Pain and other chronic symptoms (such as IBS, vertigo or bladder issues) tends to overshadow everything else in our lives. Pain and discomfort creates fear, and the two can become the focus, such that everything else in our lives fades to the background.
As we retreat from pleasurable activities, it is not surprising that depression and anxiety can follow. In fact, most chronic pain and symptom sufferers also suffer from depression or an anxiety disorder as well.
However, it can often be hard to know whether the psychological or physiological issues came first. Many chronic sufferers have a history of perfectionistic or people-pleasing tendencies that are also risk factors for depression and anxiety. And many pain and symptom sufferers experience multiple conditions that are commonly related to stress: digestive issues (IBS, Crohn’s, ulcers), migraine or tension headaches, fibromyalgia, bladder or pelvic pain issues, back or neck pain, hip, knee, shoulder or wrist pain, as well as anxiety or depression.
There is quite a lot of evidence that even pain that appears to have a physical cause can in fact be attributed to emotional factors. This was my experience. Years ago, I had chronic tendinitis in my wrists that was attributed to excessive keyboarding. I experienced inflammation and very real pain associated with using my hands to keyboard, garden, or even cook. I was treated by chiropractors, physical therapists, massage therapists and acupuncturists. I studied Alexander Technique and took Feldenkrais classes. Nothing helped much, or for long.
I had to severely restrict my activities to avoid pain. I got voice-recognition software, an ergonomic workstation, regularly wore splints on both wrists, curtailed activities such as knitting and gardening, never bore weight on my hands, and still had debilitating pain on a regular basis for over two years.
Then I came across an interesting book written by a doctor of rehabilitative medicine, John Sarno. In his work with people who had undergone back surgery, he discovered that there was very little relationship between the severity of the objective problem (a bulging disc, arthritic vertebra, scoliosis, etc.) and the level of pain experienced. And he noted that many other people who had the same conditions, as shown on their x-rays and MRIs, experienced no pain.
Dr. Sarno’s book, Healing Back Pain, addresses the psychological factors that produce pain in the body. He shows how stress and suppressed anger manifest in physical conditions that cause pain, and he has helped thousands of people overcome pain without any medical intervention. I read his book, and using his techniques I essentially eliminated my wrist pain. I now type as much as I want and don’t restrict my activities, and I experience only occasional, fleeting pain. Pain does not affect my life in any significant way anymore. I highly recommend Dr. Sarno’s books. His second book, The Mindbody Prescription, addresses other sources of pain and illness.
It can be very difficult to explain this concept to people who are in pain, because no one wants to hear “it’s all in your head.” It sounds too much like “you’re making it up” or “it’s your fault.” And doctors treating pain conditions have reinforced the belief that the body is the source of pain, because it is broken in some way. This increases the fear of causing additional damage, by attributing pain to structural variations that are usually normal age-related changes, such as bulging discs and arthritis. But studies have shown that many issues that are blamed for chronic pain are just as common in asymptomatic people (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/). A study of 3110 asymptomatic individuals at a range of ages found:
“Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.”
All pain is perceived through the brain and is very real. However, the perception of pain is greatly influenced by our level of fear and our perception of the situation. Pain is as much a response to the fear of damage than it is to any actual damage to the body. People who believe that a treatment will cure their pain are much more likely to experience relief from it. The fact is that much of the pain we experience is due to learned neural pathways rather than tissue damage or structural abnormalities. And for those who believe that their pain has a psychological basis, it is far more likely that evidence-based psychological treatments will reduce or eliminate pain than many of the medical treatments for chronic pain conditions.
In 2020, I completed a training by the Pain Psychology Center in working with clients experiencing chronic pain. A relatively new pain treatment, called Pain Reprocessing Therapy (PRT) was validated in a subsequent study at the University of Colorado. Many participants with longstanding chronic back pain experienced a complete recovery from their pain in four weeks of PRT treatment. You can read the peer-reviewed medical journal article here, or a Washington Post article summarizing the findings here.
PRT includes cognitive and behavioral strategies to overcome pain and other chronic symptoms. PRT can help clients overcome the fear of the pain or symptoms and enable them to resume ordinary activities and greatly diminish or even permanently eliminate their symptoms. PRT includes mindfulness techniques can help calm the nervous system to reduce pain perception and increase a sense of safety in the body.
Pain and other chronic symptoms, as awful as they may be, can be serving many purposes in our lives. They can give us permission to take a break, rest, and take care of ourselves, or get support and care from others. They distracts us from thoughts and emotions that we find unacceptable or inconvenient to address. They can fill our lives with doctors appointments and treatments that allow us to avoid figuring out what we truly need in order to be happy and fulfilled. Truly believing that our bodies are strong and resilient and refusing to let pain or symptoms rob us of activities we enjoy can allow clients to take back control of their lives and not be a victim any longer.
Take a test to see if your chronic pain or symptoms are likely treatable using a mind-body approach
References:
- Sarno, M.D., John E. Healing Back Pain: The Mind-Body Connection. New York, NY: Warner Books, 1991.
- Sarno, M.D., John E. The Mindbody Prescription: Healing the Body, Healing the Pain. New York, NY: Warner Books, 1998.
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Published online 2014 Nov 27. doi: 10.3174/ajnr.A4173
