Another Way to Think About Pain: The Pain Pie

Let’s talk pie—but not the sweet kind. The “Pain Pie” is a thinking tool for both patients and clinicians, born from years of trying to make sense of the mess that is chronic pain. Whether it’s your knee, your back, or pain with no clear cause, breaking pain into pie slices helps split out its pieces and find ways to shrink it.

What Goes Into the Pie?

The Pain Pie has three main ingredients:

●      Body Part Pain: Nociceptive—think sharp, aching, throbbing, or pressure. Usually starts at the site of injury, with clear aggravators and soothers.

●      Nerve Pain: Neuropathic—burning, pins-and-needles, numbness, constriction, strange sensations that zing along specific pathways.

●      Amplified (Nociplastic/Central Sensitization): When pain gets wound up in the spinal cord and brain, spreading, getting unpredictable, and far out of proportion to any one injury.

The Toppings: Amplifiers

Chronic pain gets messy, and for many, it isn’t just about structural damage. The pain pie includes “amplifiers,” like:

●      Sensory hypersensitivity (light, sound, touch, smell)

●      Sleep disturbance

●      Fatigue (mental and physical)

●      Cognitive dysfunction ("brain fog")

●      Mood disturbance (irritability, anxiety, depression)

●      Motor dysfunction (inhibition, spasming, myoclonic jerks, restless leg etc.)

●      Dysautonomia (dizzy spells, stomach upset, bladder issues, sweating, blurry vision)

These symptoms can become as central as the pain itself, often piling up over years—even as the original cause of pain may fade.

Slicing the Pie: Practical Tools

Why a pie? Because you can tackle each slice differently. Some causes can be directly treated (a pinched nerve, inflamed joint). Others require a broader approach—rehab, psychological support, lifestyle tweaks. Often, you can’t find or fix the initial trigger, but you can still chip away at amplifiers, shrinking their percentage of the pie. Hopefully, this makes the drivers of pain easier to identify.

When the Whole Recipe Matters

No two pain pies are the same. Older patients or those with complex conditions stack up more slices and amplifiers. Even when the root cause isn’t fixable, understanding and treating the pie’s “ingredients” can shrink the overall output—sometimes by whittling down lots of “little” contributors rather than just focusing on the biggest slice. That pie won’t always be gone, but each bite you shave off gives you back more of your day-to-day life and what pain has stolen from you.

Ultimately, the Pain Pie is about empowerment. For clinicians, it’s a road map. For patients, it’s a way to ask, “Which slice can I work on?” The goal isn’t to deny the pain, but to see its complexity and reclaim what you can—one piece at a time.

For more insight and practical advice, tune in to episode 7 of It’s Not in Your Head Podcast.