Pain Pain Go Away

“To diminish the suffering of pain, we need to make a crucial distinction between the pain of pain and the pain we create by our thoughts about the pain.  Fear, anger, guilt, loneliness, helplessness are all mental and emotional responses that can intensify pain.”

    -Howard Cutler (Author, Psychiatrist)

In my years as a psychiatrist, one thing has become crystal clear to me: most things will never be crystal clear.  It seems that in any given week I have yet another “just when I thought I’d seen it all…” moment.  The human body and mind are so complex that we may never have a full understanding of why the course of life for people in similar situations or with similar problems can be so different.

 A good example of this is chronic pain.  One person who is involved in a fender bender will walk away and within one day have no thought about it.  Another person, in a nearly identical situation, may wind up with headaches, neck pain, and other somatic problems for months or years.   Sometimes the etiology of chronic pain is obvious; severe and progressive arthritis, tumors and massive injuries.   Known associations to chronic pain include depression, history of past emotional or physical abuse or feeling “victimized”.   Any way that you look at it, chronic pain can be one of the most debilitating and horrendous disorders from which a person can suffer.   I am not smart enough or dumb enough to claim that I understand exactly why some people suffer so much while others do not. 

 Chronic pain can be such a confounding problem that the medical community itself has not even agreed on its definition.  Some say that pain is “chronic” if it lasts six months or more.  Others say the number should be three months.  Another point of view is that pain is chronic if it persists past the “expected time of healing” (whatever that is).   The term “sub-acute” pain is used by some to describe pain that persists greater than one month but less than six months.   There are also several “types” of pain; superficial and deep somatic pain, visceral pain, neuropathic or nerve pain, musculoskeletal pain, phantom pain, heart-break,  pain in the neck, even being a pain in the…  well, you get the picture.

 For people with chronic pain, by the way, who cares what you call it?  IT FREAKIN’ HURTS!   They are suffering and feel miserable.  In my view, one characteristic that many chronic pain sufferers share is a feeling of anger.   Anger can lead to all of the emotions in Dr. Cutler’s quote and more.   I therefore believe that, in order to help deal with chronic pain, a person must work on his or her anger about the pain.  Pain is real.  I never question a person’s experience of pain.  I believe that the way that person feels is completely valid.  What I urge is that the person work on the thoughts those feelings cause. 

 One of the most effective ways to do this is to first accept the situation.  Accept that hurting all of the time is horrible.  That it should feel awful and should cause strong negative emotions.  This is important because without acceptance, a person’s energy can be displaced from where it needs to be.   There is a quote about acceptance that I like: “The rain is unbiased and the recipient of this downfall has the option to either accept this or yell at the clouds his whole life.”   I do not know the origin of this quote, but it illustrates my point.  The greater time the person focuses only on the pain and angry negative feelings, the smaller the chance of improvement. 

 This makes sense if you think about it.   If you never accept a problem, never admit that it is your problem, how can you ever work on it?  This does not mean you have to “let go” of your emotions or feelings about it.  You can hate the problem, be furious at it, feel awful about it, regret it, and wish it was not there, but then ask yourself what you can do about it.  The key to moving forward and improving is to challenge the negative and maladaptive thoughts that the feelings cause and to replace them with adaptive and coping thoughts.

 This is the fundamental basis for a therapy called Cognitive Behavioral Therapy.  It has been studied in chronic pain and shown to be a benefit.  This is especially true when combined with medical treatment for the pain, good self-care and treatment of any other condition, such as depression, that could interfere with recovery.

 Bad things happen to people all the time.  When those things cause injury or chronic pain, it is easy to get caught up in the “unfairness” of that and the anger about it.  Your mind has the power to make pain much worse or better.  To achieve the latter, seek support.   Never try to “go it alone” with pain.  Find a good therapist.   Work on yourself.   Surround yourself with friends.  Use all the resources you can to help you stop yelling at the clouds and to get your umbrella out.

5 thoughts on “Pain Pain Go Away

  1. Geoff Schaney says:

    Dr Steve,
    Your thoughts regarding pain are very similar to conversations you and I have had over the course of my therapy. I agree with everything you say especially the use of cognitive behavioral therapy. You worked with me on that and I agree, it does work to a degree. I am finding that one of the major issues with chronic pain is the associated sleep disturbances that occur due to the pain. Having dealt with pain for twenty plus years and that pain increasing in frequency and intensity, loss of sleep has been my nemesis.

  2. Debbie Karrer says:

    Thank you for this. I have someone in my life with chronic pain and he’s always angry (at me). This helps to understand him a bit better. I have enjoyed all of your essays and have shared some of them with others. I hope you don’t mind. It’s hard to keep wisdom to yourself. 🙂

  3. Mike and Carol says:

    Jamie is not your only reader and we tell everyone we know to check your site out…you have wonderful insights and wisdom to share and you share it in a way that is so unaffected and honest that no one could feel you are preaching….
    Keep it up and we still want you to autograph the book that you may someday publish…

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