There’s a case in the medical literature of a butcher who slipped while working and got his arm caught on a meat hook. Yeah, ouch. The pain was bright, attention-grabbing, impressive, and very good at what it does – it was the Beyoncé of pain. He was in agony.
Then he realized the hook only caught his sleeve. Didn’t even penetrate the skin. And the pain went away. Weird, right?
Here’s another one. When you read the testimony of political dissidents who have been tortured, they describe a consistent pattern: before the process began, they were made to stare at the implements that would be used to harm them.
A cruel but effective method of intimidation. But it was also effective at increasing the subsequent pain they felt. Huh?
In my first book I discussed people with a gene variant that confers the ability to never feel pain. (Might sound great but, trust me, it’s not good.) And in my second book I talked about the mind-bending nature of the placebo effect. (Placebos even work if you know they’re placebos.) Pain is emotionally terrifying but intellectually, uh, kinda fascinating. Pain is a mystery. 20.4% of American adults deal with chronic pain.
Time to get to the bottom of this and learn what we can do about it. Whether you’re dealing with chronic pain, injury, illness, or recurring issues like migraines, there are insights from the science we can use to reduce suffering. And if you’re helping someone with pain, there are insights here you might want to pass along.
This is medical territory which means we need to be on our best epistemic behavior. Caveat emptor, YMMV, for informational purposes only, etc. This is information you want to discuss with your doctor. When it comes to anything serious, never accept without question anything you read from “some guy on the internet” and as much research as I look at, I’m not a doctor. I’m still “some guy on the internet.”
We’re going to draw from a wide range of sources including “The Pain Management Workbook”, “When the Air Hits Your Brain: Tales from Neurosurgery”, “The Body in Pain: The Making and Unmaking of the World”, and “The Psychology of Pain.”
Okay, let’s limp to it...
How Pain Works
The pain in your arm isn’t in your arm. All pain is in the brain. (If it wasn’t, there would be no phantom limb pain.) And pain is complex. Medicine calls it a “diffuse neurological process.” There is no single “pain center” in your gray matter.
Not to go all oenophile on you but pain does have different “flavors.” You’ve had shooting pain, searing pain, and dull pains and they’re all distinct. A good doctor can actually use that information to help diagnose what’s going on because arthritis pain often presents one way and cancer pain another.
Your nervous system has two ways of dialing back the pain signal: endorphins and “gating.” Endorphins are the body’s natural opiates. They’re what allow athletes and soldiers to keep going when injured. Great for acute, severe pain, but pretty ineffective against chronic pain.
Gating is about logistics. Tons of sensations are constantly flying up your nervous system and your brain is like “Hey! One at a time. You’re flooding my inbox.” So sensations get prioritized. If one is first in line, the others get gated. Blocked. This is why you rub your leg when it’s cramped, and why ice packs and heating pads help. You’re superimposing one sensation over another to block the ouch. Napoleon suffered terrible pain due to kidney stones and he would repeatedly burn himself with a candle to gate the abdominal pain. (Yes, this works. No, I don’t recommend it.)
But there’s another aspect to pain that gets discussed a lot less – psychology. The story about the butcher makes it clear that pain isn’t an accurate indicator of tissue damage. Hurt and harm are not the same. We’ve all dealt with pain that had no obvious cause and we’ve all seen bruises in the shower that we never felt. I’m not going to be dismissive and say “pain is all in your head” but, well, sometimes it is.
The current concept of pain is called the “biopsychosocial model.” Pain has biological, neurological, cognitive, emotional, social, and behavioral elements all intertwined. And psychology is a big factor. Bigger than we give it credit for.
Why did the pain of the torture victims get worse after seeing the weapons? Because your emotions, beliefs, expectations, and thoughts all influence what you feel. Especially the negative ones. A pinch from your partner might be as objectively painful as the poke of a doctor’s needle but it won’t be experienced as the same amount of pain. (There’s a reason why children’s hospitals are brightly colored with cute murals on the walls. That’s not an accident.)
Simply put: “indications of danger make pain worse, while credible evidence of safety reduces pain.” And this is no small effect. In lab studies where they can control a patient’s context, reducing fear and anxiety, opiates are much less effective. Why? Because a good part of what morphine does actually works via psychology, not just biology.
What’s all this mean? If we reduce stress and anxiety, improve mood and shift attention, we can reduce pain perception. It’s far from a magic “off” switch, but it can definitely help.
So what’s the first step? It’s really simple. But when you’re in pain it can seem really hard...
Relax
If you were in horrible pain and I said, “Just relax!” I wouldn’t blame you if you wanted to hit me with a sack of batteries. When pain hogties your emotions, when your blood is more stress hormones than hemoglobin, relaxation is hard.
So don’t just do it psychologically, do it physically. Try progressive muscle relaxation. Starting with your feet, tense them for 10 seconds and then let them relax. Then do your calves. And up your body all the way to your face.
Really feel the relaxation after each time you let the tension go. Studies show this can strengthen your emotional infrastructure and allow you to better cope.
Now this will help your body but attention is also a factor so we need to address the mental part more directly. If all you can think about is the pain, you’re going to tense up again soon and the pain will be back...
Distraction
Not to go all oenophile on you but pain does have different “flavors.” You’ve had shooting pain, searing pain, and dull pains and they’re all distinct. A good doctor can actually use that information to help diagnose what’s going on because arthritis pain often presents one way and cancer pain another.
Your nervous system has two ways of dialing back the pain signal: endorphins and “gating.” Endorphins are the body’s natural opiates. They’re what allow athletes and soldiers to keep going when injured. Great for acute, severe pain, but pretty ineffective against chronic pain.
Gating is about logistics. Tons of sensations are constantly flying up your nervous system and your brain is like “Hey! One at a time. You’re flooding my inbox.” So sensations get prioritized. If one is first in line, the others get gated. Blocked. This is why you rub your leg when it’s cramped, and why ice packs and heating pads help. You’re superimposing one sensation over another to block the ouch. Napoleon suffered terrible pain due to kidney stones and he would repeatedly burn himself with a candle to gate the abdominal pain. (Yes, this works. No, I don’t recommend it.)
But there’s another aspect to pain that gets discussed a lot less – psychology. The story about the butcher makes it clear that pain isn’t an accurate indicator of tissue damage. Hurt and harm are not the same. We’ve all dealt with pain that had no obvious cause and we’ve all seen bruises in the shower that we never felt. I’m not going to be dismissive and say “pain is all in your head” but, well, sometimes it is.
The current concept of pain is called the “biopsychosocial model.” Pain has biological, neurological, cognitive, emotional, social, and behavioral elements all intertwined. And psychology is a big factor. Bigger than we give it credit for.
Why did the pain of the torture victims get worse after seeing the weapons? Because your emotions, beliefs, expectations, and thoughts all influence what you feel. Especially the negative ones. A pinch from your partner might be as objectively painful as the poke of a doctor’s needle but it won’t be experienced as the same amount of pain. (There’s a reason why children’s hospitals are brightly colored with cute murals on the walls. That’s not an accident.)
Simply put: “indications of danger make pain worse, while credible evidence of safety reduces pain.” And this is no small effect. In lab studies where they can control a patient’s context, reducing fear and anxiety, opiates are much less effective. Why? Because a good part of what morphine does actually works via psychology, not just biology.
What’s all this mean? If we reduce stress and anxiety, improve mood and shift attention, we can reduce pain perception. It’s far from a magic “off” switch, but it can definitely help.
So what’s the first step? It’s really simple. But when you’re in pain it can seem really hard...
Relax
If you were in horrible pain and I said, “Just relax!” I wouldn’t blame you if you wanted to hit me with a sack of batteries. When pain hogties your emotions, when your blood is more stress hormones than hemoglobin, relaxation is hard.
So don’t just do it psychologically, do it physically. Try progressive muscle relaxation. Starting with your feet, tense them for 10 seconds and then let them relax. Then do your calves. And up your body all the way to your face.
Really feel the relaxation after each time you let the tension go. Studies show this can strengthen your emotional infrastructure and allow you to better cope.
Now this will help your body but attention is also a factor so we need to address the mental part more directly. If all you can think about is the pain, you’re going to tense up again soon and the pain will be back...
Distraction
Pain seems like an escape room you can’t escape from. Like it’s tattooed on your consciousness. Elaine Scarry writes that, “the absence of pain is a presence of world; the presence of pain is the absence of world.”
Pain screams “pay attention to me!” and so we do. But focusing on pain makes it worse. Similar to the butcher story, hypochondriacs don’t actually have a medical problem yet their overactive attention actually causes the perception of pain where there is no harm.
Luckily, the reverse is also true. When we redirect attention – when we’re distracted – pain can be dramatically reduced.
You’ve experienced this inadvertently. Something grabs your attention and you briefly forget you’re supposed to be miserable. I suggest you leverage this more deliberately. Don’t dwell on pain. To the degree you are able, stay busy, stay distracted. See friends. Brainstorm possibilities and see what works for you.
“Fuzz therapy” can help. Yes, pets. Even looking at a cute animal reduces stress and blood pressure.
Unfortunately, we can’t stay distracted all the time. (Though this clearly has not stopped me from trying.) Pain can fight back. It goes quasi-sentient. Pain, with its menacingly broad smile, starts whispering things to you...
Thoughts
Pain screams “pay attention to me!” and so we do. But focusing on pain makes it worse. Similar to the butcher story, hypochondriacs don’t actually have a medical problem yet their overactive attention actually causes the perception of pain where there is no harm.
Luckily, the reverse is also true. When we redirect attention – when we’re distracted – pain can be dramatically reduced.
You’ve experienced this inadvertently. Something grabs your attention and you briefly forget you’re supposed to be miserable. I suggest you leverage this more deliberately. Don’t dwell on pain. To the degree you are able, stay busy, stay distracted. See friends. Brainstorm possibilities and see what works for you.
“Fuzz therapy” can help. Yes, pets. Even looking at a cute animal reduces stress and blood pressure.
Unfortunately, we can’t stay distracted all the time. (Though this clearly has not stopped me from trying.) Pain can fight back. It goes quasi-sentient. Pain, with its menacingly broad smile, starts whispering things to you...
Thoughts
“This will never end. I can’t take it. This is killing me.”
Totally normal and natural thoughts when you’re in pain. But they’re not helping. As we discussed, your beliefs, expectations and emotions affect perceived pain.
The problem here is our cognitive distortions. In other words, overreacting. When stressed, we tend toward many errors of thought like Black and White Thinking (“If life isn’t perfect, it’s unbearable”), Overgeneralization (“This hurts, so my entire life is terrible”), and catastrophizing (“This is never going to end.”) They’re all exaggerations, all irrational, all too extreme. And these thoughts affect pain. It’s like casting a dark spell on yourself.
What to do? Strike back with The Logical Hammer of Rationality +4. Yes, CBT to the rescue. It’s a simple as asking yourself a few questions to dispute the irrational thoughts.
So pain starts whispering: “This is unbearable. My life is over. The world is coming to an end.”
Ask yourself: Is it a fact?
Nope. You are bearing the pain, however reluctantly. You know the world is not burning down because you’re still receiving spam texts. Accept the presence of the thoughts – but don’t believe them.
Ask yourself: Are you predicting bad things?
Yes. And given you only have “The Logical Hammer of Rationality +4” and not the “Orb of Prognostication and Prophecy” you can’t predict the future, Nostrodamus.
Ask yourself: Are you using the words: all/nothing, always/never/forever, best/worst?
Yes. That means you’re exaggerating. Saying “the plagues of Egypt got nothing on this” may not be appropriate.
Ask yourself: What has happened in the past?
Pain went away. Resumed taking health for granted and never thought about it again. Hmm, maybe that will happen this time, too...
Ask yourself: What else—neutral or positive—might happen in this situation other than what you’re predicting?
Hey, maybe there are explanations other than the worst-case scenario.
There are perspectives that can save us and others that imprison us. Choose the former.
Okay, we’ve covered a lot. Let’s round it all up – and learn how to overcome the biggest threat that pain presents...
Sum Up
Totally normal and natural thoughts when you’re in pain. But they’re not helping. As we discussed, your beliefs, expectations and emotions affect perceived pain.
The problem here is our cognitive distortions. In other words, overreacting. When stressed, we tend toward many errors of thought like Black and White Thinking (“If life isn’t perfect, it’s unbearable”), Overgeneralization (“This hurts, so my entire life is terrible”), and catastrophizing (“This is never going to end.”) They’re all exaggerations, all irrational, all too extreme. And these thoughts affect pain. It’s like casting a dark spell on yourself.
What to do? Strike back with The Logical Hammer of Rationality +4. Yes, CBT to the rescue. It’s a simple as asking yourself a few questions to dispute the irrational thoughts.
So pain starts whispering: “This is unbearable. My life is over. The world is coming to an end.”
Ask yourself: Is it a fact?
Nope. You are bearing the pain, however reluctantly. You know the world is not burning down because you’re still receiving spam texts. Accept the presence of the thoughts – but don’t believe them.
Ask yourself: Are you predicting bad things?
Yes. And given you only have “The Logical Hammer of Rationality +4” and not the “Orb of Prognostication and Prophecy” you can’t predict the future, Nostrodamus.
Ask yourself: Are you using the words: all/nothing, always/never/forever, best/worst?
Yes. That means you’re exaggerating. Saying “the plagues of Egypt got nothing on this” may not be appropriate.
Ask yourself: What has happened in the past?
Pain went away. Resumed taking health for granted and never thought about it again. Hmm, maybe that will happen this time, too...
Ask yourself: What else—neutral or positive—might happen in this situation other than what you’re predicting?
Hey, maybe there are explanations other than the worst-case scenario.
There are perspectives that can save us and others that imprison us. Choose the former.
Okay, we’ve covered a lot. Let’s round it all up – and learn how to overcome the biggest threat that pain presents...
Sum Up
Here’s how to deal with pain: Ouchie!: Pain definitely gets a one-star review -- but it’s important to realize psychology is a big part of it. Thoughts, feelings and expectations of doom make it worse and anything that makes you feel safe and calm will improve it a bit.
Relax: Yes, this is hard to do when you feel like you’re dying a millimeter at a time but progressive muscle relaxation can help.
Distraction: This gives you license to do unproductive stuff you might normally feel guilty about -- like watching comedy, listening to music or seeing friends. (Looking at cute animals can save the day.)
Thoughts: The lacerating ones pain brings can make you feel worse. Dispute them to get realistic and reduce the sting. When pain consumes you, you can feel like an outcast in your own life. You aren’t even “you” anymore; you’re a philosophical treatise on ontological anarchy. Pain has pressed itself so close to your nose that you can't see the world. Or yourself. You feel you are your pain.
You cannot let pain become your identity. This is a self-betrayal. And it makes things worse. Chronic pain patients who identify with their “sick role” don’t improve.
Research shows it helps to broaden your perspective. To think about what you like best about yourself. Your hobbies and passions. What you’re curious about. Your favorite things. What you’re good at. What you’re proud of and what you love. Pain is only one facet of your life, not the defining quality. Take the time to strengthen a positive vision of yourself so the pain is a mere footnote.
You’re more than your pain.
Pain is difficult. Pain is a challenge. But at least we now know that pain is an acceptable reason to spend more time looking at puppies.
You cannot let pain become your identity. This is a self-betrayal. And it makes things worse. Chronic pain patients who identify with their “sick role” don’t improve.
Research shows it helps to broaden your perspective. To think about what you like best about yourself. Your hobbies and passions. What you’re curious about. Your favorite things. What you’re good at. What you’re proud of and what you love. Pain is only one facet of your life, not the defining quality. Take the time to strengthen a positive vision of yourself so the pain is a mere footnote.
You’re more than your pain.
Pain is difficult. Pain is a challenge. But at least we now know that pain is an acceptable reason to spend more time looking at puppies.
