What happens in your brain when you feel pain?

Updated

Thalamus relays pain signals to the cortex. Somatosensory cortex localizes and grades intensity. Insula produces bodily awareness. Anterior cingulate generates emotional distress. Prefrontal cortex evaluates meaning. Periaqueductal grey dampens pain via descending pathways.

Thalamus, Somatosensory Cortex, Insula, Anterior Cingulate Cortex, Prefrontal Cortex, Periaqueductal Grey lit up on the Brain Atlas 3D brain: what happens in your brain when you feel pain
Figure. The brain regions that light up when you feel pain, in order: Thalamus (relay station), then Somatosensory Cortex (locating pain), then Insula (bodily feeling), then Anterior Cingulate Cortex (emotional sting), then Prefrontal Cortex (making sense), then Periaqueductal Grey (turning it down).

Watch it light up on the 3D brain

Brain regions that light up

OrderRegionWhat it does here
1ThalamusPain signals from the spinal cord arrive at the thalamus.
2Somatosensory CortexThe somatosensory cortex maps where the pain is and how intense.
3InsulaThe insula creates the feeling that the pain is happening to you.
4Anterior Cingulate CortexThe anterior cingulate adds the emotional suffering and urge to escape.
5Prefrontal CortexThe prefrontal cortex evaluates the pain's meaning and plans a response.
6Periaqueductal GreyThe periaqueductal grey sends signals down to dampen incoming pain.

1. Thalamus: relay station

Step 1 of what happens in your brain when you feel pain: Thalamus lit on the Brain Atlas 3D brain
Figure 1. Thalamus, relay station: Pain signals from the spinal cord arrive at the thalamus.

The thalamus acts as the brain's main sensory relay. Specific nuclei, such as the ventral posterior nucleus, receive nociceptive input from the spinothalamic tract and project to cortical areas. It filters and forwards signals to both sensory and limbic regions.

2. Somatosensory Cortex: locating pain

Step 2 of what happens in your brain when you feel pain: Thalamus, Somatosensory Cortex lit on the Brain Atlas 3D brain
Figure 2. Somatosensory Cortex, locating pain: The somatosensory cortex maps where the pain is and how intense.

Primary somatosensory cortex (S1) receives thalamic input and encodes the sensory-discriminative aspects of pain: location, intensity, and quality. It uses a somatotopic map, so the area activated corresponds to the body part injured.

3. Insula: bodily feeling

Step 3 of what happens in your brain when you feel pain: Thalamus, Somatosensory Cortex, Insula lit on the Brain Atlas 3D brain
Figure 3. Insula, bodily feeling: The insula creates the feeling that the pain is happening to you.

The insula integrates interoceptive signals from the body, giving rise to the subjective awareness of pain as an internal state. It is thought to be crucial for the "feeling" of pain, contributing to its unpleasantness and urgency.

4. Anterior Cingulate Cortex: emotional sting

Step 4 of what happens in your brain when you feel pain: Thalamus, Somatosensory Cortex, Insula, Anterior Cingulate Cortex lit on the Brain Atlas 3D brain
Figure 4. Anterior Cingulate Cortex, emotional sting: The anterior cingulate adds the emotional suffering and urge to escape.

The anterior cingulate cortex (ACC) processes the affective-motivational dimension of pain. It is associated with the distress, fear, and desire to withdraw from the painful stimulus. Lesions here can reduce the suffering while leaving sensory discriminative abilities intact.

5. Prefrontal Cortex: making sense

Step 5 of what happens in your brain when you feel pain: Thalamus, Somatosensory Cortex, Insula, Anterior Cingulate Cortex, Prefrontal Cortex lit on the Brain Atlas 3D brain
Figure 5. Prefrontal Cortex, making sense: The prefrontal cortex evaluates the pain's meaning and plans a response.

The prefrontal cortex, especially dorsolateral and ventromedial regions, appraises the pain in context: is it dangerous, controllable, or familiar? It can modulate emotional reactions and direct attention, influencing how much pain is felt and coping strategies.

6. Periaqueductal Grey: turning it down

Step 6 of what happens in your brain when you feel pain: Thalamus, Somatosensory Cortex, Insula, Anterior Cingulate Cortex, Prefrontal Cortex, Periaqueductal Grey lit on the Brain Atlas 3D brain
Figure 6. Periaqueductal Grey, turning it down: The periaqueductal grey sends signals down to dampen incoming pain.

The periaqueductal grey (PAG) is a key node in the descending pain modulation system. It receives input from the ACC and other regions and projects to brainstem nuclei that inhibit nociceptive transmission in the spinal cord, reducing pain intensity.

Good to know

  • The placebo effect involves activation of the prefrontal cortex and periaqueductal grey, which can inhibit pain via endogenous opioids.
  • The anterior cingulate cortex is sometimes targeted in cingulotomy, a neurosurgical procedure for intractable pain that reduces the emotional suffering.
  • The insula and anterior cingulate are part of the "salience network," which detects and responds to behaviorally relevant stimuli, including pain.

Physical pain vs social pain

Physical pain activates somatosensory cortex for localization, while social pain (e.g., exclusion) does not; both activate insula and anterior cingulate, suggesting shared circuitry for distress. The periaqueductal grey may be more specific to physical pain modulation.

Test yourself

  1. Which brain region is primarily responsible for localizing where on the body a painful stimulus occurs?

  2. Damage to which region would most likely reduce the emotional suffering associated with pain while leaving the ability to locate it intact?

  3. The descending pain modulation system, which can inhibit pain signals at the spinal cord, is centered in which structure?

0 of 3 answered · 0 correct

Simplified: many regions work together at once, and this shows the main players in the order they act.