“One of the major reasons why pain becomes immortal in our bodies is how we feel in our minds”Haider Warraich, physician and author of The Song of Our Scars: The Untold Story of Pain

We’ve all had to deal with pain at some point in our lives. The most common are back pain and headaches, but there are other ways to experience pain. It can be acute, such as stubbing your toe or accidentally bumping your head, which I’ve done numerous times, a minor inconvenience of my height. But it can also be chronic pain, which is fundamentally different. It can linger long after an injury has healed, resulting from arthritic joints or nerve damage from a traumatic injury. “In these cases, injured nerve fibers mistakenly continue to send pain signals to the brain”, causing what is known as neuropathic pain such as sciatica. Struggling with chronic pain over a long period of time is physically and emotionally debilitating. So much so, that we will try anything to get out of the discomfort.

A logical first step is to seek medical attention, but visiting your doctor for chronic musculoskeletal pain has its limitations and potential negative impacts. In fact, most primary care doctors are not trained in pain management, and they don’t have the time or resources to delve deeply into the cause of your pain. Pain treatment in a primary care setting usually involves prescription pain medications, or procedures such as cortisone injections, or you’re given a printed handout of exercises to manage your pain on your own. This unfortunate experience sets us up for a frustrating cycle of “chasing pain” from one doctor to the next, or leads us to seek out holistic pain therapies such as massage, acupuncture, cupping, etc., hoping to find relief. The frustrating search to resolve pain has contributed to an opioid addiction epidemic and unnecessary surgeries, while chronic pain keeps escalating in our country.

The Biopsychosocial Model for Pain Treatment

Five ways to reduce pain model

Most pain management researchers and clinicians agree that treating chronic pain should not just be a medical intervention, but rather a multidisciplinary approach. Biological, psychological, and social factors can all play a part in chronic pain. Once you realize how your body, mind, and social environment are related to your symptoms, you can start to address all the potential factors that might be contributing to your pain. In other words, you can’t just go after your body parts, such as your back or knee pain. You have to target the brain and lifestyle behaviors as well!

Rather than seeking pain meds or another procedure from your doctor, changing lifestyle behaviors should be your first strategy. Ask yourself these questions: Am I getting good quality sleep and nutrition? Am I drinking enough water? Is my work or family life stressful? Do I have good relationships with friends and family? And am I getting enough outdoor activity during the day? It’s understandable that if you’re in chronic pain, you’re less likely to want to move and more inclined to isolate yourself indoors and become inactive. However, prolonged periods of sitting while being socially isolated leads to detrimental changes in the nervous and immune systems, and increases the likelihood of staying in chronic pain.

Pain’s most important job is to protect you from harm. If you stub your toe for instance, your nervous system will send a pain signal to your brain to let you know how severe the injury is. If your toe is broken, the pain volume is cranked up and you won’t be able to walk without pain. If the injury to your toe is slight, your pain will quickly subside and you’ll be back to regular activity. But there’s no quick fix for chronic pain, mainly because our brain and emotions are involved.

According to researchers, chronic pain is both physical and emotional. Negative emotions are “like gasoline thrown on the fire of pain”, making chronic pain much worse, and even causing it in some cases. If you’re depressed or a highly anxious person who fears being in pain, you’re more likely to develop pain than others. The anticipation of pain from a movement or an activity is enough to steer a person away from the activity. In fact, even the early fear of pain can become a permanent self-fulfilling prophecy.

If your emotional state is unstable, you could be sending ongoing pain signals to your brain, which can become more sensitive over time. “Scientists say the more the brain processes pain, the more perceptive it gets until it’s always on high alert”. According to Rachel Zoffness, a pain psychologist and author of The Pain Management Workbook, you can “practice” at making your pain worse. She says that neural pathways in your brain are like the muscles in your body. The more you use those pathways, the bigger they get. For example, while learning to play a musical instrument, the more you practice the bigger those pathways get and the better you become playing your instrument. On the other hand, the more you inadvertently “practice pain”, the bigger the pain signals get and the more your brain becomes sensitive to pain. However, studies show that you can tone down an overly sensitive brain and moderate chronic pain messages with pain management techniques.

Active Recovery: If You’re In Pain, Moving Your Body Helps

It wasn’t that long ago that most doctors and therapists advised people with chronic pain to rest and avoid activity, but we now know that “being inactive will tend to reinforce pain sensitivity pathways.” This is why pain can be most prominent when you’re at rest. For people with chronic back pain, certain movements may trigger unpleasant sensations, but that doesn’t mean damage is being done. Slowly beginning to engage in physical activity (i.e. graded exposure) is crucial to overcome the fear of certain movements. “When someone avoids activities completely, it doesn’t allow the brain to recalibrate” and to realize the movement is safe.

Studies show that light to moderate physical activity such as walking often reduces feelings of pain during or immediately afterward, and raises people’s pain thresholds. In fact, walking with more postural awareness and arm swing can be very therapeutic for people with low back pain. If a certain type of movement or physical activity that you enjoy triggers pain, the best strategy is to implement small doses of that activity and try to increase the dose over time. Doing so will help decrease the sensitivity of your nervous system, not only because the physical activity is graded, but also because you are participating in an activity you value. The bottom line is if you’re dealing with an injury or have sensitivity to pain, don’t stop moving your body! Use it as an opportunity to bring more awareness to your body by teaching the brain that it doesn’t need to create pain in reaction to specific situations and movements.

Social Interaction and Pain

People who have a greater sense of connection and belonging seem to experience pain differently. Studies show that people who are more socially connected experience less pain than those who are less socially connected. It’s not clear why having healthy relationships and a sense of belonging helps with chronic pain, but it could be that connected people feel safer and less anxious. When we’re stressed and our body and muscles are tense and tight and our thoughts are worried, we’re more sensitive to pain. Knowing that we can lean on others for support can reduce anxiety and vigilance around unpleasant bodily sensations, which could decrease our experience of pain.

If negative emotions can make chronic pain worse, then it would make sense that positive emotions—feelings such as happiness, excitement and calmness—can lower perceptions of pain intensity. When we interact with close friends, it triggers positive emotions “when endorphin binds to opioid receptors in the brain”. This gives us that feel-good factor that we get from seeing our friends and “can have a powerful pain-killing effect”. Furthermore, acts of kindness not only amplify positive feelings but are linked to enhanced interpersonal relationships, reduced stress, heightened happiness, increased life satisfaction, and even lessened chronic pain.

Mindfulness Strategies

People meditating

There’s no doubt that your brain and body are kinetically related and can influence how you perceive pain, for better or worse. As I mentioned above, negative emotions turn up your “pain dial” while positive feelings have the opposite effect. Your words and emotions can affect how you feel, so becoming more mindful of self-talk can help calm pain. Mind-body practices that utilize breathing, such as meditation and yoga, are aimed to change a person’s mental or emotional state and can help with pain relief. Relaxation techniques such as breathing exercises, massage, and art and music therapy can also help to reduce pain and inflammation, causing muscle relaxation and enhancing a person’s mood.

If you consider the number of chronic pain sufferers in our country (CDC estimates 51 million people, more than 20% of US adults), it’s apparent that pain management should be more than pills and medical procedures. We know that treatment for depression and anxiety is not just a pill, so it’s not a surprise that treatment for pain is not just a pill as well. The biopsychosocial model prioritizes emotional health as much as physical health. Healthy lifestyle behaviors such as getting good quality sleep, eating healthy wholesome foods, reducing stress, drinking enough water, getting enough outdoor activity during the day, and having strong social connections can help to reduce chronic pain. If you think about it, isn’t that just a healthy prescription for how we should live our lives?

If you need support and coaching to help you improve your health and overcome chronic pain, please ask about our Health and Pain Management Coaching.

Infographic of Chronic Pain