The Six Fs of Pain

When chronic pain shows up, your brain doesn't just sit there and observe it. It reacts. And the way it reacts, the patterns it falls into, can either maintain the pain cycle or begin to interrupt it.

Over years of clinical work and personal experience with chronic pain, I've found it helpful to identify six common responses to pain. I call them the Six Fs. Understanding which ones you default to is the first step toward changing your relationship with pain.

1. Fighting

The instinct to fight pain is natural. You clench against it, push through it, try to overpower it with willpower. But chronic pain isn't an opponent you can defeat by force. Fighting activates your threat response, which tells the brain there's danger, and danger is exactly what keeps pain signals firing.

The more you fight chronic pain, the more your brain interprets the situation as threatening. And the more threatening it seems, the more pain it produces.

2. Fleeing

Fleeing is the avoidance response. You stop doing the things that trigger pain. You cancel plans, avoid movement, withdraw from activities you used to enjoy. On the surface, this seems rational. If something hurts, don't do it.

But with neuroplastic pain, avoidance reinforces the brain's belief that those activities are dangerous. Every time you avoid something because of pain, you're teaching your brain that the pain was justified. The pain gets louder, and your world gets smaller.

3. Fixing

Fixing is the problem-solving response. You research treatments, see specialists, try new medications, adjust your ergonomics, buy different shoes, change your mattress. You approach pain as a mechanical problem that just needs the right solution.

For acute injuries, fixing is exactly right. But for chronic neuroplastic pain, the endless search for a physical fix keeps you focused on the body as the source of the problem, when the source is actually in the brain's learned pain pathways. The fixing mindset can become its own trap.

4. Fearing

Fear is the engine of chronic pain. Fear of pain, fear of movement, fear of reinjury, fear that something is seriously wrong, fear that the pain will never go away. This fear isn't irrational. It's a natural response to a deeply unpleasant experience.

But fear is also the primary fuel for the pain-danger cycle. When your brain perceives threat, it produces protective responses, and pain is one of those responses. Reducing the fear around pain is one of the most powerful things you can do for recovery. This is exactly what Pain Reprocessing Therapy targets.

5. Focusing

Hypervigilance: constantly monitoring your body for pain, checking in on how much it hurts, scanning for changes. When pain is a major part of your life, it makes sense that your attention would be drawn to it. But this focused attention amplifies the pain signal.

Think of it like this: if I asked you to focus on the feeling of your left shoe against your foot, you'd suddenly notice sensations you weren't aware of a moment ago. Attention amplifies sensation. When you're constantly monitoring pain, you're turning up the volume.

6. Fusing

Fusing is an ACT concept. It means becoming entangled with your thoughts about pain to the point where the thoughts feel like reality. "I'll always be in pain." "Something is seriously wrong with me." "I can't do anything anymore." These thoughts feel true when you're fused with them. They become the lens through which you see everything.

Defusion, learning to see these thoughts as mental events rather than facts, is one of the most liberating skills you can develop. It doesn't make the thoughts go away. It changes your relationship with them so they no longer dictate your behavior.

What to Do Instead

The alternative to the Six Fs isn't passivity. It's what I call engaged safety: approaching pain with curiosity and calm rather than fear and reactivity. It means:

• Acknowledging pain without treating it as a threat
• Moving toward activities rather than away from them
• Letting go of the need to fix and instead understanding what's happening neurologically
• Reducing the fear response through education and gentle exposure
• Softening attention rather than amplifying it
• Holding thoughts about pain lightly rather than fusing with them

This is the foundation of the work I do at The Neuroplastic Pain Institute. Whether through Pain Reprocessing Therapy, Brainspotting, ACT, or clinical hypnosis, the goal is the same: helping your brain move from threat to safety so that pain can resolve.

If you recognize yourself in any of these patterns, that's a good thing. Awareness is the first step. The patterns aren't your fault. They're your brain's best attempt to protect you. But with the right support, you can teach your brain a new response.