Making Chronic Pain Optional

Imagine this: You are diagnosed with kidney stones. Your doctor explains that soon you will start passing the stones in your urine. How much pain do you think you will be in as you pass the stones? Most people automatically assume passing a kidney stone is going to be painful. But why do we assume this? Is it possible for pain like this to be optional?

What Culture Teaches Us About Pain

I have had the privilege of traveling throughout the world, teaching about mental health and intervening in crisis situations. In my travels, I have come across a myriad of beliefs about pain—including different approaches to pain management.

For instance, I have been in dentists’ offices where the dentist believes that children and older adults do not feel pain. As a result, dental procedures are performed on these patients without anesthetic. For most people, just imagining someone drilling on their teeth without a local anesthetic is enough to induce pain. Yet, many times children and the elderly endure these types of procedures without significant complaint.

How can this be?

We assume that pain is a universal experience, shared by all people. But it isn’t. Let's say you’re scheduled to have a joint replacement, such as a knee or hip surgery. How long would you expect to be limited in your movement after the surgery? You are probably not picturing yourself walking a few hours after surgery; that’s because in the United States, patients spend up to eight weeks using a walker or a cane while they recover post-operatively.

Southeast Asia

Source: Chatrawee Wiratgasem/Shutterstock

However, if you were living in a small village in Vietnam or Cambodia and being treated by a humanitarian medical team providing orthopedic surgeries, you would likely function quite well on the same day you had your joint replacement surgery. Interestingly, many of these patients who receive a new knee or hip can stand, walk, squat down to the ground and get back up again, shortly after coming out of anesthesia. Why? These individuals are not expecting joint replacement surgery to be painful.

Thinking Differently About Pain

Our perception of what hurts is not actually determined by what is physically happening to us. In other words, pain is not felt in the peripheral nerves that run throughout our body. Pain is a result of the brain interpreting the sensory information that it is receiving as a threat.

Your brain has created a neuromatrix of cognitive, behavioral, emotional, and sensory information. The brain then relies on this mix of information to analyze whether a threat exists, and therefore, if pain needs to be produced in response.

When we examine and challenge the deeply held—and often hidden—cultural beliefs we have about pain, we might find chronic pain less distressing. In fact, chronic pain may need not be a permanent fixture in our daily lives at all.

Examining the role that sensory information alone can have in our experience of pain is as simple as using a magnifying lens. It has been found that individuals with chronic arthritic pain reported heightened sensations of pain when they viewed their hand under magnification, but decreased pain levels when their hand appeared smaller. The ability to manipulate pain levels just by changing the visual perception of a chronic pain area is no doubt fascinating. But this demonstration does more than enthrall; it supports the notion that changing other elements of the brain’s neuromatrix can indeed affect how our brain produces pain.

Acceptance Leads to Better Pain Management

Let’s revisit our first example: a new diagnosis of a chronic condition that produces kidney stones, one where you will continually pass the stones. Apart from standard medical treatments, there is also a mind-body approach to pain management that could improve your functioning and reduce pain—even the pain associated with passing a kidney stone.

Another element of our brain’s neuromatrix is simply our opinion about pain itself. We all have thoughts and beliefs about pain, and often pain is viewed as a barrier to living our lives. For many who suffer with chronic pain, it's a constant threat, something that prevents us from moving forward, a source of suffering that demands our attention.

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Naturally, then, we seek to control pain. We want to rid ourselves of pain in order to move on with our “real” lives. Therein lies the problem, because trying to control chronic pain does not work. What's worse is that many times the effort to control pain only increases our struggle, and, as a result, our suffering. We suffer when we attempt to fix what cannot be fixed.

Acceptance is the antidote to suffering. Acceptance—a key element of Acceptance and Commitment Therapy (ACT)— has been shown to help individuals increase their levels of functioning and manage their pain more effectively. Even patients who chronically produce kidney stones can learn to view their condition with openness, acceptance, and willingness, reducing their distress in the process.

Acceptance is a key part of pain management because of its ability to maneuver the brain to shift sensory information processing. Through acceptance, the brain can begin to view sensory information as a curiosity, rather than a threat—something interesting to explore, examine, hold, and then gently put back on the shelf, like an old, dusty book.

To learn more, visit the Association for Contextual Behavioral Science.