Most of us think of pain as something that happens in the body. We imagine bleeding knees, headaches, burns, or bruises. But pain is much more than that. Pain is created by the brain, not just the skin or nerves. This is why emotional experiences like rejection, heartbreak, or grief can hurt just as deeply as a physical injury. The overlap between physical and emotional pain in the brain becomes even more interesting when we look at people who are born without the ability to feel physical pain at all. These individuals have a rare condition called Congenital Insensitivity to Pain with Anhidrosis (CIPA). Even though their bodies cannot sense pain, they still experience emotional suffering. Their interesting experience helps us understand what pain really is and how the brain processes it.

How the Brain Creates Both Physical and Emotional Pain

Pain is not only a reaction to damage. The brain plays the biggest role by interpreting signals and giving them meanings. Brain areas involved in physical pain also become active when someone faces emotional hurt. For example, parts of the brain that respond to your finger being cut also respond when you feel rejected by someone important or when you go through a breakup.

This overlapping system explains why emotional pain can feel so deep and overwhelming. The brain does not see emotional pain as something “less serious.” It reacts to emotional hurt with many of the same pathways used for physical pain. This suggests that emotional pain is not just a metaphor or something to represent but a real, biological experience.

CIPA: When Physical Pain Is Absent but Emotional Pain Still Exists

CIPA is a condition where people cannot feel physical pain because the nerves responsible for detecting injury never developed properly. They may break a bone and not even notice. They might burn themselves without feeling anything. But even though their bodies don’t feel it, their emotional awareness is completely active.

People with CIPA still feel sadness, fear, frustration, embarrassment, and loneliness. Emotional pain does not require physical pain nerves. It comes from higher brain areas that process relationships, memories, interpretations, and personal deep meanings. These areas remain the same in people with CIPA, which is why emotional pain continues to exist even though no physical sensations can be felt.

What makes CIPA so interesting is that it proves physical and emotional pain rely on different systems, even though they share some common brain pathways. Emotional hurt is its own type of pain, created mainly by the brain’s emotional paths rather than the body’s pain receptors.

Pain and Empathy in People Who Cannot Feel Pain

Another important question is; how can people with CIPA understand what it means for someone else to be in pain? For most people, empathy mostly comes from comparing someone’s suffering to their own past experiences. When we see someone get hurt, our brain automatically imagines what that pain might feel like, and this helps us feel connected and empathize.

Someone with CIPA has never felt physical pain, so they lack this comparison of connection. Many with CIPA can still understand that others are hurting, but their emotional reaction might be different from someone who has personally experienced pain. Sometimes, their ability to feel deeply for another person’s physical suffering may be slightly reduced. Though this does not mean they don’t care or don’t sympathize. It simply means their brain has developed no certain reference points that most people have to what pain feels like. This shows how physical experiences also shape emotional understanding. Pain makes us able not only understand how to protect ourselves but also how to relate to the suffering of others.

The Fight, Flight, or Freeze Response Without Pain

Pain normally triggers immediate reactions that help keep us safe. When something hurts, the body reacts quickly. Your heart races, your muscles tense, and your brain starts to be on alert. This is part of the fight, flight, or freeze response.

People with CIPA do not receive these danger signals or alerts from physical injury. Without pain to feel, their responses to physical threats can be very different. However, emotional threats still activate the brain’s alert systems. Fear, arguments, stress, and anxiety still create strong reactions because these depend on emotional circuits on the brain pathway, not on the pain sensing nerves that CIPA affects. This once again shows that emotional pain is mainly a brain thing rather than a body experience.

CIPA reveals that pain is not just about cuts, burns, or broken bones. Even when the body can’t feel injury, people can still feel hurt on the inside. They still go through sadness, fear, stress, and loneliness. This shows that pain is something the brain creates, not only something the body senses and sends.

By looking at people with CIPA, we can see how physical and emotional pain are connected and overlaps but are also different. Emotional pain has its own system in the brain, and it doesn’t disappear just because physical pain is gone. CIPA also makes us understand how physical pain helps us learn, build empathy, and understand other people’s suffering. In the end, this condition reminds us that emotional pain is real, impactful, and important to who we are as humans, even when the body feels nothing at all.

References:

Danziger, N. (2006). Is pain the price of empathy? The perception of others’ pain in patients with congenital insensitivity to pain. Brain, 129(9), 2494–2507. https://doi.org/10.1093/brain/awl155

De Ridder, D., Adhia, D., & Vanneste, S. (2021). The Anatomy of Pain and Suffering in the Brain and Its Clinical Implications. Neuroscience & Biobehavioral Reviews, 130(130), 125–146. https://doi.org/10.1016/j.neubiorev.2021.08.013

Roberts, N. F. (2020, February 14). Emotional & Physical Pain Are Almost The Same – To Your Brain. Forbes. https://www.forbes.com/sites/nicolefisher/2020/02/14/emotional–physical-pain-are-almost-the-sameto-your-brain/

Rodríguez-Blanque, R., Nielsen, L. M., Piqueras-Sola, B., Sánchez-García, J. C., Cortés-Martín, C., Reinoso-Cobo, A., & Cortés-Martín, J. (2024). A Systematic Review of Congenital Insensitivity to Pain, a Rare Disease. Journal of Personalized Medicine, 14(6), 570. https://doi.org/10.3390/jpm14060570

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