Chronic pain is not a traditional type of “problem” that many associate with seeking counseling. Typically, mental health services are associated with depression, anxiety, or substance use. Chronic pain is a mental health issue, and I would encourage individuals with chronic pain to consider the emotional implications and causes in regards to their pain. A licensed professional can help the individual process through traumatic events or stressors in their life that may be increasing, prolonging, or ultimately worsening the individual’s chronic pain.
The medical community is one in which chronic pain remains a mystery. Medically speaking, most injuries are fully healed within one to three months, excluding severe spinal injuries or nerve damage which may not fully restore to their previous states. During this time, pain is classified as ‘acute’ due to the proximity to the actual injury that has occurred. Any and all pain is rightfully attributed to the injury that has occurred at that time. Pain is the body’s way of having the individual slow down, use the afflicted area less, and allow it the time it needs to properly heal. Pain lasting longer than three months is considered chronic pain.
In his book, The Hidden Psychology of Pain, Dr. James Alexander discusses and explores five myths related to chronic pain and how the brain can trick the body into hiding emotional trauma or stress as physical pain.
Chronic pain is the result of damage.
This is an inaccurate assumption. Yes, pain occurs after an injury; however, this is termed acute pain due to the proximity to the actual injury or event. Chronic pain is defined as pain that lasts longer than three months but medically speaking, the injury has or should have healed. Chronic pain is a medical mystery. Typically, a medical professional is looking for a specific cause (injury, abnormality, etc.) from the structural makeup of the individual’s body to arrive at a diagnosis. Chronic pain often times is more intense than the medical profession feels a specific injury should be (given that pain is subjective), giving rise to the idea that medically there is no explanation for why the pain is as intense as the individual reports or why it is persisting past the expected healing time.
Chronic pain is evidence of spinal/body weakness and vulnerability.
Our bodies naturally change as we age. Abnormalities of the spine or other bodily structures are normal and expected as we age. The medical profession only sees the patients whom are experiencing pain. They run a battery of tests (x-rays, CT scans, MRIs, etc.) to try to find the culprit or pinpoint a specific cause. There is little in terms of guesswork used to arrive at a cause/diagnosis, but typically hard evidence found through the use of these tests. A lot of the abnormalities found could be attributed to the typical aging process. Someone without pain of similar age and health could have the same or similar result in the tests as an individual with pain. However, the medical profession does not see these individuals, as common sense implies that if you are not in need of a doctor (i.e. not in pain) then you would not seek out their services. Why is it that some people develop chronic pain and others seem to not experience any? This lends evidence to emotionally stored traumas or stressors within the body and the mind/body connection.
Chronic pain is only likely to get worse with time.
This stems from the idea that pain comes from injury or damage. Medically speaking, after three months any injury should be healed. While there are some disorders or injuries, such as nerve damage, that do not have a fix or that cannot be healed, they should not get worse in severity. Take for instance nerve damage. Dr. Alexander argues that injuries such as nerve damage would not lead to increased intensity of pain, but rather would lead to the nerve dying off and no longer functioning at all, possibly alleviating the presence of pain. As therapists, we understand how thoughts can have a great impact on our moods, emotions, and behaviors. Same applies to pain. If the individual gets the notion that the pain will only get worse as there is no cure or clear cause, their brain works with that idea and creates the impression of worse pain. This starts a negative feedback loop, where their thoughts influence the pain, and the increase in pain reinforces their thoughts, which leads to a continuation of this pattern. CBT (cognitive-behavioral therapy) is a good tool to use to combat the thinking errors found in this negative feedback loop.
Chronic pain is ultimately crippling.
This ties in to the above discussion and reflects on the negative feedback loop that is often the case with many individuals suffering from chronic pain. Many times, individuals with pain will decrease their activities in an effort to avoid further injury or to avoid pain through activity. This is counterproductive to actually helping alleviate pain. Most medical professionals will agree that there is a time immediately after an injury in which the person should be more cautious and take it easy - resting more frequently - to allow the body time to heal. However, if the individual remains immobile, they will find that the pain is worse. Muscles can atrophy (essentially waste away) without consistent use. Once this occurs, more pain is likely, as the body is drawing on other areas in order to function and move. Movement actually plays a big role in pumping oxygen to our muscles. When muscles become oxygen deprived, they can become painful and/or more susceptible to injury. Worry about further injury prevents an individual from moving, which makes the ischema (lack of oxygen in muscles or tissue) worse, and again another negative feedback loop is occurring. Movement is highly encouraged when dealing with chronic pain.
Chronic pain precludes independence or the ability to earn.
This is another thinking error in regards to the effects of chronic pain. Individuals can begin to worry and stress over the impact their pain will have on their ability to do their job, provide for their family, or to maintain independence physically from others. This thought increases the likelihood that an individual may develop chronic pain. The persistent fear and worry of these negative outcomes can increase the amount of pain one feels. Our brains are amazing organs and sometimes it is easier to deal with the physical pain than the emotional. Thus it can create the perception of an increase in the physical pain so that deeper underlying issues are not in the forefront of the individual’s mind, acting as a defense mechanism.
In my next blog, titled Chronic Pain Part 2: The Brain, I will discuss how our brains interpret and add emotional value to injuries which can increase our likelihoods to develop chronic pain in the future, as well as how our brain works to protect us through the use of pain as a deterrent (defense mechanism).
Resource
Alexander, James. (2014). The Hidden Psychology of Pain. Bloomington, IN: Balboa Press.
The medical community is one in which chronic pain remains a mystery. Medically speaking, most injuries are fully healed within one to three months, excluding severe spinal injuries or nerve damage which may not fully restore to their previous states. During this time, pain is classified as ‘acute’ due to the proximity to the actual injury that has occurred. Any and all pain is rightfully attributed to the injury that has occurred at that time. Pain is the body’s way of having the individual slow down, use the afflicted area less, and allow it the time it needs to properly heal. Pain lasting longer than three months is considered chronic pain.
In his book, The Hidden Psychology of Pain, Dr. James Alexander discusses and explores five myths related to chronic pain and how the brain can trick the body into hiding emotional trauma or stress as physical pain.
Chronic pain is the result of damage.
This is an inaccurate assumption. Yes, pain occurs after an injury; however, this is termed acute pain due to the proximity to the actual injury or event. Chronic pain is defined as pain that lasts longer than three months but medically speaking, the injury has or should have healed. Chronic pain is a medical mystery. Typically, a medical professional is looking for a specific cause (injury, abnormality, etc.) from the structural makeup of the individual’s body to arrive at a diagnosis. Chronic pain often times is more intense than the medical profession feels a specific injury should be (given that pain is subjective), giving rise to the idea that medically there is no explanation for why the pain is as intense as the individual reports or why it is persisting past the expected healing time.
Chronic pain is evidence of spinal/body weakness and vulnerability.
Our bodies naturally change as we age. Abnormalities of the spine or other bodily structures are normal and expected as we age. The medical profession only sees the patients whom are experiencing pain. They run a battery of tests (x-rays, CT scans, MRIs, etc.) to try to find the culprit or pinpoint a specific cause. There is little in terms of guesswork used to arrive at a cause/diagnosis, but typically hard evidence found through the use of these tests. A lot of the abnormalities found could be attributed to the typical aging process. Someone without pain of similar age and health could have the same or similar result in the tests as an individual with pain. However, the medical profession does not see these individuals, as common sense implies that if you are not in need of a doctor (i.e. not in pain) then you would not seek out their services. Why is it that some people develop chronic pain and others seem to not experience any? This lends evidence to emotionally stored traumas or stressors within the body and the mind/body connection.
Chronic pain is only likely to get worse with time.
This stems from the idea that pain comes from injury or damage. Medically speaking, after three months any injury should be healed. While there are some disorders or injuries, such as nerve damage, that do not have a fix or that cannot be healed, they should not get worse in severity. Take for instance nerve damage. Dr. Alexander argues that injuries such as nerve damage would not lead to increased intensity of pain, but rather would lead to the nerve dying off and no longer functioning at all, possibly alleviating the presence of pain. As therapists, we understand how thoughts can have a great impact on our moods, emotions, and behaviors. Same applies to pain. If the individual gets the notion that the pain will only get worse as there is no cure or clear cause, their brain works with that idea and creates the impression of worse pain. This starts a negative feedback loop, where their thoughts influence the pain, and the increase in pain reinforces their thoughts, which leads to a continuation of this pattern. CBT (cognitive-behavioral therapy) is a good tool to use to combat the thinking errors found in this negative feedback loop.
Chronic pain is ultimately crippling.
This ties in to the above discussion and reflects on the negative feedback loop that is often the case with many individuals suffering from chronic pain. Many times, individuals with pain will decrease their activities in an effort to avoid further injury or to avoid pain through activity. This is counterproductive to actually helping alleviate pain. Most medical professionals will agree that there is a time immediately after an injury in which the person should be more cautious and take it easy - resting more frequently - to allow the body time to heal. However, if the individual remains immobile, they will find that the pain is worse. Muscles can atrophy (essentially waste away) without consistent use. Once this occurs, more pain is likely, as the body is drawing on other areas in order to function and move. Movement actually plays a big role in pumping oxygen to our muscles. When muscles become oxygen deprived, they can become painful and/or more susceptible to injury. Worry about further injury prevents an individual from moving, which makes the ischema (lack of oxygen in muscles or tissue) worse, and again another negative feedback loop is occurring. Movement is highly encouraged when dealing with chronic pain.
Chronic pain precludes independence or the ability to earn.
This is another thinking error in regards to the effects of chronic pain. Individuals can begin to worry and stress over the impact their pain will have on their ability to do their job, provide for their family, or to maintain independence physically from others. This thought increases the likelihood that an individual may develop chronic pain. The persistent fear and worry of these negative outcomes can increase the amount of pain one feels. Our brains are amazing organs and sometimes it is easier to deal with the physical pain than the emotional. Thus it can create the perception of an increase in the physical pain so that deeper underlying issues are not in the forefront of the individual’s mind, acting as a defense mechanism.
In my next blog, titled Chronic Pain Part 2: The Brain, I will discuss how our brains interpret and add emotional value to injuries which can increase our likelihoods to develop chronic pain in the future, as well as how our brain works to protect us through the use of pain as a deterrent (defense mechanism).
Resource
Alexander, James. (2014). The Hidden Psychology of Pain. Bloomington, IN: Balboa Press.
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