February 17, 2016

Understanding & Managing Chronic Pain.

anger frustration pain stress

We’ve all experienced trauma. Whether it’s falling off your bike as a kid, being the victim abuse, or suffering from depression, we’ve all had something that our bodies have to respond to.

Often times our bodies are naturally able to heal, even if it may take some time. Sometimes, though, there are some places that just don’t seem to heal. They hurt, and continue to hurt, for days, weeks, months, or even years.

I struggled with low back pain for years—on two separate occasions. I wish I had known this information during my first bout of pain, but as they say, you learn things when you do for a reason. Going through those years of pain (almost four years total—way too freakin’ long if you ask me) has given me a sense of perspective that only suffering can bring. Now I hope to give you this information so that you may be more wise than I was and learn to help yourself, which may end up being the most important part of your recovery. (Altmaier et al. 1993)

Getting to know your pain

Pain is such a vague thing—very real signals that are interpreted in such abstract ways by the brain. This hurts because it’s hurt, that hurts because I’m sad, this hurts because it used to hurt.

Let’s take a step back and look at what pain actually is: a warning sign. Pain is simply a series of messages that go from your body to your brain. The problem is that often times, these messages are more like playing a childhood game of telephone than a direct-line connection. In determining what the signals mean, your brain considers all of the contexts surrounding the event—your physical state, your emotional state, your level of safety, your previous experiences, and so many other things (Carlino et al. 2014). Therefore your body may start by saying “ooh, that hurts a bit,” and your mind on the other end of the chain responds with the power of a 3-alarm fire. Your pain is always real. Its interpretation, on the other hand, may be a bit out of proportion.

It’s important to emphasize the warning aspect of this: pain often doesn’t correspond to actual damage. There was a recent study that evaluated 1,211 healthy Japanese adults that did not report any level of pain in their back or spines. What the researchers found was startling: 36% of those in their 20s had disc degeneration, while 96% of those in their 80s had disc degeneration (Nakashima et al. 2015). Yet they reported no symptoms.

This is not to say that your pain is all in your head. The signals you experience are very real. It’s just to say that pain is not the same thing as tissue damage.

Pain often persists far past when the body actually heals. Why this happens is still unknown; the important part of this is to know that it does happen. Knowing is the key (Louw et al., 2012).

Unwinding your pain

Unwinding our traumas or chronic pain can be a difficult thought. For some of us, the pain has been there for so long that we can’t imagine living without it. For others, the trauma of the event that caused the pain may be so overwhelming that, like the physical pain, we can’t imagine it not being a part of us.

Well, I’m here to tell you that it doesn’t have to be that way.

When I was going through my first bout of chronic pain, I fought it for years. Eventually, despite daily yoga practice, eating well, stretching in every way I thought possible, etc., I submitted to the idea that my pain was there for life—it was just a part of who I was. I struggled for another full year before finding something that finally worked for me and beginning to believe that I could find a way to not be in pain. Now I’m happy to say that I exist in a state free of that which once plagued me. I’ve learned what causes my pain, what triggers its episodes, and how to deal with it. As I said before, knowing is key.


There are really three stages to any injury: the event, the healing, and the adaptation. The event and the healing are obvious. But what about the adaptation?

For most simple injuries—let’s take a paper cut for example—we have the cut (and probably a moment of cursing), a period of time for it to heal, and then an adaptation period where you learn to use your finger normally again. For something simple like a paper cut, you may avoid using that finger fully for the week or so as it heals, but then as soon as it’s back together, you probably have no problem going back to using it normally. That’s the adaptation.

However, adaptation is trickier for other issues—say, something complex like a broken leg. The injury itself is much more traumatic and the healing period is much longer. Therefore, by the time you’re ready to begin adapting the recovered limb, you may have lost some of your “normal” patterns of movement and sensation. This can be complicated by how you may feel about the broken leg: How traumatic was the original incident? How annoying is it to function with a cast on? Is the healing taking too long? Are you able to do your job while it’s healing?

And this is where the physical part of chronic pain comes in: our bodies literally adapt to be able to feel the sensations more directly (Kwon et al. 2014). You can think of it in context of the weather. In the middle of summer, if it’s suddenly 50 degrees outside, it’ll be absolutely frigid (depending on where you live, obviously—here in the South, 75 degrees in the middle of summer is freezing!). However, as the seasons progress, you begin to adapt to the cold—you literally feel it less. Or, a more accurate way of stating it—you are less sensitized to it.

So to get back on topic, if you break your leg and it hurts for a while, then your mind will start to look for those pain signals more often. And more likely than not, it will find them. If you’re angry or upset or frustrated about the leg, your mind may look for them more, and, naturally, it will find them more.

The same can be said about more elusive or strange pains—those that come from anxiety, depression, etc. They may not have any acute physical trigger like a broken leg, but they are still there. These can come up for any reason, but I like to think about it in this context: you are constantly experiencing different types of pain sensations—sitting on a chair, walking barefoot, stretching, etc., all produce very minor pain signals. Your mind doesn’t pay much attention to them because they’re just a normal part of life.

However, if you’re chronically stressed, or depressed, or anxious, your mind may look for them more often, and begin to feel them more often, and then they’ll get stronger to the point where they truly are a problem. In this way you become sensitized to pain.

From a personal level, I know this is not fun to deal with. Research has shown that just knowing how this stuff works is a huge part of recovery and adaptation (Louw et al., 2013). If you know to look for certain things—avoidance habits, emotional triggers, etc., then you can start to improve on your own. You can empower yourself to be able to heal just by changing how you look at your pain and your habits.

So I’ll leave you on this note: let’s take a look at a few key steps to starting this healing process. This is meant to be an introduction to healing, so keep that in mind. You may find it hugely beneficial to get a guide—a therapist, counselor, manual therapist—anyone that knows the process of healing to help you through.


3 steps to effective pain management:

1. Start to notice your habits.

Are there things you avoid because of the pain—movements, bodily positions, etc? Are there any key triggers that make you hurt? Do you hurt more when you’re stressed or anxious?

2. Take action.

Take what you’ve noticed and apply it to your life. Try to move in new ways. Recognize when you’re getting stressed and allow yourself to relax. Change your habits to allow yourself to heal and adapt.

3. Get support.

What is it that you need to help you recover and adapt? Manual Therapy, Massage, Counseling, Meditation, Yoga… there are a million different approaches that can help a person heal and adapt. Usually it’s not just one thing. Sometimes, it’ll be a simple physical issue that something like manual therapy can address. Other times it’ll be more vague and complex. Experiment and find what works best for you.







Allen, R., M. Zahn (2015). Understanding Pain.

Altmaier E.M., D.W. Russel, C.F. Kao, T.R. Lehmann, J.N. Weinstein(1993). Role of self-efficacy in rehabilitation outcome among chronic low back pain patients. Journal of Counsel Psychology, 40: 335-339.

Carlino E., E. Frisaldi, F. Benedetti (2014) Pain and the context. Nat. Rev. Rheumatol, 10: 348–355.

Kwon M., M. Altin, H. Duenas, L. Alev. (2014). The role of descending inhibitory pathways on chronic pain modulation and clinical implications. Pain Practice, 14 (7) :656-67

Lehman, Greg (2015). Pain fundamentals: A pain science education workbook for patients and therapists.

Louw A., D. Butler, I. Diener, E. Puentedura (2012). Preoperative education for lumbar radiculopathy: A survey of US spine surgeons. Int J Spine Surg., 1 (6): 130-9.

Louw A., E. Puentedura (2013). Therapeutic neruoscience education, teaching patients about pain. USA: International Spine and Pain Institute. Print.

Nakashima H., Y. Yukawa, K. Suda, M. Yamagata, T. Ueta, F. Kato. (2015). Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine, 40(6):392-8.





Author: Michael Black

Editor: Renée Picard

Image: amenclinicsphotos ac at Flickr 

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