Unsafe things hurt. If your brain thinks you’re safe, the pain goes down. Pain is more about sensitivity than about injury
Pain itself often modifies the way the central nervous system works, so that a patient actually becomes more sensitive and gets more pain with less provocation. It’s called “central sensitization” because it involves changes in the central nervous system (CNS) in particular — the brain and the spinal cord.
Sensitized patients are not only more sensitive to things that should hurt, but sometimes to ordinary touch and pressure as well. Their pain also “echoes,” fading more slowly than in other people.
Being kind to your nervous system
Avoidance is basically all about making your life less stressful: gentler, easier, safer. Confidence and safety are critical.
Centralization of pain is the process of the central nervous system’s “opinion” of the situation becoming more important than the actual state of the tissues. This is not an “all in the head” problem, but a “strongly affected by the head” problem, like an ulcer that is caused by a very real bug but is severely aggravated by stress.
When your CNS is “freaked out” and over-interpreting every signal from the tissues as more painful than it should, therapy becomes more about soothing yourself and feeling safe than about fixing tissues. Pain is, at a very fundamental level, all about your brain’s assessment of safety: unsafe things hurt. If your brain thinks you’re safe, pain goes down.
No one actually knows how to treat sensitization. If they did, it would deserve a Nobel prize! But, if it’s possible at all, it must be a “re-calibration” in principle: teaching the pain system what a “normal” stimuli is. Avoidance and exposure are opposites, but they are both the main general ideas about how re-calibration might be achieved.