Pain, Thoughts, Belief and Learning

Introduction

In this section we look at the ways that thinking about pain can change how bad it is and how much we suffer with it. As we go through this section, please keep two important things in mind. The first is that the amount of pain you might feel after an injury is not always equal to the amount of physical damage the injury has caused. Some small injuries can be very painful, while other very serious injuries may not hurt that much. The second is that suffering is not always equal to pain. In the section on pain and feelings, we talked about how a condition that is usually not that painful for you can cause so much more emotional suffering when you are really upset about other problems not related to the pain. We will see in this section that thinking – and especially thinking about what the pain means to us – has a lot to do with how much we actually hurt and how miserable we feel. We will also see that, although pain and suffering are not necessarily equal, or the same, there are ways of thinking and things you can learn that will help you have less pain and suffering.

Paying Attention to Pain

The meaning of pain

We’ve talked about how one of the important differences between acute and chronic pain is what the pain means to you in the moment. With a recent injury, you can’t really afford to ignore what the pain is telling you: You’ve injured a part of your body and now you need to take care of it, rest it and give it time to heal. Acute pain is very much like a red light on the dashboard of your car that comes on when there’s something wrong with the engine. When the light comes on you know you need to do something different. In some instances you need to pull over immediately in order to avoid causing serious damage to your vehicle.

What would happen though if a warning light kept coming on in your car and three mechanics in a row (one of them an expensive specialist) told you that in fact there is nothing wrong under the hood? What if they told you that it’s safe for you to ignore that light, or that maybe you should try to find a way to disable it, either temporarily or for good?

In some ways, this is what chronic pain is like. It’s a signal that has lost its original meaning. Since we’ve said that chronic pain is pain that continues to be felt even though the original injury has healed, then the pain is no longer a signal that means that movement is dangerous. This means that the opinions of your doctors and other healers are all important to this part of your decision making. If you have confidence in them and can believe what they say about the pain you feel, then you can change your understanding of the pain signal. You can accept, and live as if the meaning of the pain signal is that it is only pain and not damage or harm. In other words, it’s a pain that’s safe to ignore. Of course, as we all know, ignoring a bright red light on your dashboard is much easier than ignoring severe pain.

The reduction of suffering

So, this is the first big job in learning to use our thoughts to manage pain effectively: to make sure that you know what the pain is really telling you, what it means and what it doesn’t mean. The bottom line is that pain and suffering can be quite severe, and quite troublesome and difficult to manage, even though there is no longer a dangerous or damaging injury that has yet to heal. In fact, this could be said of the majority of chronically painful conditions that people have. There is little doubt that your misery will be worse if you’re worried that “there’s something wrong or else I wouldn’t be hurting”. To say it differently, it’s very likely that you’re hurting more than you need to be if you don’t understand the actual meaning of your pain.

So, what’s the best way to make sure that your thoughts and beliefs about the meaning of your pain are correct? First, you have to hear from health care providers you trust that “there’s nothing wrong” in terms of tissue damage, even if the pain continues to be really bad and feels just like it did when there was something wrong at the physical level. This means that you learn to view your discomfort as “only pain” — it’s “hurt” but not “harm” – even if it’s severe and long-lasting. Once this understanding about your pain begins to make sense, you can begin to put it to the test by experimenting with movement and activity. If your providers are right about your pain, increasing movement might cause you more discomfort (at least initially) but it won’t damage you. Gently you can begin to increase your activity level, paying attention to whether or not any re-injury is taking place. If not, this is more evidence that you can safely increase your activity even though you have this much familiar pain. You may discover that it is possible for you to decide to give less attention to your pain without putting yourself in danger of more harm.

Developing pain tolerance

In this section we want to describe ways you can suffer less by learning to think about pain differently. First, let’s talk about paying attention. Most of us have had the bad experience of waking up in the middle of the night in pain, with a headache or toothache, or maybe with low back pain. After struggling to get back to sleep we are likely to eventually get up, maybe to stretch or take pain medicine. Sometimes people read or watch TV or have warm drink, hoping to fall back to sleep. These things help mostly because they give our brain something else to do. Lying still in a quiet bedroom with nothing to think about but the pain causes us to feel more pain. Our brains are built to focus on the most attention-getting signals coming at us at any time. This is why it’s so important to avoid staying focused on pain when the pain can be safely ignored. By giving the brain things to be aware of we can move it away from focusing on pain. A cup of tea in the middle of the night helps in part because it is a pleasant way to move your brain’s attention away from something distressing and uncomfortable.

Doctors refer to this as an inhibitory brain process. When information from the environment uses up enough processing space in the brain, there’s not as much room left for feeling pain. By paying attention to what’s around us, for example by watching a good movie or playing a video game, you can decrease your brain’s ability to pay attention to pain. This is true of activities that are fun or really interesting as well as things related to survival or your sense of basic safety. Soldiers and athletes will often not even notice their wounds until they are safely away from the heat of battle or competition and have the chance to relax. Anyone can use physical movement and touch in the same way. When we move with exercise, walking or having fun dancing or when we are touched in certain ways – for example during a massage –signals are sent to the brain that will crowd out the pain signal.

It’s also possible for the brain to make its own internal signals for soothing pain through a process called “descending inhibition”. Good examples of this process are when you use your imagination, for instance when you day-dream, use guided imagery tapes, or self-hypnosis. During these activities you are not relying on physical distractions but instead are working with your brain to generate your own internal conversation. You make yourself a set of mental pictures that work to block the experience of pain.

We now know that during such activities your brain actually sends a signal back down the spinal cord that partially blocks the pain signal coming up the spinal cord from the body to the brain in the first place. This is a big part of what’s happening for example when you learn to use your power of thought to develop images that help you relax and feel a sense of well-being.

The same thing can happen when you learn to produce mental pictures or physical sensations that reduce pain directly. A popular example of this is the kind of mental relaxation training that people learn to stop pain in a body part that is being made worse by muscle tension, tightness and inflammation. Such training may include giving yourself relaxing messages in which you tell yourself to slow down, let go, breathe deeply and so on. You can also use visualizations or mental pictures of muscles relaxing and getting stronger, body parts being warmed or cooled as needed, and pain signals being slowly weakened or dissolved.

Related to mental imagery is the role of mindfulness and meditation. People often think of meditation as a way of finding a quiet place to escape from the discomfort. Actually a good definition of meditation is that it is learning to pay attention to what’s right in front of you, and learning to ‘be present’ and to stay aware of breathing for instance, no matter what else is going on around you.

Remember that in a previous section when we were talking about feelings we said that the only feelings that cause us trouble are those that we try to resist. In a similar way we know that feelings are much easier to manage and live with when we learn to simply sit quietly, and allow ourselves to feel what there is to feel, without trying to resist or change it. A very useful experiment is to learn to respond to pain in the same way. Once we’ve figured out that pain can be safely ignored then we can also learn to sit quietly in the presence of the pain, without fear or worry. If it’s true that the more we try to resist discomfort the worse it gets, then we should be able to benefit from the practice of simply paying quiet attention. Being quietly interested in just what’s in front of you, like your breath, or your chronic pain for that matter, is a way to change your experience of pain in a positive way.

Summary

So, to actually reduce your pain and learn to manage it more effectively using your thoughts there are several steps to take and some different techniques to practice:

First, work with your health care providers to clarify the meaning of your pain. What’s it really telling you? Can you safely ignore it without running the risk of causing yourself any harm?

If the answer to that question is yes, it’s time to get busy. Gradually develop patterns of increasing physical activity. Use gentle touch, heat, cold and other forms of physical stimulation to disrupt or interfere with the pain signal.

Develop activities that use your mind. Read interesting books or magazines, watch good movies, play video games, and get on the computer. You may also find it very useful to gradually and carefully begin to make new friends. One of the psychologists who pioneered a number of effective pain management techniques, Dr. Wilbert Fordyce, was known for a number of simple, wise sayings, including his observation that “People who have something better to do don’t hurt as much.” What he meant is that if we keep the brain busy with pleasant or neutral information, we can crowd out the perception of pain.

Develop the use of techniques such as imagery and visualization, and even self-hypnosis. Specific training modules for doing so will be added to this website.

Finally, experiment with mindfulness meditation. Sit quietly and just focus on breathing, allowing your body to feel whatever it will. Notice your sensations and make an effort to just return to your attention back to your breath. This is a remarkably difficult but rewarding activity to practice. Even just sitting for 5 minutes twice a day will significantly change the way you relate and respond to your pain.

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