Managing the "Bad Neighbor" That is Chronic Pain

Pain is a brain-body-mind experience, which gives you more power to manage it.

Posted Feb 08, 2013

Millions of Americans suffer from chronic pain, which takes a significant toll on virtually every aspect of one’s life. Some of my patients have described it as like having a “jackhammer in one’s brain,” or a “fire” in one’s body. I’ve come to think of pain as a “bad neighbor,” among other things. As an example, anyone who has ever lived in an apartment building has probably has had at least one neighbor who was loud, inconsiderate, or otherwise horribly bothersome. Neighbors like these can be frustratingly unresponsive to polite requests to tone it down. We want to shriek at them, “Go away!” or demand, “Why are you doing this to me?” Yet, shrieking and yelling tend to leave both of you more aggravated in the end and typically result in worse, rather than better behavior on the neighbor’s part. Without a clear resolution in sight, one’s frustration and feelings of helplessness mount. In some ways, it is not so different with chronic pain, whose presence very often results in symptoms of depression, anxiety, and other mental health issues in addition to the pain symptoms themselves.

The good news is that it isn’t – and is – “all in your head.” What I mean by that is, by definition, pain is a complex perceptual experience that involves physical, cognitive, and emotional aspects, and causes the person distress. Because of the integral role our brains play in pain perception, we couldn’t even experience pain as such without a brain. So, it’s always “in our heads,” even when there is a discernable physical problem with nerves or tissues, etc. Furthermore, current pain research shows that our emotions and thoughts can either exacerbate or reduce the sensation of pain. So, distress and dwelling upon pain and its impact on physical function, relationships, employment, etc. can make make one feel worse physically as well as emotionally. Conversely, engaging in various cognitive, behavioral, and other mind-body strategies can interfere with the communication between nerves and the brain, reducing pain’s perceived severity and increasing feelings of calmness. Practicing the above can also shift how we perceive the meaning of pain.

For example, current research supports a relationship between catastrophizing thoughts (e.g., “It’s never going to get better! I can’t live like this!”) and increased pain intensity. Conversely, the construct of acceptance (i.e., the stance that despite having pain, one is committed to engaging in important activities and in effect, living one’s life) is associated with reduced pain severity, improved pain coping, and better functioning. So, instead of ”I can’t handle this! I’ll never be like I was!” the thought might be, “Walking my daughter to school in the mornings is extremely important to me. I know if I pace myself and practice x, y, or z, I can manage my pain well enough to tolerate it on the walks.” Small goals can lead to big gains over time.

I would add that the willingness to engage in activities and relationships that are meaningful even if things aren’t exactly as we wish they’d be can be incredibly healing. A good mental health provider can help one to better understand physical and emotional triggers of pain, learn how to pace oneself to avoid exacerbating symptoms while still engaging in normal daily activities, and increase feelings of acceptance, without feeling resigned or hopeless. And as pain severity is decreased and coping is improved, there can be significant improvements in enjoyment and function across multiple aspects of one’s life.

Some of the most effective mind-body tools for pain managment include mindfulness, hypnosis, and biofeedback. With practice, these can help significantly manage stress and improve pain coping. These can help you to lead a life that, while not perfect, can be more enjoyable and meaningful.

For many, eliminating pain completely may not be achievable. But, to use the neighbor analogy again, it is possible to note when the guy in the next unit is banging on the door to borrow yet another cup of sugar, or blasting loud music, and say to oneself, “Oh, there’s that annoying guy again.” Then, without either answering the door or banging on the adjoining wall, one can instead ignore the guy and walk away, shifting the focus to other, more important or soothing things. Finally, like most things worth doing, learning and honing skills for decreasing stress and pain symptoms takes practice, but in the long run, the benefits are worth the effort.