“Your Pain is Real: An Introduction to Chronic Pain” #painmanagement
By: Rebecca Stein, ASW
Physical pain is REAL, even if it’s invisible. Yet, despite what anyone may tell you, your experience is unique to you and you alone. It can impact everyone differently so making sense of it by comparing your pain with someone else’s and how they’re dealing or handling is self-inflicted Jiu-jitsu on your self-esteem.
There are two types of physical pain:
- Structural pain, caused by the body
- Psychosomatic, pain caused by the mind. Yes, that’s right, your psyche can express its self through years of trauma in your body.
But pain is pain in the mind. A level 10 pain for someone who broke his leg may also be a level 10 pain for someone who was in a car crash but showed no signs of a structural break. Both types of pain can be isolating. PERIOD. So when medical professionals, parents, teachers, and therapists can’t identify the pain you feel or worse, diminish it as either “all in your head” or discount it with “just push through it,” the pain typically intensifies due to the lack of support from others.
What is Pain?
Okay, so you learned to not put your hand on a hot stove because your brain sends pain signals to your hand so that your hand reacts by removing itself from the stove. The message is then relayed back to your brain as “ouch.” This is a GOOD thing! It’s your protection. When you have psychosomatic pain, the brain is in overdrive and sends these danger signals over and over again to the body causing significant distress. Only, there’s no visible fire. Leaving you and others to doubt or question the pain. But it’s there even when you try to ignore it. When you can change your relationship with the pain to one of protection, you no longer see the pain as dangerous. Instead, it’s a friend helping you remove your hand from the stove and prevent “emotional “scarring.
The Connection between the Mind and the Body:
Maybe you’ve been working in a toxic work environment, and even though you’re thriving, always having to defend and protect yourself and your subordinates from the political jousting has finally taken its toll, mentally and physically. Or maybe you’re the golden child of your family and you’ve been showered with love your whole life because you’ve performed to the highest levels, academically and professionally but you’re run-down and running to the doctor monthly with new symptoms. Or maybe you find yourself in a state of “panic” in social situations and experience frequent panic attacks, preventing you from making the connections you desire. Likewise, you may find yourself “at a loss for words” when put under pressure to meet a specific deadline.
Consciously, you may find yourself still able to go about your daily tasks, while the smooth muscles in your stomach are actively churning and struggling to digest properly due to the repressed, unconscious thoughts you are having. How could you blame yourself when 95% of your thoughts are in your unconscious awareness? Yes, you are only conscious 5% of the time! This is why Mr. Insomnia may come creeping in under the covers at night to awaken you of your unconscious, despite consciously not thinking of anything in particular. If you’re lucky, Mrs. Nightmare will come to join you!
All jokes aside, we have all experienced The Mind Body Syndrome (TMS), also known as Tension Myoneural Syndrome by Dr. John Sarno from New York Medical Center. Maybe you found your face blushing or “butterflies” in your stomach from a first date. Possibly, you felt your hands become sweaty, your heart rate increase, or your stomach churn prior to a test, speech, competition, or performance. In all of these instances, your mind told your body it was in danger (‘thrill’ of falling in love!) which created a psychosomatic response in your body. In all of these situations, your brain’s perception of the stress-inducing stimuli creates a “danger signal” in the body or an unconscious sensation rise in your body.
What happens when these Danger Signals can’t stop firing?
Chronic Pain. And yes, typically highly intelligent people experience this type of pain since their “smart brains” are constantly thinking and firing neurons but cannot figure out a way to calm down. As a result, tension headaches, back pain, neck pain, fibromyalgia, thyroid issues, temporomandibular joint syndrome (TMJ), piriformis syndrome, repetitive stress injury, irritable bowel syndrome (IBS), interstitial cystitis (Irritable bladder syndrome), chronic regional pain syndrome (CRPS), chronic fatigue syndrome (CFS), chronic hives, panic disorder, insomnia, obsessive-compulsive disorder, multiple chemical sensitivities and many other Mind-Body Syndromes can result.
The Good Thing/ The Light Switch
Your brain had to learn these neural pathways of fear and danger, and just like it took years to learn them, your “smart brain” can unlearn them. For someone with TMS, this could mean a life with no chronic pain. For someone with a structural based condition, this could mean reduced flare-ups, increased immune functioning, and overall better quality of life.
- When your brain thinks there is a tiger in front of you, it responds by fighting, fleeing, or freezing. What happens when your brain chronically believes there is a tiger in front of you? It becomes overwhelmed with uncomfortable emotions that may get repressed and are only seen through the expression of pain and/or anxiety.
- Even in structural pain cases, the mind has a powerful effect on the interpretation of the pain and body as well as the interpretation of environmental stimuli as dangerous, causing stress on the body, which leads to increased flare-ups.
- The goal is not to get rid of good stress. Good stress (known as Eustress) is inevitable and useful. It can motivate us to initiate and achieve! Conversely bad stress, Distress, causes damage and harm, mentally, emotionally, and physically. When we avoid pain, physically and emotionally, in our lives, stress can reach above a threshold of distress, leading to a state of shut down. With the help of a trained therapist, you can learn to approach physical and emotional pain.
- If you can change this message of danger to one of safety, the brain no longer registers the stress stimuli as a threat but of something that you can get curious about and even move towards!
- Knowing the source of your mind-body pain is caused by an overactive nervous system will stop you from going through unnecessary medical procedures, pain medications, injections, increased substance use, medical visits, and an unlimited number of expenses.
You are Not Alone:
As a therapist trained in pain management as well as someone who personally has overcome both structural and psychosomatic pain, I really do “get it.” In seeking my own counseling as a young adult, I quickly felt like even the most seasoned therapist did not do justice to the pain I was experiencing, simply because she didn’t get it. She’d never been through it and was well-intentioned but misguided.
I have too often seen extremes in opposite directions where the therapist takes on too much of an empathetic role, which places the client as “the sick one,” recreating previous familial roles the client is too familiar with, or therapists who believe there is a step-by-step protocol to treating chronic pain and therefore treat the client like another number in the system instead of an actual person who deserved validation for what they are feeling. Balancing compassion and empathy with a bit of nudging is truly the therapeutic art in pain management. As a therapist, I use cognitive-behavioral, somatic, psychodynamic, experiential, and exposure-based therapies to treat the person as a whole. Much like the way I approach you in session, you too will learn to approach the pain, from a place of compassion and curiosity with an attentive ear. From there, you will find the strength and empowerment to truly heal.