I've had chronic pain. It sucks, it really does. So I can relate.

My instinctive reaction has often been to think, "What's wrong with me?" At times, it has taken every fibre of my being to fight against that thought. I believe it's something we're all conditioned to think. And it makes sense: pain is often a direct response to injury. But pain is complex. It can become more confusing the longer it sticks around.

All of our tissues have a fairly predictable healing time after injury. Pain is a natural part of that process. It's designed to stop us from doing things that might get in the way of healing, and to help us recover. Our nervous system is also closely linked with our immune system, right down to the cellular level, so it makes sense that pain and inflammation go hand in hand.

Alright, I get all of this. The intellectual side is easy for me to wrap my head around.

Where the rubber hits the road for me is how pain makes me feel. Pain turns my attention inward, making it hard to concentrate on my work and on the people around me. It's not just a bit of vigilance: it triggers anxiety that can feel like panic. My body completely tightens up, and I can even shake a little. I feel so tired as well. Life can be exhausting.

The pain also comes with a bigger story attached: I'm going to struggle to show up at work, in my life and in my community. I worry about how my behaviour comes across to the people around me. Staying socially in tune takes so much effort that it feels inauthentic. I might be a bit short with people or more withdrawn than usual.

My mind starts racing ahead to worst-case scenarios and planning for them. I have thoughts like, "This will never get better." Then it does get better for a while, until it comes back again, and again, and again. Each time, it's more deflating than the last.

I lose all confidence in my body and in my ability to do the things I used to love, like sport, being active and lifting. Even when I do them, they bring no joy, just more fear. And as soon as I get even a sniff that pain might be on its way, I start worrying about it and how I won't cope when it arrives. All of this feels innate and instinctive, and not necessarily under my conscious control. It's tough!

You might have noticed a common theme running through all of this. For me, it's fear and threat. They're the ones driving the pain bus.

Things started to change when I began to notice, label and have a conversation with this fear. Pain is the alarm, and it tends to get louder the more you poke it, prod it and focus on it. Instead of trying to push the pain away, suppress it or desperately find a fix, I turned my attention to the fear itself. That shift gave me a different way to approach the pain.

Fear and our emotional experience of pain

Our emotions are a window into the state of our nervous system at any given moment. We feel a lot of different emotions, and we can sort them by the side of the nervous system they tend to sit with: rest and digest, or fight and flight. The graphic below shows how they fit into those groups.

A quick note first. These steps are for pain that has been around a while and has been checked by your GP or health professional. If your pain is new or changing, get it checked first. And if fear or low mood feels like too much, talk to your GP or a mental health professional.

When we have persistent pain, the aim is to:

1. Notice the emotions that come with your pain.
2. Notice whether those emotions lean towards protect mode rather than rest and restore, and whether there’s a pattern.
3. Understand that if you’re in pain, your brain has picked up enough threat in the system to produce a pain response. It’s okay if you can’t identify the threat straight away. It might take a bit of practice and a closer look. Sometimes we don’t realise how much tension we’ve been holding until it’s gone. Think of those times when a weight has been “lifted off your shoulders”.
4. Label the fear in the moment, when you notice it, whether it shows up as hypervigilance (being on high alert), anxiety, irritability, impatience, anger or something else. Write it down.
5. Accept it, and try not to change it. That’s important.
6. Watch it with curiosity. Take a step back. You’re learning about yourself, like you’re your own research project. This can take the edge off, interrupt the spiral and give you some space. It did for me.
7. Choose an activity, posture or behaviour that brings you closer to the rest and restore emotions. Something that brings some peace, comfort or calm. It might be hard at first, but with practice it gets easier.
8. Be compassionate with yourself. This one is essential. Treat yourself the way you’d treat a good friend who’s struggling with fear and anxiety. Keep a diary, or find another way to support yourself.

Take home messages:

In my experience as a clinician, people in a lot of pain who are very hard on themselves often find it difficult to shift their pain. It’s one of those things where trying harder doesn’t necessarily get the best results. Point 8 is therefore a very fundamental pillar.

This is going to take some time. The idea is that, gradually, threat drives the bus less and less aggressively. You may find calm more easily, and your protective pain response may become less severe too.

There’s a lot of good evidence to guide how we help people in pain. Much of what I’ve described above is taught in an approach called pain reprocessing therapy, which has shown promising results for chronic back pain (Ashar et al., 2022). Pain care often combines the two: a psychological approach, such as cognitive behavioural therapy (CBT) or pain reprocessing therapy, and a graded movement program.

The pain education and movement side is where we can help here at The Biomechanics, working alongside your GP or psychologist. See you soon!

Further reading:

Self-Compassion by Kristin Neff.

The Way Out by Alan Gordon (pain reprocessing therapy).

References

Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., Carlisle, J., Polisky, L., Geuter, S., Flood, T. F., Kragel, P. A., Dimidjian, S., Lumley, M. A., & Wager, T. D. (2022). Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: A randomized clinical trial. JAMA Psychiatry, 79(1), 13–23. https://doi.org/10.1001/jamapsychiatry.2021.2669