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What is Pain Management?

Living with Chronic Pain

         If you’re someone who has been living with chronic pain, you may wish you could learn some pain management techniques that would eliminate your pain altogether. 

         There are people who go through life without being able to feel pain.  But it's far from the desirable experience we might imagine it would be. 

          Without pain to let them know when they're doing something that will harm their body, they're extremely likely to injure themselves – especially as children.  They could eat extremely hot food that burns their tongue without feeling any pain.  They could hurt  themselves playing outside – they could even break a bone  without feeling any pain. The parents of these children have to be constantly vigilant to make sure they don't injure themselves.

Good Pain?

          If you’re living with chronic pain, you may passionately disagree with the doctor of one little girl who couldn't feel pain when he said, “Pain is a gift.” 

          But it’s not hard to see that pain plays an invaluable role in our physical well-being.  Its purpose is to warn us of potential danger to our body.  And when the pain mechanism is working properly, once it has served that purpose, the pain goes away.

Good Pain Gone Bad

          The problem is that, for a variety of reasons, the pain mechanism doesn’t always work as it should.  Yes, some of those reasons are purely physiological.  But the key to effective pain management is the understanding that virtually any time we feel pain – whether it’s short-term or long – our instinctive, emotional, and thinking brains all play a major role.

          Here are just a few of the ways our brain can cause pain that’s not directly related to a physical injury:

  • If we’re extremely frightened when we get injured, our amygdala (the part of the emotional brain that alerts us to potential danger) will continue to activate the pain centers of the brain long after the initial injury has healed.

  • Chronic stress can trigger the release of literally hundreds of chemicals which affect our nervous system, immune system, and other systems of the body in ways that can cause ongoing pain – pain which isn't helped by most pain medications.

  • On another page of this site, we describe the placebo effect – the power of positive beliefs and expectations to have a healing effect on the body.  Well there’s an equal but opposite effect known as the “nocebo effect” – that is, the power of our negative beliefs and expectations to cause illness and pain. 

          Some of the pain conditions than can be caused or worsened by the “nocebo” effect include:

            Back pain
                           Neck pain
                                    Tension and migraine headaches
                                            Temporomandibular joint (TMJ) syndrome
                                                    Chronic tendonitis
                                                           Chronic abdominal and pelvic pain syndromes
                                                                  Repetitive stress injury
                                                                               Acid reflux
                                                                                     Irritable bowel syndrome (IBS)

The Good News About "Bad" Pain

           The good news about pain that’s caused by your brain is that it can be dramatically reduced – or even eliminated – by developing your MPFC and learning to live more from that inner core of peace, calm, and contentment.

          Virtually all pain has three components:

  • your purely physical sensations
  • your feelings about the pain (the affective component)
  • what you think about the pain (the cognitive component)

          Both the affective and cognitive components of pain exist below the surface of your ordinary awareness. But even though you're not aware of them, they contribute to your experience of pain just as much, if not more, than the purely physical component.           

          The techniques offered in this section (as well as other techniques on this site) will  develop your MPFC.  When your MPFC is stronger, you'll be more aware of how your feelings, beliefs, and expectations are affecting your experience of pain.  

         A well-developed MPFC also gives you more choice as to how you respond to and experience painful sensations. 

         With regular practice of the techniques, you may be pleasantly amazed at your ability to modify and reduce the pain you experience just by using the power of your own awareness.

Don's Experience with Pain Management

          For many years, I’d heard about the power of meditation – especially mindfulness meditation – to reduce or eliminate pain.  Until 1994, I never had any reason to try it out. 

          In the winter of 1994, I started developing a severe toothache on the right side of my mouth. I got some temporary relief after going to the dentist, but it kept coming back - even after going to the dentist a second time.  One evening, it became extremely painful and the pain relievers weren’t working.  I remembered hearing about using mindfulness for pain relief and decided to experiment with it.

          Instead of trying to make the pain go away by relaxing or distracting myself, I laid down on my bed and simply started observing the sensations.   I watched from a very quiet place inside, without making any effort to change what I felt.  Gradually, what I had thought of as ''pain" which I had to control or get rid of changed in a rather mysterious way.  I became aware that it was actually an interesting web of sensations, some of which were unpleasant, and some of which – to my astonishment – were actually pleasant. 

          I also noticed that how I experienced the "pain" was directed affected by the way I  attended to it.  When I resisted or tried to make it better, it got worse. The more I relaxed my attention and just watched without any attempt to change it, the more it changed from unpleasant "pain" to an interesting mix of pressure, heat, and moving energy. 

          At one point – to my total amazement – the intense sensations actually became intensely pleasurable.  But this required a level of focus that was difficult to maintain. 

          I can’t say the pain went away after this. I did go back to the dentist and he finally fixed the problem (yes, it involved a root canal!).  But my experience of pain has never been quite the same since.

          By sheer coincidence, I was contacted a few years later – after finishing my doctoral coursework – by a psychologist who was working with physical therapists and chiropractors in different locations around New York City.  I was hired to work with pain patients, and saw more than 100 people over the course of a year.

         I taught them to use mindfulness as well as other techniques on this website (breathing, relaxation, imagery, concentration, cognitive-behavioral therapy, along with music and other things I improvised for each individual).  I was deeply moved to see how people responded to these practices, often in cases where medication, and even surgery, had not brought them much relief.

          One woman I saw, in spite of two surgeries and a number of different pain medications, had not had a pain-free moment in nearly seventeen years.  After a brief relaxation with music, she opened her eyes, and with tears running down her cheeks, slowly said, “I can’t believe it.  This is the first time in so long I’ve felt no pain.”