The first step to treating chronic pain
Pain is an essential signal, alerting you there is a threat that needs your attention now. When pain lasts for an extended period of time, though, there is a mismatch between the threat and the pain signal. Your brain over-protects that area, sending extra pain signals to your body. When pain limits your ability to do what you need and want to do, it keeps keep you in a state of chronic stress, where less energy is available for healing and repair, compounding the problem. The first step in healing chronic pain is restoring the ability of your brain and body to work in conjunction to heal without limiting movement through extra-protective pain signals. This guide shows you how to take the step and rethink pain.
The meaning of pain
Pain is your brain’s and body’s way of working together to get your attention when there is a problem in some part of your body.1
- Acute pain is the initial stage of pain. When there is damage to a part of the body, the nerve cells in that area send signals through your spinal cord to the part of your brain responsible for regulating that part of your body. Your brain sends a signal back with a level of pain that matches the level of threat to your well-being.
- Chronic pain is much less straightforward and scientists, although making great strides, are still trying to figure out why pain sticks around, gets worse, and spreads, even after the damage in the body is repaired. It is believed what happens is your brain overprotects that part of your body. It takes your experiences with this pain in the past and your worries about how this pain will limit you in the future and adds them to the current level of injury and inflammation.
With chronic pain, the brain is simply doing its job—trying to keep you safe. This is why chronic pain requires a whole-person approach. It helps your parts to work together as they are designed for you to thrive.
The challenges to a whole-person approach to chronic pain
The treatments to ‘fight the pain’—such as medication, weight loss, exercise, and stress reduction—can work, but they can also put your physiology in a survival state. When you are trying to fix the problem of pain, it shifts your physiology into fighting a threat. Energy goes to fight, flee, or freeze. The pain, and thus your body, becomes a threat.
Researchers know that your mindset changes how well treatments work. Chronic pain and the way we think about the treatments can reinforce the mindset that your body is a problem. 2
This is because The Hinge Point for health is when you shift from the Survive State to the Thrive State.
When you are living with chronic pain, the first step to healing is to be aware of the common mindsets about these treatments that could be undermining their ability to help you. This guide helps you shift your mindset about treating chronic pain to help you use treatments to shift to the Thrive State where more energy goes into healing.
Weight loss and chronic pain
If you are carrying extra weight you probably have been told weight loss will help.3 The truth is, weight loss does not fix the root cause of chronic pain, it can add to it. Trying to lose weight to fix the pain can cause you to push your body to burn more calories. We are led to believe that enduring pain now will lead to less pain later. When you read the mechanism that causes chronic pain, it’s clear the opposite is true. It’s essential to know that pushing through pain compounds the root cause of chronic pain.
Exercise and chronic pain
A major barrier to exercising when you are experiencing pain is the old saying ‘no pain, no gain’ or the belief that there is a ‘good sore’. It has created a strongly-held belief that starting an exercise program will be painful. It even has people believing soreness is good, a sign you ‘did something’. Both of these are not only untrue, but they add to the stress of being in pain and lower motivation.
There is no scientific evidence soreness improves strength.4 In fact, muscle soreness is inflammation, which creates more work for your body to heal, slowing the process of growing stronger. When you push through pain, your brain thinks you didn’t get the message and that it needs to send more pain signals.5
To make matters worse, pain associated with exercise drains motivation.6 Your brain is hardwired to avoid what makes you feel worse in the present and choose what makes you feel better in the present. Experiencing pain when you start exercising tells your brain exercise is something to avoid. This is why getting started and staying motivated to exercise is said to be the hardest part of exercising. But it doesn’t have to be!
Stress and chronic pain
Stress creates tension in the body. That tension is there to prepare you to move. The ‘survive’ state signals digestion and other growth and repair systems to slow down so you have the energy to fight, flee, or freeze.
When you are living with chronic pain, you are in a chronic stress state. When your body is the threat and your brain is telling it to be ready to move, it creates more inflammation and pain. Trying to relax won’t work until your parts are working together again. 7
You might understand logically why weight loss, exercise, and managing stress will help. It seems like that should be enough to get you motivated, but knowing what to do, and not doing it, makes you feel worse about yourself. Feeling worse about yourself puts you in a ‘survive’ state, where you use more instant ways to feel better, like food or medication, and makes you afraid to exercise for fear you will make pain worse.
Whole-person health is the essential first step in treating chronic pain
Your whole-person health includes your internal and external elements. The external elements tell about the state of your internal elements. Your mental, spiritual, physical and emotional parts are all designed to work together. However, living with pain can separate them. A major part of healing chronic pain is helping these inner parts work together again.
The mental component of chronic pain
The way out of that downward spiral is by bringing together the parts of your whole person. Shift your attention from what you know in your brain to what you know in the other parts of your whole person.
We can use a brain-based approach to treating pain, but a whole-person approach works much more effectively. When we know what would help it is not enough to stay motivated to do it. Although the brain is part of the cause of chronic pain, it needs your whole person to work together to bring pain signals back to the acute pain mechanism. Let’s look at how to move from knowing what to do to choosing the right plan for you.
The spiritual component of chronic pain
This is the part of you that holds what is most important to you right now. It’s the root cause of the frustration and stress of living with pain because you feel cut off from what matters most to you. When you feel stuck, and unable to alleviate the pain, it’s common to disconnect from this part of you.
The first step is to get back to the heart of what matters most to you. This can be emotional, but as I discuss below, those emotions are simply the messengers. They are not a problem when you understand their role in your thriving.
Start by thinking about these questions:
- What do I most want to be able to do?
- Who do I want to do it with?
- How is the pain limiting me?
Simply notice and write it down. Give it time and stay curious. Know that you are doing the essential part of reconnecting with your natural motivation source and most reliable guide to truly managing chronic pain.
The emotional component of chronic pain
If someone you care about came to you and said “I am in pain and feel so frustrated”, your first response would most likely be, “How can I help?” When you turn that kindness inside, you break down the barriers between your brain and body. This calms your nervous system, opening the doorway to giving more power to the treatments for chronic pain. 8
By acknowledging the emotions that you feel about being in chronic pain such as fear, guilt, worry, anger and frustration, you can use them as a guide. The key is not ignoring them but also not overidentifying with them. Emotions are simply messengers. You don’t have to like them, simply notice them. Stay curious about what they are trying to tell you is most important to you right now. This takes practice, but can be a turning point helping for chronic pain.
The physical component of chronic pain
What most pain scientists agree on is that rest and avoiding activity are no longer helpful advice. This is for two main reasons.
- “Motion is lotion” is the more common term now, to remind us that movement can promote healing when it is used well.
- Your body is a use-it-to-keep-it system. When pain limits movement, you lower the functional skills of strength, stamina, and mobility, which further limits your ability to move and creates a downward spiral of loss of function.
The challenge is that exercise often makes the pain worse. That is because many common exercises are not based on exercise science for health. They are based on a blend of sports exercise science and marketing science
This leads to struggles with motivation to exercise. That leads to deconditioning and worry when moving your body in daily life.
When you move, your brain remembers what you used to be able to do, your body knows what it can do now. When the two are not on speaking terms, you can either end up doing too much or believing you can’t exercise or cycling between both. 9
This leads us to the next step in a whole-person approach to treating chronic pain.
How mindful, kind exercise treats the roots of chronic pain
There is a powerful combination that you need to turn the tide of chronic pain. It addresses all of these challenges and needs at the same time. Exercise science, mindfulness, and self-kindness each on their own have been shown to reduce chronic pain. But together, they bring your whole person back to the state they can work together as designed for you to thrive.
Exercise science. Moving your body in a pain-free range lets your body tell your brain you can move without pain. It does not matter if this is one finger or toe—if that is pain-free, start there. Staying aware and curious about what your body is telling you lets you know where you can move in a pain-free range. 10
Mindfulness. Since the root cause of chronic pain is a brain-body communication breakdown, typically approaches to exercise that tell you to ‘just do it’ and distract to get through it just won’t work. Mindfulness is the skill of paying attention with curiosity. This transforms exercise into a time to reconnect your brain and body’s ability to work together as designed. 11
Self-kindness. When mindfulness has you noticing that you are in pain and can’t do what you used to, it’s easy to get caught up in the emotions of frustration. Self-kindness is the skill need to be able to adjust, rather than push through the pain. Using the know-how from movement science, you do this with confidence you can in fact move with greater ease and less strain. 12
Mindful, kind exercise is a powerful combination that treats the root causes of chronic pain and side effects that keep you stuck. It takes re-thinking what it means to exercise and how you relate to your body when you have pain. That takes practice.
The word exercise means “to practice”. Exercising for chronic pain is time set aside to practice moving without pain. This is not just exercising, it’s Exercising Well. You are practicing moving to be well now.
This mindset and intention include your whole person as you move. Activities like shopping or housework are moving to take care of someone or something else. Because you need to get those things done, you sometimes need to push through the pain. This can turn these activities into a time of practicing ignoring parts of your whole person.
Moving the way you are designed, with mindfulness and self-kindness, is the foundational treatment for chronic pain. It restores your whole person’s ability to work together so you thrive, restoring whole-person health. This shifts your physiology into a state where energy goes into healing, repair and growth, so that treatments like weight loss, exercise, and stress reduction can work more effectively for treating chronic pain.
Create your plan: With the 4 science-based principles of mindful, kind exercise to treat chronic pain
These steps are the Well-habits system for whole-person health and lasting habits. It is based on a blend of movement and motivation science to transform your goals into lasting habits.
- W: Start with Your Core Why. Tap into your spiritual element by connecting what you do to treat chronic pain with your passions in life. Writing down the specifics about what is most important to you about reducing or eliminating chronic pain gives you the most personalized guidance and natural motivation.
- E: Know how much is Enough. Satisfy your brain’s need for a concrete path and stay out of the ‘land of never enough’. First make sure you have restored muscle memory for moving the way you are designed. If moving is straining, its time to go back to these basics of exercise science. Know the general guidelines for the ranges of how much is enough, based on solid scientific evidence. The FREE Be Well Now app shows you how in a simple step-by-step format.
- L: Link what you are doing to how you feel now. By trusting the physical element of your whole person health, you are able to use your most personalized guide, your Inner Trainer. Meeting yourself where you are now so you are moving in a pain-free range is the way to regain strength and confidence while telling your brain to calm pain signals. Mindfulness is the key skill here that lets you listen to your body.
- Loop: Loop back to your Core Why to ensure that how you feel as you move is in fact taking you in the right direction for whole person health. You are using your emotional element here as messengers from your body back to your brain. This is what creates a habit. Feeling better in your body tells your brain this is something to repeat. Feeling worse tells your brain you need to adjust. Self-kindness is the key skill here to break the habit of pushing through pain or avoiding movement. Stay Kind Inside as you move so you can use pain as a guide to adjust and make mindful, kind exercise a habit for your whole-person health.
- website article, New York TimesL https://www.nytimes.com/2021/11/09/well/mind/glial-cells-chronic-pain-treatment.html
- Sean R. Zion, Alia J. Crum, Chapter Eight – Mindsets Matter: A New Framework for Harnessing the Placebo Effect in Modern Medicine ,Editor(s): Luana Colloca, International Review of Neurobiology, Academic Press, Volume 138, 2018, Pages 137-160, ISSN 0074-7742, ISBN 9780128143254
- Ryan CG, Vijayaraman A, Denny V, Ogier A, Ells L, et al. (2017) The association between baseline persistent pain and weight change in patients attending a specialist weight management service. PLOS ONE 12(6): e0179227.
- Wilke J, Behringer M. Is “Delayed Onset Muscle Soreness” a False Friend? The Potential Implication of the Fascial Connective Tissue in Post-Exercise Discomfort. Int J Mol Sci. 2021 Aug 31;22(17):9482. doi: 10.3390/ijms22179482. PMID: 34502387; PMCID: PMC8431437.
- Kathleen A Sluka, PT, PhD, FAPTA, Steven Z George, PT, PhD, FAPTA, A New Definition of Pain: Update and Implications for Physical Therapist Practice and Rehabilitation Science, Physical Therapy, Volume 101, Issue 4, April 2021, pzab019
- Habits Smith KS, Graybiel AM. Habit formation. Dialogues Clin Neurosci. 2016;18(1):33‐
- Abdallah CG, Geha P. Chronic Pain and Chronic Stress: Two Sides of the Same Coin? Chronic Stress (Thousand Oaks). 2017 Feb;1:2470547017704763. doi: 10.1177/2470547017704763. Epub 2017 Jun 8
- Amaro-Díaz, Lidia, Casandra I. Montoro, Laura R. Fischer-Jbali, and Carmen M. Galvez-Sánchez. 2022. “Chronic Pain and Emotional Stroop: A Systematic Review” Journal of Clinical Medicine11, no. 12: 3259. https://doi.org/10.3390/jcm11123259
- Langevin HM. Reconnecting the Brain With the Rest of the Body in Musculoskeletal Pain Research. J Pain. 2021 Jan;22(1):1-8. doi: 10.1016/j.jpain.2020.02.006. Epub 2020 Jun 14. PMID: 32553621; PMCID: PMC7736274.
- Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017 Jan 14;1(1):CD011279. doi: 10.1002/14651858.CD011279.pub2. Update in: Cochrane Database Syst Rev. 2017 Apr 24;4:CD011279. PMID: 28087891; PMCID: PMC6469540.
- Veehof MM, Trompetter HR, Bohlmeijer ET, Schreurs KM. Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cogn Behav Ther. 2016;45(1):5-31. doi: 10.1080/16506073.2015.1098724. Epub 2016 Jan 28. PMID: 26818413.
- Torrijos-Zarcero M, Mediavilla R, Rodríguez-Vega B, Del Río-Diéguez M, López-Álvarez I, Rocamora-González C, Palao-Tarrero Á. Mindful Self-Compassion program for chronic pain patients: A randomized controlled trial. Eur J Pain. 2021 Apr;25(4):930-944. doi: 10.1002/ejp.1734. Epub 2021 Feb 9. PMID: 33471404.