How to Combat Pain

July 20, 2026

AI Summary

5 min read

In a 1973 case, a 29-year-old construction worker drove a nail through his boot, clear through the other side. The pain was excruciating. He was sedated with fentanyl and other opioids in the emergency room. When doctors removed his boot, they found a miracle: the nail had passed cleanly between his toes. There was no puncture wound, no blood, no tissue damage. Yet his brain had produced agony anyway. Six years later, a second construction worker was hit in the jaw by a misfiring nail gun. He saw a nail shoot across the room and bury itself in a wall. He felt a mild toothache and headache, and went about his life for six days. When a dentist finally scanned his jaw, they found a four-inch nail embedded in his face, protruding into his prefrontal cortex. He had felt almost nothing. At the University of California San Francisco, pain psychologist Rachel Zoffner uses these two stories—"a tale of two nails"—to demonstrate the central puzzle of pain: hurt and harm are not the same thing.

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What you'll learn

1 (00:01) **Introduction: The Puzzle of Pain** - Shankar opens with the paradox: pain persists without visible damage, vanishes without treatment, and shifts with mood and context.
2 (03:27) **Guest Introduction: Rachel Zoffner** - Psychologist at UCSF who studies the mind’s role in pain.
3 (05:28) **A Tale of Two Nails** - Two construction-worker cases that upend the damage-equals-pain assumption.
4 (14:35) **Pain Is Constructed by the Brain** - Neuroscience refutes the idea that pain lives only in the hurt body part.
5 (18:14) **Case Study: Mateo and Phantom Pain** - A 12-year-old loses his hand in a firework explosion, then suffers phantom pain.
6 (23:37) **Context Changes Pain** - The same injury feels different depending on situation, emotions, and social setting.
7 (26:09) **Pain Is Never “All in Your Head”** - Emotions and pain share the same brain machinery (limbic system, amygdala).

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Show Notes

Pain feels like a simple message from the body. If your elbow hurts, there must be something wrong with your elbow. If your back is painfully stiff, you need some work done on your back. But psychologist Rachel Zoffness says our minds play a much larger role in our experience of pain than many of us realize. This week, we look at what's really happening when we experience pain, and how a better understanding of this process can open up new possibilities for treatment and healing.

In our companion conversation for Hidden Brain+ subscribers, Rachel Zoffness goes deeper into techniques that can help to reduce our brains' sensitivity to pain. You can hear that episode, which is called "Plastic Brain, Changeable Brain," with a free seven-day trial to Hidden Brain+. Go to support.hiddenbrain.org or apple.co/hiddenbrain to access your trial subscription.

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