Chronic Pain as Path
John W. Steele, Ph.D. Licensed Psychologist
Chronic pain comes in many forms: headache, joint pain, fibromyalgia, sciatica,
etc. For me it was back pain. It waxed and waned for many years. Doctors
couldn’t find a cause. So I experimented with meditation, yoga, healing imagery,
and so on. My Zen practice helped me see that it’s possible to live with pain
without turning it into suffering. When I reframe pain as a challenge rather than a
threat, it makes all the difference. Still, there’s no escaping the fact that pain can
be tormenting. In my work with patients, I’m inspired to see what a powerful
motivator pain can be. Choosing to get up close to our own pain can set us on a
path of self-discovery. We gain access to our powerful inner resources, not only
for coping, but also for waking up and living to our full potential.
Acute pain serves as a warning signal. We instinctively react in ways that help us
avoid further injury. Acute pain usually goes away when injuries heal. Chronic
pain is often (not always) elicited by an injury, but worsened by factors removed
from the cause. It usually lasts for more than six months and is typically not
explained by underlying tissue damage. When we react to chronic pain as if it
were a signal to prevent further injury we make things worse. By avoiding
activities we associate with pain, we deprive ourselves of the exercise we need
to stay strong and supple. Continuing on this path leads to further disability,
despair, and suffering.
Many people seek medical treatment for chronic pain but it is rarely effective.
Medications often relieve acute pain. They are generally less effective with
chronic pain. Over time, pain medications tend to provide less and less relief. In
the case of opiates, their side effects include tolerance, dependency and
impaired cognitive functioning.
For several centuries a biomedical model dominated our understanding of illness
and still influences how we think about pain. The biomedical approach posits a
simple causal connection between tissue damage and pain: the more damage,
the more pain. Our current model of illness sees psychosocial factors interacting
with biological processes. Research has shown that the experience of pain is not
determined by the amount of tissue damage. For example, in a study of disability
in workers with back injuries, researchers found that physical pathology
accounted for only 10% of the disability, whereas 59% of the disability was
explained by psychosocial factors.
1The ‘gate control’ theory of pain shifted our paradigm by proposing that the brain
is not a passive recipient of pain signals. Instead, it plays a dynamic role in pain
perception. Studies indicate that psychological factors enhance or inhibit the flow
of pain signals and influence the way the brain responds to painful stimuli.
Cognitive and emotional reactions, such as hypervigilance to potential pain,
catastrophic thinking and fear of re-injury can ‘rewire’ the brain in ways that
makes the experience of pain more troublesome.
Our growing understanding of the brain and mind-body interactions brings new
hope to the field of pain management. Research supports the effectiveness of
modalities such as Cognitive-Behavioral Therapy and Mindfulness-Based Stress
Reduction. Such approaches can help us change our mental and emotional
reactions and develop more adaptive coping skills. Gaining mastery over our
pain can set us on a path of enjoying a more active, meaningful and fulfilling life.
1. Burton, A.K., Tillotson, K.M., Main, C.J., & Hollis, S. (1995). Psychosocial
predictors of disability in acute and sub acute low back trouble.
Spine, 20,722-728.