This is module II of my free chronic pain course.
If you came to this site via a search engine or via a link from another website, you can start this free course by clicking here. This way you will receive all the modules in a logic and easy to understand sequence.
Why do we need to talk about what pain is? It is obvious, isn´t it? Maybe it seems to be stupid to even raise that question?
But let me assure you, it is not!
Actually, it is one of the most important questions, as really understanding pain is a key component of getting out of pain.
When I read through all the mails I am receiving, there is a recurring pattern, and it is this:
People do not understand pain, and they fear it!
People do not understand pain, and they fear it!
The consequence is that pain starts to control and manipulate their lives drastically.
This is not necessary, and it is only because they do not know what pain is and how it works.
This is why we need to illuminate and shed some light on it.
After this article you will clearly understand pain, or at least you will be clear about what it is and what it is not, and that will take away a lot of its scary nature.
Per definition pain is an unpleasant sensory and emotional experience, associated with actual or potential tissue damage.
As this is quite a mouthful, let us have a closer look at what that means.
The sensory part just means that you feel something.
The emotional part is what you make out of it, what it means to you, what you think it is, how you feel about it. And that of course is highly subjective.
Furthermore, in my opinion, it is what makes pain pain. Without that emotional and judgmental component, it would be nothing but a more or less intensive feeling.
To make things even simpler I would state that you can label pain a pain if you have an aversion to it, if you are bothered by it, if you want it to go away as soon as possible.
That to me is pain, or at least it is the pain that takes away the quality of your life.
Now let us talk about how pain usually begins.
First, let us examine the traditional path, the one most people experience and then let us have a look at a path that especially people in chronic pain experience.
Imagine there are countless reporters in your body, constantly updating your brain with the newest information, gossip and happenings in your body.
These reporters are highly specialized. Some of them are constantly “chatting with your brain”, and some of them are quiet and only start talking to your brain once they spot potentially dangerous changes or actual harm (for example a hand too close to a camp fire or a sprained ankle).
The information these reporters communicate to your brain is the sensory information – it is what you permanently feel in and on your body.
The information put forth to your brain by reporters which only get active during potential danger or harm, is called nociception. Literally nociception means sense of pain.
And traditionally pain is meant to be a warning signal. So nociceptive input is a warning signal sent towards your brain
Once the information arrives at the brain it gets evaluated.
For example, “where does the info come from (what body part) and how strong is it”? These are the objective parts of the info, and only display a small part of the puzzle.
Way more important is the fact that this info gets mixed up with other info from inside your mind (things like experience, belief, expectation, …) and from the outside (visual and auditory input). This info is purely subjective and might not reflect reality.
For example: We feel something and then …
All this info from inside our body, your mind and from the outside gets blended together and at the end of the day your brain must make sense of it and make a decision.
Your brain has to make a decision!
Is this dangerous or not? After this evaluation we might or might not experience pain.
What exactly determines if we feel pain is not 100% clear. Ideas suggest that we feel pain if we think we are in danger, and that of course is highly subjective, too.
This danger can be real (hot fire) or imaginary (an MRI showing a minor and harmless lesion of a disc, which scares us, or we think or get told is dangerous).
So, what is the sense of pain? Is there a sense after all?
Acute pain points to a potential or actual danger or damage, so it is a warning signal.
But with chronic pain things are different. Mostly, injuries have healed, diseases have been cured, but the pain persists.
When pain becomes chronic it loses most of its warning characteristics and develops its own momentum and becomes a disease of itself.
That is the position very often taken in traditional medicine. They say chronic pain has become a disease itself (with which I would agree), but that it has lost its warning function, and this is something I do not agree with completely.
For example, when cancer, MS or other serious diseases are there, why is there pain? It is “too late already to warn”, so what is the point? The disease has broken out and pain does not serve as a warning signal any longer. That might be true.
But most people in chronic pain do not have such serious diseases, but still experience pain.
From my interactions with my readers and from personal experience I think chronic pain still has a warning function in most cases.
But the thing/threat that it points to has changed from a physical one to an emotional or psychological one.
For people with serious diseases that might be less true (although the more I learn about psychoneuroimmunology, the less I am sure of that either), but in the end that seems not to be too important after all.
We have seen an indication for this with Simon, who has MS and neuropathic pain, but still found tremendous relief from his pain by applying neuro mind techniques on a daily basis.
Of course, this did not cure the MS, but it helped him to get relief from his pain and to claim his life back.
Relief is possible, even in the presence of disease.
That again shows how possible relief from chronic pain is, even in the presence of disease.
But back to the emotional/psychological threat that I believe chronic pain often wants to point to.
It is probably no coincidence that people in chronic pain are very often perfectionistic, disciplined, hardworking, successful and ambitious. Although sometimes they do not see themselves like this while other people clearly see how hard they are on themselves.
I also found that many people in chronic pain often are very caring for other people, either in their family or in their jobs. A perfect example for this is Judy, who said:
“With us people in chronic pain it seems to be common to be very driven, like Type A people. I personally always had compassion for my friends and my family, but not for me. Now I have learned that and I am working on it. I am learning to truly look after myself, and it feels like I come back to my real me”
Maybe dare to take a closer look at your life.
I think pain is often a sign to take a closer look at your own life, on how you perceive it and how hard you are one yourself. That is especially true to me when it comes to chronic pain.
I think chronic pain might not only be a disease, but indeed a warning signal, too.
A warning sign that we need to take better care of ourselves, or that otherwise we eventually not only damage our body but also do a great deal of harm to our mind and psyche.
So many of us are so hard, too hard on ourselves – we just want to do it right, do what we think is right, or do what others expect us to do.
I think chronic pain very often is a sign – our body and mind find a way to get our attention and this way tell us to have a closer look at our lives and ourselves. There might be issues (conscious or unconscious ones) to be solved.
This is a difficult task and often help from outside is needed, in form of friends, books or therapists – depending on the “size” of the issue and our resources to deal with it.
Having said that, I do not think it is necessary to immediately solve these issues, however acknowledging and accepting them is a must.
I think and experienced that it is totally possible to find relief if we just begin to change our attitude towards pain by practicing neuro mind techniques and accepting our life as it is – at least for now and in this very moment.
This way we not only tackle sensitization, the physio-neurological basis of chronic pain, but also the psychologic component of it, namely the way we reflect and interpret pain.
Ultimately this leads to a positive change in the way we treat ourselves, the way we think and the way we act.
The absolute root causes of our problems that pain maybe wanted to point to (like repressed anger, perfectionism and hard work due to low self-esteem, the unpleasant workplace situation, financial hardship etc.), might not be eradicated.
They still might be all there, but the affect they have on us diminishes.
Slowly, slowly, one step at a time we gain back control of our inner world, and thus can relieve a lot of pain, in many cases completely, so it does not limit us in the way we want to live our lives.
From what I have told you so far you might have already an idea on what influences pain, but I want to take a closer look, so you will really understand how big the impact of your brain and your thoughts is, when it comes to pain.
This way I would like you to realize the power of neuro mind techniques.
Let us start with tissue damage, something we know can but does not have to have an influence on the level of pain.
In a lot of cases there is a correlation between tissue damage and pain, but there are also many cases where there is no such one.
While it is usually true that a broken bone will hurt more than the sting of a bee, it is also true that many people with severely damaged or degenerated discs, spinal canals, scoliosis and other things do not experience pain at all.
The simple message is: Pain does not equal tissue damage, and tissue damage can but does not have to be the source of pain. Especially in chronic pain it rarely is the main cause.
So, let us turn our attention to these factors that have a way more powerful influence on how strong you feel pain.
I would like to divide these factors into external and internal ones, and already now want to emphasize that the latter are way more powerful.
External factors are the things we get told, we see, we hear etc.
These things then undergo evaluation of internal factors. Things like belief, experience, knowledge, emotions, personality etc., which ultimately have the biggest influence on our pain experience.
But let me slice that down for you and look at these factors one at a time.
Let us begin with the external factors. A doctor, a friend or your spouse might be there to discuss with you your situation. Their words can be calming, reassuring, understanding, or they can be frightening. It all depends on the message and the way you interpret it.
There is a huge difference between the scenario where…
… your doctor tells you that there is no real damage, or that the damage might be nothing to worry about, that your pain might be mental and due to stress and your current life situation, that there are ways to deal with that, that many other people have similar problems, and that over time and with help you will be fine.
Or:
… where your doctor tells that you might need surgery, that you have a really bad spine, does not take the time to explain you everything in detail, uses jargon you do not understand and that might actually scare you, dismisses your story and your feeling that your pain might be due to stress, cannot or wont explain why you are in pain although your spine and all other things look OK.
The potential outcomes of these two scenarios can be very different.
In the first scenario you probably feel calm, supported and maybe even experience some relief from your pain, just because you now understand it.
In the second scenario however, you might feel an aggravation of your pain, and you might develop fear and anxiety towards the pain, which can aggravate it even more.
Still, what both scenarios will do with you and the way you experience pain is determined by your interpretation of and your belief in these words.
If you do not belief in what you hear, it does not matter if the words are positive or negative.
If you think or actually know it better, it will be what you think it is – if that makes sense to you. It will become a self-fulfilling prophecy, simply because of the power of your mind.
If you do not believe the soothing words of your doctor, you still might be scared and if you do not believe in the horror scenario someone is painting for you, you also might not get scared and will not experience any aggravation.
Here you can see the immense power that your mind and your inner world has on you, and thus I would also like you to realize the power of neuro mind techniques.
Therefore, I want to dig even deeper, and give you real life examples on how belief, experience and expectation, fear and anxiety, information or a lack of information, personality and perceived threat can influence your pain.
I want to emphasize that all these things lye under your control and that you cannot separate them perfectly from one and another, but that they show some overlap.
I will begin with belief, experience and expectation and then go on with the rest.
In the example above with the two scenarios I made the point of how strong belief and trust can affect pain, and in my opinion belief blends with experience and expectation.
I think experience is a precursor for expectation and belief. Experience comes first and shapes expectation and belief.
Here are two real life examples on how belief and experience can shape pain.
Dr. Mosely, a pain scientist, shared a nice story which I want to share with you, too. I do not remember all the nitty gritty, but enough to get the message across.
Dr. Mosely likes to spend time outdoors camping and walking in the bush. Of course, every now and then he would get some light bruises and stings from thorns lying on the ground. One day he felt such a sting, which he had felt so often before, and thought he might just have stepped on a thorn. He thought he knew what had happened and was not really bothered by it, but he was bitten by a snake and had to be treated!
What was a dangerous situation did not bother him too much as he thought he had just stepped on a thorn.
But this experience drastically shaped his belief and expectation system. Sometime later Dr. Mosely again went camping in the bushes and while taking a walk stepped on a thorn, like so many times before.
But this time he felt an excruciating pain. His brain had learned that there were snakes around in this type of terrain and had built a new association with the feeling of a sting in that type of terrain.
Now a sting was possibly not only from a thorn, but might also be from a poisonous snake, and might equal a life-threatening situation.
This story nicely illustrates what past experience and expectation can do to us when it comes to how and how strong we experience pain, even in the absence of a sensitized nervous system.
The second story is one of my own and back from the day when I was suffering from chronic forearm pain.
I had been in mild but disturbing pain for months. Pain that did rise after a rock-climbing session but did not pass away.
I thought I had injured a muscle in my right forearm.
My pain did not get better after a week or so, and I decided to see a doctor and found that there was no injury.
But instead of my pain getting better over time, it persisted and got even worse.
It started to spread and now I had the very same pain in my left forearm, too.
At the time, that left me puzzled as you can imagine. Now I know this was due to sensitization. But no one understood this, and I got the wildest and most absurd explanations why I was in pain.
But none of these explanations made sense to me, and most of them were related to biomechanics and my posture. This is a very common explanation people get when they ask why they are in pain.
And do not get me wrong. Biomechanics play a big role, but bad posture does not produce these “strange” pains that are so diffuse and hard to replicate.
And then too, even with bad posture you might be pain free, although it might limit you in sports.
When biomechanics and posture are the main source of a pain issue, it can be reproduced by certain movements, and often goes away once you get of out of that movement.
Bad posture can be a source of pain, and this pain can be the trigger for sensitization and then for chronic pain. But once that has happened, looking only at posture and movement will not help at all, or only transiently – at least that is my experience.
But back to my story. I was told a lot of bullshit (sorry for ranting) from therapists – I believe because they either did not understand my symptoms themselves but ignored that and still wanted to help, or they were so caught up in their belief system that they could not look beyond what they have learned and believed in – although it obviously did not help. This is a very common scenario, unfortunately.
One day however I saw a therapist that had a massive impact on my pain. He assessed my posture and simply said: You are alright, not perfect, but alright. You should be lucky, there many people with real structural problems, you don´t have any. Just go climbing, it will do you good.
He did not explain me anything about my mind, my beliefs and thoughts and how they influenced my pain, but he told me the truth for my situation back then.
From that day on I had 50% less pain, and it was when I realized how powerful my mind is.
It was then when I started to trust my feelings and thoughts, my own analysis of myself and came up with my very own ideas how to get out of pain by reprogramming my brain – and it worked.
I talk about this in way more detail in my personal story with chronic pain, which you can find on my website on my about page.
But why am I telling you all this? I tell you this because if you are in chronic pain, it is so important that someone educates you on what pain is and busts some myths for you.
This is my first try on this. But I also know how important it is to have someone answering all the questions that might now come up in your mind, how important it is to be surrounded by people that have or had similar problems and to be guided on your journey out of pain.
It makes things so much easier and faster. What took me basically 10 years of my life to figure out, takes people in the Phoenix Program usually not more than 6 – 12 months, which is nothing but simply amazing.
Therefore, I recommend the Phoenix Program. It is a place where you find all the support and knowledge you need, which is nicely shown by some quotes from people in the program. These quotes are taken from some interviews with them.
“Because people in the Phoenix Program are from all over the world, there is always someone around, no matter what time of the day. There is always someone with hope, someone to support and help you.”
“I had so many questions when I started – questions on medication, questions about what could be causing my pain. Jonathan and Naomi were always happy to answer my questions and were tremendously reassuring.”
This is a huge one! Being afraid, being scared of pain and worrying the next move could knock you out for days or brining up a flare, this is one of the biggest issues for people in chronic pain.
In my opinion this mainly stems from two things.
Let us start with the lack of information as well as “wrong” information, which I talked a lot so far but without giving it a name.
In my experience the lack of information is one of the biggest issues with people in chronic pain because it allows them to interpret horror stories into their pain.
They do not understand it because no one explains them what pain is, and this often scares people.
Their imaginations what might be wrong with them go to wild places.
People think of what they could have, how seldom and bad their situation must be because no one has a sound explanation for their pain.
Because people then are scared and often worry 24/7, they prime themselves for chronic pain because they develop unhealthy associations in their brain and increase muscle tension due to self-created stress from worrying.
More on this in the next part of this course, where I explain how pain becomes chronic.
For now, it is enough to know that a lack of information can lead to fear which then might occupy your mind permanently and thus make the pain the center of your life.
But not only the lack of information is a factor but also untrue, false information.
A classic example is the bad back with herniated discs and persistent pain. If you have such a condition and you get treated for it correctly, your pain should get better, IF the disc was the initiator of your pain. If it was not, or if it was just a contributing factor, your pain will persist.
Please note that a herniated disc definitely can cause pain, but that this pain should get better over time. After some months the pain should be gone, and if it has not, it is probably not your disc any longer that is causing the pain but rather a sensitized nervous system, which should be treated with different means than physical problems.
Unfortunately, this is often not acknowledged.
Quite often, more drastic procedures like surgeries are recommended and actually executed, but often do not help.
This can put patients on a long and frustrating journey, and although it is known for decades that pain is nothing mechanical in itself, this still gets ignored by many professionals.
This is why education on pain is so vital and important.
Side note: Pain is nothing mechanical but can have a mechanical reason.
Let us talk about perceived threat, another great influencer.
What do I mean with perceived threat?
It is the potential consequence that pain might have on your life. Things like…
In my experience, the more drastic we perceive such a “threat” or these consequences, the stronger the pain can become.
And this is a very subjective thing and heavily depends on how well you are able to deal with the stress of life and yourself.
Again, I would like to point out my idea that chronic pain serves a purpose, namely, to point to the fact that we must take a closer look at our lives.
If we are struggling in our jobs, we can ask why. But for a “real why”, not falling short and blaming our suffering on others and victimizing ourselves. We rather can have look how we ended up in that particular situation in the first place and how we contributed to it.
The same goes with our mortgage, hobbies, partnerships, roles in life, and everything else.
You can always ask yourself the question: What game am I playing? Why am I doing what I am doing? Go deep! You have to go beyond the surface to get real answers to these questions.
But once you receive them, it will shed a lot of light on your situation and you might start to see clearly.
You might see what contributes to your anxiety, and to your pain. This can be very calming, but emotionally painful at the same time. But it will help you to see clearly.
Las but not least I would like to say a few words on personality and chronic pain, as this will blend with all the things I have said so far.
Jonathan Kuttner, the founder of the Phoenix Program, found that people with chronic pain are often very perfectionistic, hardworking, often successful, and / or caring for others.
I found the very same thing when I interviewed with my readers, or when I read through the mails I receive so often.
So often I see people striving for extremely high ideals and being very hard on themselves.
This can become problematic, emotionally as well as physically.
Physically this attitude can alter muscle tension, which can contribute to physical factors (muscle tension, inflamed tendons, etc.) that can perpetuate signals that might lead to sensitization and thus chronic pain.
Again, I think the pain serves as a sign post. Wake up and take care of yourself – not only physically, but especially emotionally.
In the next part of this course I will explain how pain becomes chronic. It will be the logic extension of this module.
And if you have not done it so far, I highly recommend checking out the Phoenix Program.