sensitive people is that they often don't trust their own perception. They've been told so many times that they're too sensitive or overreacting, that they second guess everything they feel. This is where tools like heart rate variability monitoring and psychophysiological coherence with HeartMath can be game changing.

[00:40:58] These give you bio data that [00:41:00] demonstrate the dominance of a type of nervous system state in your body. When a patient can see objective evidence that their nervous system is in sympathetic activation or dorsal shutdown, it validates their subjective experience. It's not all in your head. It's measurable.

[00:41:16] It's real, and it's something we can work with. Also, looking at other body systems like gastrointestinal function, physical and cognitive fatigue. These give insight into the current nervous system state they're in. Their state of mind, attitude and perspective then guides their reactions to everyday occurrences through a lens of safety or danger.

[00:41:38] They need to be able to categorize and label their nervous system state in the moment by learning what they each feel like in their bodies and what their minds wander to when in sympathetic or dorsal shutdown survival states. Think of it like learning a new language. At first, you need a translator. The HRV data is your translator, [00:42:00] but eventually you start to recognize the patterns yourself. You start to know, oh, this is what sympathetic activation feels like in my body. This is what dorsal shutdown feels like, and once you can name it, you can work with it. Advocating for yourself as a highly sensitive person.

[00:42:18] If you're a highly sensitive person with chronic pain, there's a good chance you've had frustrating experiences with healthcare providers who didn't understand your nervous system processing. So let me give you some language and strategies for advocating for yourself, because here's the thing, you shouldn't have to educate your doctor, but sometimes you do.

[00:42:35] And having the right words can make all the difference. First, name it. You can say, I'm a highly sensitive person. That's a neurobiological trait that affects how my nervous system processes stimuli, including pain. Research shows that 20 to 33% of the population has this trait, and it means I process sensations more deeply than average.

[00:42:55] Just naming it can shift the conversation. It reframes your experience from this [00:43:00] patient is difficult to, this patient has a nervous system that requires a different approach. And honestly, if your provider responds with skepticism or dismissiveness to that statement, you've just learned something valuable about whether they're the right fit for you.

[00:43:14] Second, describe your patterns. Instead of just saying, I'm in pain, give your provider the context. I notice my pain gets significantly worse when I'm stressed, even if I haven't done anything physically demanding: a difficult conversation at work can trigger a flare that lasts for days. I also notice that I'm very sensitive to medications.

[00:43:35] I tend to experience side effects at lower doses than most people. This helps your provider understand that your pain isn't just structural, it's neurobiological. And here's a pro tip. Keep a pain journal that tracks not just pain levels, but also life stressors, sleep quality, emotional states, and other contextual factors.

[00:43:54] Bring that data to your appointments. Providers respond to patterns. Third, ask for [00:44:00] titration. You can say, I've noticed that aggressive treatment approaches tend to backfire for me, my nervous system gets overwhelmed easily. Can we start with smaller doses, gentler interventions, and progress more slowly?

[00:44:13] Most providers will respect this request, especially if you frame it as knowledge rather than resistance. You're not being difficult, you're being precise about what your nervous system needs. Fourth, request validation. This might sound simple, but it's powerful. You can say, I need you to understand that I'm not exaggerating or catastrophizing.

[00:44:35] My nervous system genuinely processes pain differently. I need validation that what I'm experiencing is real, even if it doesn't match what you'd expect based on my imaging or exam findings. A provider who can offer that validation becomes a partner in your healing rather than another source of invalidation.

[00:44:53] And if they can offer that, if they respond with, well, your MRI looks fine, so...that's your cue to find [00:45:00] someone else. Fifth, bring research. If you're working with a provider who's skeptical, bring them evidence. Print out studies on sensory processing sensitivity. Share research on the relationship between high sensitivity and pain tolerance.

[00:45:14] Give them this episode to listen to. Education can transform a dismissive provider into an ally. But here's the thing, and I want to be really honest with you about this. It's not your job to educate your provider. You're already caring enough. You're already managing chronic pain, navigating a sensitized nervous system, and trying to function in a world that wasn't designed with you in mind.

[00:45:37] So if you have the energy and capacity to educate your provider, great, but if you don't, that's okay too. It's okay to just find someone who already gets it. And finally, know when to walk away. If you're working with a provider who consistently invalidates your experience, who tells you you're too focused on your symptoms, who refuses to adjust their approach to accommodate your nervous system, it's okay to find someone [00:46:00] else.

[00:46:00] You deserve a provider who sees your sensitivity, not as a problem to fix, but as a reality to work with. And here's what I tell my patients. The right provider will make you feel seen, not scrutinized. They'll make you feel curious about your nervous system, not ashamed of it. They'll make you feel like a partner in your healing, not a problem to be solved. If you're not feeling that, keep looking. They're out there. I don't promise my highly sensitive patients that their pain will disappear. That would be dishonest. We can diminish the suffering and emotional response to pain, which amplifies the pain experience. This helps minimize both central and peripheral sensitization and increases crosstalk between prefrontal cortex areas and the somatosensory cortex, communication that's inhibited during predominant limbic system responses. For highly sensitive people, this reframe is so essential. The goal isn't to eliminate sensitivity. It's to work with it to expand the [00:47:00] window of tolerance, to transform hypervigilance, and to helpful self-awareness to reduce the allostatic load that keeps the nervous system in a state of chronic threat.

[00:47:09] Let me tell you about a patient I worked with because I think her story will resonate with you. She was 34 years old, hypermobile, a burnt out healthcare worker with three years of debilitating pelvic pain. She'd seen seven providers before me. Every single one told her. She was too focused on her symptoms.

[00:47:29] One actually suggested she was making it worse by paying too much attention to her body. Can you imagine? A healthcare worker, someone trained to notice symptoms, to assess, to be vigilant, being told her professional skillset was the problem? She came to me depleted, shut down, barely making eye contact.

[00:47:46] Her window of tolerance had narrowed to almost nothing. In our first session, I asked her, when you have pain, what do you do? She said, I try to ignore it. I try to push through. I tell myself I'm being weak, that I need to toughen up. And when that [00:48:00] doesn't work, I just shut down. I go numb. I asked, has that strategy worked?

[00:48:06] She laughed. A bitter, exhausted laugh. No, it's made everything worse. So we started over from the ground up. We worked on nervous system regulation, breath work, gentle movement, tracking her nervous system states. We introduced interoceptive framing, logging moments without pain, noticing neutral sensations, practicing curious appraisal.

[00:48:28] We started microdosing exposure to movements she'd been avoiding. There were setbacks, but instead of interpreting those as failure, we pivoted. We focused on self-compassion. We moved adjacent to the pain instead of fighting it directly. And here's what she learned. Setbacks weren't evidence that she was broken.

[00:48:47] They were information about her nervous system's current capacity. By month six, she told me something I'll never forget. I still feel everything. My nervous system is still sensitive. I don't think that's ever going [00:49:00] away, but now, I can feel the good things too. I can feel my daughter's hand in mind without immediately scanning for pain.

[00:49:07] I can feel tired without it meaning I'm failing. The sensitivity didn't disappear. I just learned it doesn't have to mean danger. That's what recovery looks like for highly sensitive people with chronic pain, not the absence of sensitivity, but the restoration of safety. And here's what I want you to understand.

[00:49:26] Her sensitivity, the same trait that made her vulnerable to pain amplification was also what made her healing so profound. Because highly sensitive nervous systems don't just process pain more deeply. They also process safety more deeply, connection more deeply, healing more deeply. When her nervous system finally felt safe, the transformation was remarkable.

[00:49:49] So if you're listening to this and thinking, but my sensitivity is the problem I want you to consider. What if it's actually your pathway home? Let me take you deeper into the science for a moment. [00:50:00] Because understanding what's happening in your brain and nervous system can be incredibly empowering.

[00:50:05] When we talk about sensory processing sensitivity, we're talking about differences in how the brain processes information. Functional MRI studies show that highly sensitive people have increased activation in brain regions that are associated with awareness, empathy, and sensory processing, particularly the insula.

[00:50:23] The insula is your brain's integration hub for interoceptive information, everything happening inside your body. Heart rate, breathing, gut sensations, muscle tension, and yes, pain. In highly sensitive people, the insula is more active. It's processing more data, making more connections, comparing current sensations to past experiences more thoroughly.

[00:50:45] This is why HSPs often describe their pain with such rich detail. Their brains are literally processing more information about the pain experience. But here's where it gets really interesting. The insula doesn't just process sensation, it also [00:51:00] processes emotion. It's a key player in what neuroscientists call interoceptive prediction.

[00:51:05] Your brain is constantly making predictions about the meaning of sensations. Is this pain dangerous? Is it temporary? Is it getting worse? For highly sensitive people, these predictions are more elaborate, more emotionally rich, and more influenced by past experiences. This is why sensation that might register as mild discomfort for one person can register a significant threat for an HSP, not because they're exaggerating, but because their brain is processing more contextual information and making more complex predictions. Now add chronic pain to this equation, chronic pain creates what we call central sensitization, a state where the central nervous system amplifies pain signals.

[00:51:49] The volume gets turned up on everything. Neurons in the spinal cord and brain become more excitable. The threshold for activation drops. Signals that wouldn't normally be interpreted as [00:52:00] pain, start triggering pain responses. For highly sensitive people, this creates that bidirectional trap I keep talking about. Their brains were already processing sensations more deeply. Now, the volume on those sensations has been turned way up. And here's the kicker. This amplification isn't just happening in the pain pathways. It's happening across the entire nervous system. Research shows that people with chronic pain often have dysregulated autonomic nervous systems.

[00:52:27] The sympathetic nervous system, your fight or flight response, can get stuck in the on position or after prolonged activation. It can flip to the opposite extreme, dorsal vagal shut down, where the system essentially gives up and goes into conservation mode. For highly sensitive people, these autonomic shifts happen more easily and more intensely because their nervous systems are already working harder to process stimuli.

[00:52:51] This is why addressing allostatic load is so critical. Every stressor, physical, emotional, psychological, environmental adds to the total burden on the [00:53:00] nervous system, and when that burden exceeds capacity, the system cannot regulate effectively. But here's the hopeful part, and this is where the science gets really exciting.

[00:53:09] Neuroplasticity is real. The brain can change. The nervous system can learn new patterns. When we use interventions like Pain Reprocessing Therapy, we're essentially retraining the brain's predictive models. We're teaching the insula, this sensation isn't dangerous. You can process it without amplifying it.

[00:53:28] You can notice it without catastrophizing. When we work on expanding the window of tolerance, we're building the nervous system's capacity to handle stimuli without flipping into survival states. When we address allostatic load, we're reducing the total burden on the system, which then frees up capacity for regulation and healing.

[00:53:48] And when we validate the HSPs experience, when we say your nervous system is processing differently and that's real, we're reducing the secondary suffering that comes from being told you're the problem. [00:54:00] The neuroscience tells us something powerful. Sensitivity isn't a bug in the system. It's a feature.

[00:54:05] It's a different way of processing information that comes with both challenges and gifts. The challenge is that highly sensitive nervous systems are more vulnerable to overwhelm,

[00:54:14] more prone to amplification, and require more careful titration in treatment. The gift is that these same nervous systems are capable of profound healing when they finally feel safe. Because the same depth of processing that amplifies pain can also amplify safety, connection, and recovery. If your nervous system could speak, what would it want you to know about how it's been trying to protect you all this time?

[00:54:39] I wanna speak directly to the providers listening for a moment, because if you're working with patients who have chronic pain, statistically about one in four to one in three of them is a highly sensitive person. And if you don't understand how to recognize and work with this trait, you're going to misinterpret that presentation and apply interventions that backfire.

[00:54:56] And honestly, you're going to lose patients, not because you're a bad [00:55:00] clinician, but because you're using the wrong framework. Here's what you need to know. Recognition is the first step when a highly sensitive person walks into your office with chronic pain, there are specific patterns in how they describe their experience, more descriptive components to their pain, more clarity and focus on the feeling of pain, not just its existence. More references to emotions and adjectives describing the pain. Language is more dramatic with changes in vocal tone and pitch or cadence.

[00:55:27] More emotional expression. Your first instinct might be to label this as catastrophizing or psychological overlay, but please resist that instinct. What you're seeing is a nervous system in an activated state, either hyper arousal or hypo arousal. These presentations are clues about their autonomic state, not evidence of psychological dysfunction.

[00:55:49] Think of it like this. If a patient came in with a fever, you wouldn't say you're catastrophizing about your temperature. You'd recognize the fever is a sign that something's happening in their system. The same logic [00:56:00] applies here. Assessment needs to be comprehensive. Don't just assess pain, assess their history with pain, this specific complaint and pain in general.

[00:56:09] Get an idea of how they've managed in the past and how their pain experience currently is influencing their lives in a negative inhibitory way. Ask, what do they think or do when they felt pain in the past? In the present, what do they think about their future? Can they imagine a life without pain? Or do they feel this is a life sentence and their new normal?

[00:56:28] These questions reveal their window of tolerance, their allostatic load, and their capacity for engaging in treatment. Also, assess other body systems, GI functions, sleep quality, physical and cognitive fatigue. These give insight into their current nervous system state. Look at life stressors, relationship dynamics, work demands.

[00:56:47] All of these factors contribute to allostatic load and influence pain processing. You're not just treating a body part, you're treating a whole nervous system embedded in a whole life. Treatments should be personalized. Standard [00:57:00] protocols often don't work for HSPs. Aggressive physical therapy can overwhelm their nervous systems.

[00:57:05] Pushing through pain can increase sensitization rather than build resilience. Even relaxation techniques can backfire if the patient's in a shutdown state and forced relaxation feels threatening. But here's what works. Patience. HSPs need more time to trust that movement won't hurt them. That regulation techniques are safe, that you're not gonna push them beyond their capacity.

[00:57:27] Your patients communicate safety and when you rush, their nervous system detects threat. When you slow down your co-regulating. Titration. Start smaller than you think you need to. Microdose exposure. Progress more slowly, respect their narrower window of tolerance. I know this goes against your training. I know you've been taught that exposure needs to be robust, to be effective.

[00:57:51] But for HSPs robust exposure, often retraumatizes. Titrated exposure heals. Validation. Before you do anything else, validate their [00:58:00] experience. Your nervous system is processing pain differently. That's real. That's not weakness, and we're going to work with your nervous system, not against it. This one sentence can transform your therapeutic relationship.

[00:58:12] Pivot when needed. If a patient is experiencing increased life stress, don't push harder on pain reduction. Pivot to nervous system regulation, self-compassion and neutral sensations. Move adjacent to the pain rather than confronting it directly.

[00:58:27] This requires clinical flexibility. It requires you to let go of your agenda and meet the patient where they are. Address allostatic load. You can't just treat the pain. You have to address the cumulative burden on their nervous system. This might mean referring them to a therapist for trauma work. It might mean having conversations about work-life balance, boundary setting or relationship dynamics. It might mean coordinating care with other providers to address sleep disorders, auto-immune conditions or hormonal imbalances. You're not just a pain specialist, you're a nervous system detective. [00:59:00] Use objective data, tools like HRV monitoring can help HSPs trust their own perception and see objective evidence of their nervous system states. This builds self-efficacy and reduces the secondary suffering of self-doubt. The goal is different. You're not trying to eliminate pain. You're trying to diminish the suffering and emotional response to pain, which amplifies the pain experience. You're trying to minimize central and peripheral sensitization.

[00:59:26] You're trying to increase crosstalk between prefrontal cortex areas and the somatosensory cortex, communication that's inhibited during predominant limbic system responses. You're trying to expand their window of tolerance, reduce their allostatic load, and help them work with their sensitivity rather than against it.

[00:59:44] And here's the thing that will make you a better clinician. When you learn to work effectively with highly sensitive people, you become better at treating everyone because the principles that work for HSPs: validation, titration, nervous system regulation, addressing allostatic load, these are [01:00:00] principles that benefit all patients with chronic pain.

[01:00:02] HSPs just require you to be more precise, more patient, and more attuned, and that precision, patience, and attunement will transform your practice. So let me ask you this. What would change in your practice if you approached every patient as if they might be highly sensitive? What if, instead of waiting for them to prove they need a different approach, you started with the assumption that slower, more attuned, more validating care is always better.

[01:00:27] I guarantee your outcomes would improve across the board. Before we wrap up, I wanna address something that doesn't get talked about enough. How culture and developmental stage shape the experience of being a highly sensitive person with chronic pain.

[01:00:41] In some cultures, emotional expressiveness around pain is encouraged. It's seen as honest, as authentic, as a natural response to suffering. In these contexts, highly sensitive people might feel more permission to express their pain experience fully. But in other cultures, particularly in Western individualistic cultures [01:01:00] that value stoicism and toughing it out, emotional expressiveness around pain is often pathologized.

[01:01:06] It's seen as weakness, as attention getting, as failure to cope. For highly sensitive people in these cultures, there's an added layer of suffering, shame. They're not just dealing with the pain itself, they're dealing with the internalized message that their response to pain is wrong. They should be able to handle it better, that their sensitivity is a character flaw.

[01:01:28] Gender also plays a role here. Research shows that women's pain is more likely to be dismissed or attributed to psychological factors than men's pain. And if you're a highly sensitive woman with chronic pain, you're facing a double blind. Your emotional expressiveness gets interpreted through a gendered lens as hysteria or being dramatic.

[01:01:47] And here's the cruel irony. The same expressiveness that gets pathologized in women is often what finally gets men taken seriously because men are socialized to suppress emotion. When they do express pain emotionally, [01:02:00] providers think this must be really bad if he's showing emotion, but women, they're expected to be emotional.

[01:02:07] So when they express pain emotionally, it's dismissed as just how women are. The experience also looks different across the lifespan. In children and adolescents, high sensitivity often presents as emotional reactivity, sensory overwhelm, and difficulty with transitions. When chronic pain enters a picture during these developmental years, it can derail everything.

[01:02:30] Missing school, withdrawing from social activities, developing fear avoidance patterns that persist into adulthood. For young HSPs with chronic pain, early intervention is critical.

[01:02:42] Teaching them about their nervous systems, giving them regulation tools, helping them understand that their sensitivity is a trait rather than a flaw. This can prevent decades of suffering. In young adults, this is often when the collision between high sensitivity and chronic pain become most visible. I [01:03:00] see a lot of young adults who've developed what I call compensatory perfectionism. They push themselves relentlessly to prove they're not weak, they're not failing, they're not too sensitive, and that pushing it increases allostatic load and worsens pain. By middle adulthood, many highly sensitive adults have learned to mask their sensitivity by this point.

[01:03:20] They've developed coping mechanisms at work until chronic pain overwhelms their capacity. These are the patients who say, I've always been able to handle everything. I don't understand why I'm falling apart now. What's happened is that years of accumulated stress, unprocessed trauma and suppressed sensitivity have finally exceeded their nervous system's capacity.

[01:03:41] The pain is the tipping point, not the cause. In older adults, sensitivity doesn't disappear with age, but the presentation often shifts. Older HSPs with chronic pain are dealing with additional layers, age-related changes in pain processing, comorbid health conditions, loss of independence, grief [01:04:00] and loss. But here's what's beautiful. Older HSPs often have more self-knowledge, more acceptance of their trait, and more wisdom about what works for their nervous systems. When they finally find a provider who understands sensitivity, the healing can be profound. So here's a question worth sitting with.

[01:04:19] What cultural messages about pain and sensitivity did you absorb growing up, and how are those messages still influencing how you relate to your own pain today? Where are you in this lifespan journey? What would it mean to honor your sensitivity at this stage of life instead of fighting it? So if you're a highly sensitive person living with chronic pain, I want you to hear this.

[01:04:39] Your sensitivity is not a disorder. Your detailed descriptions of pain aren't catastrophizing. Your emotional expressiveness isn't weakness. Your body awareness isn't the problem. You have a nervous system that processes stimuli more deeply, and when chronic pain entered the picture, it created bidirectional sensitization [01:05:00] that requires a different approach. The medical system hasn't been designed with you in mind. Most pain protocols are built for nervous systems that process differently than yours, and that's not your fault. But here's what I need you to understand, and this is the part I want you to write down, to save, to come back to when you're doubting yourself. Your sensitivity, the same trait that makes you vulnerable to pain amplification is also your pathway to healing. Because highly sensitive nervous systems don't just process pain more deeply, they also process safety more deeply, connection more deeply, and healing more deeply. When your nervous system finally feels safe, when you find providers who validate your experience, when you learn to work with your sensitivity rather than against it, when you expand your window of tolerance and reduce your allostatic load, the healing that becomes possible is profound. I've seen it happen over and over and over again. Patients who've suffered for years, who've been told they're the problem, who've lost hope, [01:06:00] they find their way back.

[01:06:01] Not to the absence of sensitivity, but to the restoration of safety. And in that safety, everything changes. Your pain might not disappear completely, but the suffering diminishes. The emotional amplification quiets. The hypervigilance transforms into helpful self-awareness. The narrow window of tolerance expands.

[01:06:21] You start to feel like yourself again, not despite your sensitivity, but because of it. So here's what I want you to do, and I mean actually do, not just think about doing. First, stop fighting your sensitivity. Stop trying to be less sensitive, less aware, less attuned. Your nervous system's wired this way, and that wiring comes with gifts.

[01:06:41] What if you spent the energy you're using to fight your sensitivity on learning to work with it instead? Second, find providers who understand. Bring them research, bring them this episode, advocate for yourself, and if they can't or won't adjust their approach, find someone who will. You deserve a provider who sees you, not just your [01:07:00] symptoms.

[01:07:00] Third, address your allostatic load. You can't just treat pain. You have to reduce the cumulative burden on your nervous system. Better sleep, healthier boundaries, trauma processing, stress management, all of it matters. What's one thing you could do this week to reduce your allostatic load by even 5%?

[01:07:19] Fourth, practice interceptive reframing. Notice what doesn't hurt. Log neutral sensations. Practice curious appraisal instead of automatic threat detection. Your nervous system's collecting data all the time. Just make sure it's collecting balanced data. Fifth, be patient with yourself. Healing for highly sensitive people doesn't happen on the same timeline as it does for others.

[01:07:42] You need more time, smaller steps, gentler titration. That's not weakness, that's working with your nervous system. What would change if you gave yourself permission to heal at your own pace? And finally, remember that you're not alone. Up to one third of the population shares [01:08:00] this trait.

[01:08:00] There are millions of highly sensitive people navigating chronic pain. You're part of a community even if you haven't found them yet, because the same trait that makes you feel pain more intensely is also the trait that allows you to experience profound healing when your nervous system finally feels safe. Your sensitivity isn't the enemy, it's the pathway home.

[01:08:22] And honestly, the world needs more highly sensitive people who've learned to work with their nervous systems. Because once you understand your own sensitivity, you become a beacon for others who are still struggling. You become proof that healing is possible. You become the validation you wish you'd had years ago.

[01:08:39] So thank you. Thank you for listening. Thank you for being willing to see your sensitivity differently. Thank you for doing the hard work of learning to work with your nervous system instead of against it. This is Dr. Zev Nevo, and you've been listening to Mind Your Body. If this episode resonated with you, please share it with someone who needs to hear it.[01:09:00] 

[01:09:00] Share it with your provider. Share it with another highly sensitive person who's been told they're too much. Share it with someone who's still fighting their nervous system and doesn't know there's another way, because this conversation, it changes lives. And if you're a highly sensitive person who just heard yourself described for the first time, welcome, you're not broken, you're not alone, and you're exactly where you need to be.

[01:09:25] See you next time.