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Know Pain, Know Gains: how facing your pain helps to reduce it

Can you think of five different things that you would like to do, but can’t because of your pain? Give each of them a score out of 10 with zero as “cannot do” and ten is “I can do it.”

functional scale

Now how do we work our way up these scales? The first step is to face our pain. We need to do the opposite of avoiding thinking about it, feeling it, and keeping away from situations that might make it worse. If we don’t address the pain that we are experiencing and instead hope that by ignoring it, it will go away, then it can actually become more entrenched. Three things happen when we avoid our pain.

The first is that our brain may make mistakes in the body representation of the painful area. Errors in body representation are seen in people with macrosomatognosia who perceive that their painful area is larger than it actually is; in amputees who see their amputated limb as large, twisted or heavy; and in people with CRPS who report that their affected limb feels as if it no longer belongs to them. This is a picture of the sensory homunculus which is a sensory body part map along the cerebral cortex. When a sensation is felt in our body the impulse of this experience is sent to the spinal cord and then to the brain to be processed. The image of our body formed by the mind is influenced by all input: noises, smells, taste, touch, sight, pain, movement, memory, scans, emotions, proprioception and interception. The more accurate our input is, the better our body representation is.

pain pathway flowchart

Also our brain loves efficiency and often uses mental shortcuts to arrive at decisions. This image of a pain pathway flowchart shows that pain perception initially requires 4 steps: transduction, transmission, projection then perception. But just as our mouth waters in response to thinking about eating a lemon, the brain is happier to skip steps in simple processes to keep headspace for higher order decision making and thinking. If the information it has about our pain is incomplete or imprecise then the safest approach is to create a larger area of persistent pain. This protective mechanism happens so as to stop us from damaging the area further while letting our brain plan transport routes or what to make for dinner.

And thirdly, an avoidance mindset stops us from living our one precious life and doing the things that we love to do. This is what people find so unfair about their pain. It as if it has taken control of the steering wheel of their lives.

describing my pain

An exercise that helps us to face our pain starts with taking five slow breaths. Once we’ve done this we breathe into the painful area and clarify the exact location and size of the pain. We know its colour, texture, temperature and maybe have a symbol or image of it. The goal of this exercise is to notice pain with curiosity instead of fear and to encourage the brain to take a longer path in interpreting the messages the body is giving it.

emotions my pain triggers

Next we notice the thoughts and emotions that we have about the pain and instead of struggling against them we aim to watch them. See them with detachment, imagine that they are clouds moving across the sky. The tricky part of this exercise is in the choice not to let them control our behaviour. If our thoughts shift the focus to the past or the future we need to breathe and bring our attention back to the present. It might be that you need a coping statement at this point.

coping phrases

Then we think about one of the activities that we have stopped doing because of our pain. Is there a way that we can reengage with it again? What one small step can we take towards doing it again? I asked someone recently to get out of bed every day. Now they sit on their porch each morning, they listen to birdsong and watch the trees. That is their one small step.

focus on the step in front of you

For the next week every time you feel your pain - breathe into it, see it, notice how you feel about it and remind yourself of your one small step. If you are having a pain flare and it is too much to engage with your pain, then breathe into an area with no pain at all and let this comfort spread through your body.

breathe into my pain

There are many more things we can do to face our pain but this is a good place to start.

Good luck

❤️

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