Pain is in Your Brain & We Choose How We Suffer It


I start all therapy with this quote. It also opens one of my favorite workbooks: Seeking Safety1.

In both chronic pain and vestibular communities I see a lot of people have intense friction and at times even change doctors when a health care provider dares to suggest that their condition is partially psychological. There is this huge rift between doctors and patients when it comes to psychiatric issues. Both sides become extremely passive aggressive and usually part on bad terms without these symptoms being addressed.

The reality is that most of the time the doctor agrees that there is a bonafide chronic pain or vestibular problem at play. However, the doctor also believes that there is a behavioral component which is worsening and at times creating symptoms. This can come across as patient blaming, especially since most doctors have crap bedside manners, however, there is truth to this. It all comes down to the brain.

Emotional and physical pain are much the same, and they share the same biological mind

Our emotional brain neighbors and often shares space with how we process physical sensations, pain in particular. There is an evolutionary component to this. When an animal is injured the emotion of psychological suffering is what gets it to retreat and care for itself. This also occurs when sensory data becomes unreliable in the form of triggered anxiety. That emotion causes the animal to increase hyper-vigilance in order to safely navigate.

We human beings are no different. However, this shared emotional/sensation system can also perpetuate psychological and somatic issues. In chronic pain there is typically a feedback loop that develops between the physical pain response and the emotional pain response. We now know that chronic pain often causes depression, and depression worsens chronic pain. However, while we can’t often directly control sources of physical suffering we can take command when it comes to the emotional and indirectly also lessen physical pain.

I’ve written about this before in my article on Mindfulness and Chronic Pain2. There are also a lot of wonderful articles that discuss the relationship between physical and emotional pain.

How can we change our response to emotional suffering?

A good start is to change your routine when you are in pain. There are a lot of free and simple mindfulness meditation exercises that can help bring attention back to the present moment. Meditation does not solve the entire problem, but it gives us room. It reduces the noise of emotional pain. Much of our depression and anxiety comes from thoughts of the past and future. Much of the weight of anxiety and depression comes from anticipation. Often when I notice someone with chronic pain is struggling it is because they are caught in what they would rather be doing. This is a natural instinct, we don’t choose it, but we are the only ones who can overcome it.

Once we’ve shifted our emotional focus we can channel all of our energy into the now and come up with a plan. We have choices when it comes to how we endure pain. It makes a difference if we’re laying in dark silence, or if we’re watching or listening to something with the blinds partially open. Small changes can go a long way. Gently increasing stimuli also give the brain other places that it can attach it’s attention to. It’s important to have a chronic pain survival guide and do whatever we can to increase our comfort.

We also have to look at the long game when it comes to living with chronic illness

We have to have a sense of purpose in life. This can be hard to hold onto in the face of chronic illness since often our personal goals have been derailed. However, we need to keep going and identify what we live for now. While purpose does a lot to resolve emotional pain, it often can take things one step further.

When we have something that we are living for it is much easier to implement that pesky advice our doctors give us. When we have something we want to do it is easier to eat right, be more active, develop better habits and overall be engaged in life. Having something to live for often will totally flip the script.

I also challenge those who are living with chronic illness and not working to really do a thorough self assessment. There are a lot of credentials that can be gotten on the cheap at community colleges. Tailoring a career with chronic health needs is often possible. Fear tends to be what holds us back from taking these big steps in life. It is anxiety over being faced with pain and failure in the past, and fear of having to endure pain and failure in the future. You can see why I go on about mindfulness so much ;).

When work or school isn’t possible it is still imperative to find a positive reason for getting up each morning. Whether it be volunteering, patient advocacy, getting really involved in a hobby. It is also important to recognize when faced with a new diagnosis we have to grieve, and accept who we are now.

Therapy isn’t a terrible idea

If you’ve never done it before it might be an idea to go to therapy, and if you are in therapy and are stuck address this with your therapist. The goal of the therapist should be to help you see yourself better, and then help you identify plans for change.

However, having the right therapist is extremely important. I am going to admit my bias here: I am a new school therapist. Therapy has changed a lot in recent years, and many of the newer models focus more on improving coping skills in the present versus focusing on the greater self narrative.

The idea is that by regaining control of healthy affect regulation, essentially our ability to change our own emotional state, much of the overarching negative self narrative begins to resolve itself. We are who we are now. When we are able to change how we feel in the now, we are automatically beginning to rewrite our story.

I also feel strongly that most chronic pain patients can gain a lot of benefit from short term therapy. If a therapist starts with effective quick and dirty models like Motivational Interviewing or Solution Focused Therapy to create space to plan for healthy change behavior a lot of progress can be made really fast. Also, the newer models like Mindfulness Based Stress Reduction and Dialectical Behavior Therapy can help to quickly implement healthy coping skills.

When searching for a therapist, or attempting to re-evaluate your treatment plan with a current therapist it is perfectly ok to ask what models they use in therapy. It is actually a great idea to ask on the phone before even scheduling.

Models I find beneficial:

You may not be responsible for being knocked down, but you are certainly responsible for getting back up. – Wally Amos

We have within us an amazing capacity for change, and we have more control over how we feel than we think we do. It’s important to continue moving forward, and redefine life for what it is now. We do not choose to have our lives derailed by chronic illness, nor do we choose for it to affect our emotions. However, we are responsible for changing the picture, in fact we are the only ones who can do it.

Links Summary:

The connection between physical and emotional pain

How to change our response to emotional suffering

The long game: changing attitudes towards like with chronic illness

Evidenced based therapy models for chronic illness and pain management

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