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Chronic Pain

Your Pain Is Legitimate

Behavior change can alleviate pain, but that does not make pain less real.

Key points

  • Pain is experienced in your brain through the trigeminal system.
  • Behavior change can alleviate chronic pain because of how pain is "wired" in the brain.
  • Changing how you react to pain may reduce how much pain interferes with your life; that does not change the legitimacy of your pain experience.

“Shouldn’t you have healed by now?”

“I think your pain may be all in your head.”

If you are living with chronic pain, you know how dispiriting these comments can be. We hear them from physicians and spouses, co-workers, and friends. These comments represent a fundamental misunderstanding about the mind-body relationship as it pertains to pain.

Your chronic pain has a cause.

The trigeminal system is the pain-perceiving center of the brain. Pain sensations picked up by nerves all over your body are sent to the trigeminal nucleus for processing. This is basically where those signals are translated into “pain” by your brain.

Acute pain occurs when we have actual or potential tissue damage, and those signals travel through our trigeminal system and are translated into the sensation of pain. The purpose of acute pain is to signal, “Hey! We have a problem here!” It allows us to make the best choice in the moment to reduce the possibility of damage to our bodies.

Chronic pain (pain that lasts more than three to six months) can occur for lots of different reasons. Sometimes, we have ongoing damage to body tissue due to a chronic illness, such as osteoarthritis. In some cases, nerve damage causes pain, such as diabetic neuropathy. But in other cases, our trigeminal system is literally working overtime. For people with nociplastic pain conditions, such as migraine and fibromyalgia, the pain comes from changes in pain-sensing pathways. Pain signals are being sent even though no actual or potential tissue is present. Some people may even have a combination: chronic lower back pain can arise from tissue damage and pain pathways changes.

All pain is experienced in the brain. And no matter what is causing your pain, you have a path forward.

Behavioral pain treatment addresses the biological realities of chronic pain.

Behavioral pain treatments can help alleviate chronic pain, particularly when combined with medication and other non-pharmacologic medical treatments. That is because pain travels on specific types of nerves. Although the initial burst of acute pain after an injury is a big, bold signal to your brain, most chronic pain runs on smaller nerves that are easier to interfere with. So, one way to manage pain is to interfere with pain signals.

Depression, anxiety, stress, and other psychological factors do not necessarily cause bodily pain. But they can impact the way your body perceives pain. You can think of pain signals like water trying to get through a hose. Some things, like depression, straighten the hose and allow the water (pain) to flow easily through. Other things, like doing a job you are passionate about, physical activity, and spending time with friends, can bend the hose, making it harder for the water (pain) to go through. The water is still turned on at the tap, just like your chronic pain condition is still present. But just as it is harder for the water to make it through to the end of the hose, alleviating factors make it harder for pain signals to reach the forefront of your awareness.

The way we react to stress plays an important role in how much pain we experience. Pain is a stressful experience. So we will likely respond to pain; however, we typically respond to other stressful experiences. When some people encounter stress, they plan for potential negative outcomes. This way of responding to stress may help you get ahead in your career but is less helpful when experiencing pain.

For people in chronic pain, a more adaptive way of responding to stress seems to be focusing on how you feel right now and problem-solving what you can do in the moment to help you achieve your goals. This is one reason why mindfulness and yoga may be so helpful for chronic pain. These techniques teach you to focus on the present moment and be more aware of all your senses, not just pain.

There is a reciprocal relationship between pain and functioning. The more you go to work, see friends, and exercise, the less pain you experience. On the other hand, it is clearly easier to function when you are in less pain. Therapists (occupational, physical, and psychological) all try to help improve your functioning while keeping your pain at a manageable level, because if your functioning improves, chances are, your pain experience will improve as well. So these therapists try to use times you feel best, like after a particularly effective medical treatment, to help you enhance your functioning so that you stand a better chance of reducing your pain experience in the long run.

Pain is not your fault.

“Shouldn’t you have healed by now?” Changes in your body or nervous system are still producing pain signaling in your brain, regardless of whether any initial tissue damage has healed.

“I think your pain may all be in your head.” All pain is in the brain. But your pain is perfectly real, regardless of whether it is accompanied by tissue damage. One type of pain is not more “real” than another.

At the end of the day, when people living with chronic pain hear these kinds of dispiriting comments from family, friends, coworkers, and doctors, it makes us feel like the pain is our fault. Like, somehow, we are causing this pain, and if we could just be different in some way, the pain would stop. But chronic pain conditions are not a matter of willpower. They are complicated, brain-body interactions that often require a multidisciplinary approach to effective management.

Behavioral interventions may help alleviate your pain; that does not make your pain less real.

Changing your lifestyle may reduce your pain; that does not mean your lifestyle caused your pain in the first place.

Changing how you react to pain may reduce how much pain interferes with your life; that does not change the legitimacy of your pain experience.

That’s just how pain works. Because pain is in the brain and in the body. And if doing cognitive behavioral therapy, physical therapy, occupational therapy, yoga, changing your diet, therapeutic massage, or walking daily helps you manage your pain, that doesn’t mean it is less real. It means you are taking charge of your care, building your pain care team, and finding a combination of strategies that help you manage a legitimate chronic illness so you can re-engage more fully in living your life.

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