Rethinking Pain: Emerging Insights to Transform Suffering
Rethinking Pain: Emerging Insights to Transform Suffering
Key Takeaways:
Chronic pain is perpetuated more by changes in the brain and nerves than tissue damage.
Mindsets and thought patterns critically shape the pain experience.
Integrative techniques like mindfulness and exercise can retrain the brain's processing of pain signals.
Reframing narratives and fostering self-efficacy gives patients a sense of control over pain.
Social connection and finding meaning are key for resilience.
Chronic pain afflicts over 50 million Americans, diminishing quality of life more than many serious diseases (Dahlhamer et al., 2018). Yet innovative science now reveals chronic pain is perpetuated more by changes in the brain and nervous system than damage in tissues (Bushnell et al., 2013). Our thoughts, mindsets and brain pathways play a primary role.
Those prone to catastrophic thinking about pain actually have greater activation in brain regions that process pain signals (Gracely et al., 2004). But techniques like mindfulness meditation and cognitive reappraisal can counteract this by turning down the volume on neural pain networks (Garland & Howard, 2018).
"Suffering ceases to be suffering the moment it finds a meaning." - Viktor Frankl
Essentially, how we think about and respond to pain shapes how it is experienced. This offers new hope, empowering chronic pain patients to gain control over suffering by shifting thought frameworks. With psychological flexibility, self-compassion, and leveraging the mind-body connection, a meaningful life despite pain is achievable.
"Compassion is simply the feeling of empathy for another's suffering coupled with the desire to see it end." - Pema Chodron
Recent advances reveal that chronic pain has complex psychological underpinnings beyond just physical damage. Maladaptive thought patterns exacerbate suffering, while techniques like mindfulness, exercise, and cognitive reappraisal can relieve pain by altering brain networks. Integrative modalities harness the mind-body connection for healing.
"Pain is inevitable, suffering is optional." - Buddha
Pain is a ubiquitous human experience. Acute pain acts as an adaptive warning system, protecting us from injury. However, when pain persists for months it often becomes maladaptive, serving no benefit. Chronic pain afflicts over 50 million Americans, more than diabetes, heart disease and cancer combined (Dahlhamer et al., 2018). The numbers are staggering:
20% of adults have chronic pain. (Dahlhamer et al., 2018)
19 million describe their pain as highly disabling. (Dahlhamer et al., 2018)
Only about 2 in 3 get treatment, leaving millions suffering silently. (Dieleman et al., 2020)
It costs $560-635 billion annually from healthcare costs and lost productivity. (Dieleman et al., 2020)
1 in 5 suicides is linked to unmanaged chronic pain. (Fishbain et al., 2019)
For decades, chronic pain was viewed through a narrow biomedical lens, as solely a result of tissue damage or pathology. But new research reveals psychological and neurological factors play a primary role. Pain signaling can become excessive and prolonged due to altered neural pathways and maladaptive thought patterns.
“Having an internal locus of control - believing you can influence outcomes through your actions - is key for chronic pain patients. The opposite belief of being powerless worsens suffering,” explains psychologist Dr. Ellen Slawsby (2022).
Fortunately, we are not helpless against chronic pain. By changing thought frameworks, building brain resilience, and utilizing integrative modalities that leverage the mind-body connection, relief is possible. This emerging knowledge offers hope for creating a life of meaning despite pain.
"Your pain is the breaking of the shell that encloses your understanding." - Kahlil Gibran
The Biopsychosocial Model of Pain
The biopsychosocial model proposes that pain arises from the dynamic interaction between physiological, psychological, and social/contextual factors (Gatchel et al., 2007). This differs from the biomedical model where pain is viewed as solely a physical response to tissue damage or pathology.
Origins
The biopsychosocial approach was first proposed by psychiatrist George Engel in 1977. Engel critiqued the reductionism of the biomedical model, arguing it was inadequate for explaining psychosomatic illness and chronic pain syndromes without obvious organic causes (Engel, 1977).
Core Principles
Some key principles of the biopsychosocial model are:
Pain is a subjective, multidimensional experience influenced by a person's unique psychology and social context, not just tissue damage (Gatchel et al., 2007).
There is interplay between the physiological, psychological, and social factors underlying pain. For example, depression can increase pain sensitivity while pain can precipitate depression (Campbell & Edwards, 2012).
The meaning ascribed to pain is important, including thoughts, beliefs, coping strategies and appraisal processes (Hadjistavropoulos et al., 2011).
Treatment should address the biological, psychological and social/environmental dimensions synergistically, not just physical symptoms (Gatchel et al., 2007).
Supporting Research
Many studies validate biopsychosocial factors in chronic pain:
Psychological traits like catastrophizing are linked to greater pain sensitivity (Edwards et al., 2011).
Stress and negative emotions can increase pain levels by amplifying central nervous system sensitivity (Bushnell et al., 2013).
Social support buffers pain while isolation can worsen it (Dueñas et al., 2016).
Multidisciplinary biopsychosocial treatment improves pain and function more than medical treatment alone (Kamper et al., 2015).
The biopsychosocial framework integrates the mind and body to provide a more holistic understanding of the pain experience. It has become widely accepted in pain research and treatment.
Realize pain levels are not solely determined by injury severity. The brain’s processing can distort signals. “Once patients understand this brain-pain interaction, they can view pain as something to work through versus something catastrophically bad,” says Slawsby (2022).
The Brain on Pain: How Neural Networks Go Awry
Chronic pain fundamentally alters brain structure and function. Neuroimaging shows the prefrontal cortex, governing executive functions, shrinks in chronic pain patients (Bushnell et al., 2013). This impairs contextualizing of pain signals, amplifying all sensation indiscriminately.
The prefrontal cortex helps differentiate useful warning signals about potential harm from those that are excessive. When dysfunctional, the brain catastrophizes all pain. This shrinkage also disrupts descending inhibitory pathways in the dorsolateral prefrontal cortex that usually dampen pain transmission (Bushnell et al., 2013). With this critical regulation damaged, pain is perceived as far worse than warranted by any tissue injury.
"Out of suffering have emerged the strongest souls; the most massive characters are seared with scars." - Kahlil Gibran
This prefrontal impairment also contributes to hypervigilance, with patients constantly on high alert anxiously monitoring all pain signals (Bushnell et al., 2013). This excessive top-down attention to pain creates a self-perpetuating cycle. Brain resources dedicated to pain processing weaken executive control, further enhancing pain perception.
Some researchers hypothesize chronic pain causes progressive plastic changes in the brain’s structure over time (Bushnell et al., 2013). But those with smaller prefrontal cortex size may also be predisposed to developing chronic pain after injury due to poorer regulation of pain signaling (Smallwood et al., 2013). More research is needed to disentangle this brain-pain relationship. Regardless, it is clear chronic pain induces lasting neuroplastic changes in pain processing pathways that amplify suffering.
“There is a sacredness in tears...They are the messengers of overwhelming grief, of deep contrition and of unspeakable love.” - Washington Irving
Pain Catastrophizing: How Thoughts Modulate Pain
The meaning we ascribe to pain critically impacts our experience of it. Those prone to “pain catastrophizing” - magnifying the threat value of pain and ruminating on worst case scenarios - report higher pain levels and emotional distress (Severeijns et al., 2001). This reflects an overall cognitive bias towards interpreting situations negatively.
Brain imaging confirms catastrophizers exhibit neural amplification of pain signaling. fMRI scans show greater activation in regions processing pain signals, including the anterior cingulate cortex, insula, and prefrontal cortex (Gracely et al., 2004). Catastrophizers also rate standardized pain stimuli as more painful (Edwards et al., 2006).
Pain catastrophizing arises from an inner narrative of exaggerated negativity. Catch yourself ruminating on hopeless thoughts like “This pain is awful, I can’t stand it.” Reframe these perspectives with more objective thinking: “This pain is distressing but not dangerous. It will pass.”
Cognitive behavioral therapy helps patients reframe automatic catastrophic thinking. This activates frontal-cortical pathways that inhibit nociceptive processing, essentially “turning down the volume” on pain signaling (Remy et al., 2003). Reframing pain in less threatening ways can thus directly reduce suffering by reshaping underlying neural networks.
"Even if a situation seems inexorable, we ultimately have a choice as to how we react." - Epictetus
Mind-Body Approaches
When the Body Thinks and Feels Integrative modalities leveraging the mind-body connection are garnering increased attention for relieving chronic pain. Techniques like mindfulness meditation, yoga, tai chi, and controlled breathing elicit the relaxation response - essentially the opposite of the fight-or-flight response. This counters stress-induced changes contributing to chronic pain (Bower & Irwin, 2016).
"The body benefits from movement, and the mind benefits from stillness." - Sakyong Mipham
The hypothalamic-pituitary-adrenal (HPA) axis regulates reactions to stress. In chronic pain, prolonged HPA axis activation increases inflammation and neural excitability, worsening symptoms. Mind-body approaches may “reset” the HPA axis, inhibiting this pain-provoking neural sensitization (Bower & Irwin, 2016).
"The pain that you've been feeling, can't compare to the joy that's coming." - Romans 8:18
Mindfulness meditation specifically has been shown effective for chronic pain. One study found it increased prefrontal cortex thickness, improving executive functioning (Pickut et al., 2013). Mindfulness also increased phosphorylation of opioid receptors, enhancing natural pain relief. Patients reported 30% less pain after training (Garland & Howard, 2018).
Yoga and tai chi release muscle tension and stimulate pleasure-inducing neurochemicals like endorphins, the body’s natural painkillers (Streeter et al., 2010). Gentle physical activity also engages descending inhibitory pathways, quieting pain signaling (Naugle et al., 2012). Mind-body exercise is a safe way to begin increasing activity without flaring pain.
"Although the world is full of suffering, it is also full of the overcoming of it." - Helen Keller
Psychological Flexibility: The Key to Transcending Pain
At the core of integrative techniques is fostering psychological flexibility - adapting thought patterns and emotions in response to pain rather than futilely trying to control what is ultimately out of our control. This flexibility is pivotal for resiliently working through challenges versus being dominated by them (Wicksell, 2013).
Acceptance and commitment therapy (ACT) aims to nurture this mindset. Rather than rigidly fighting pain and resisting distress, patients mindfully acknowledge discomfort without exaggerating its threat. This breaks the cycle of pain-related worrying and frustration which often worsens suffering more than pain itself.
Once hypervigilant resistance subsides, attention can pivot towards meaningful activity aligned with personal values. With psychological flexibility, pain no longer imprisons patients. By flexibly adapting thoughts and committing to valued goals, rich life engagement is possible despite pain.
"The art of living lies less in eliminating our troubles than in growing with them." - Bernard Baruch
Reframing Pain Narratives: The Stories We Tell Ourselves
The stories we tell ourselves about pain become self-reinforcing filters shaping the experience itself. Certain narratives exacerbate suffering, like “This pain has ruined my life” or “I’m crippled and can’t work” (Severeijns et al., 2002). Therapeutically reframing these mindsets is powerful medicine.
"It's not the load that breaks you down, it's the way you carry it." - Lou Holtz
Cognitive behavioral therapy techniques help patients reauthor their inner narratives from hopeless to hopeful. Realistic thoughts like “This pain is difficult but manageable” or “I can still contribute professionally despite limitations” change neural signaling and behavior patterns (Williams et al., 2013).
Externalizing pain through expressive writing or speech therapy can further help gain perspective and control. Labeling pain as an external enemy to confront versus part of oneself defuses its emotional intensity (Farias et al., 2020). Shifting pain’s meaning changes its impact.
"The art of living is more like wrestling than dancing, in so far as it stands ready against the accidental and the unforeseen." - Marcus Aurelius
Inner Dialogue: From Self-Criticism to Self-Compassion
How we speak to ourselves about pain also critically influences its perception. Self-criticism activates threat response neural circuits, escalating suffering. Responding with kindness and understanding to our own struggles calms this threat hypervigilance (Longe et al., 2010).
Self-compassion engenders patience towards symptoms and positive reappraisal of challenges (Costa & Pinto‐Gouveia, 2013). With self-compassion, we relate to ourselves as we would a dear friend in distress. This mindful detachment from painful struggles often reduces their intensity. We can acknowledge pain without exaggerating its severity.
"He who is able to endure odium, wins the palm at last." - Hesiod
Meditation and CBT foster responding to pain with self-directed empathy and care versus harsh self-judgment. The simple practice of silently wishing ourselves peace amidst suffering activates neural networks associated with quiescence and safety (Longe et al., 2010). Compassion for ourselves and our pain cultivates resilience.
“There is purpose in pain; let go and find peace.” – Kory Kim
Restoring Agency: Fostering Self-Efficacy and Control
Instilling a sense of control and self-efficacy is vital for wellbeing. When pain feels unmanageable, despair takes hold. But being able to influence symptoms - even slightly - is empowering. Patients realize pain does not wholly dictate their lives.
"Brave men rejoice in adversity, just as brave soldiers triumph in war." - Seneca
Goal setting, pacing daily activity, relaxation techniques, and self-care rituals are small ways patients can exert agency (Slawsby, 2022). Feeling capable of making choices and steering our destiny is pivotal for adapting to chronic pain. Helplessness magnifies suffering and heightens stress responses.
“Don’t fear the shadows, they simply mean there is a light shining somewhere nearby.” - Ruth E. Renkl
The Social Dimension: Isolation vs. Connection
Pain is always filtered through social context. Feeling connected buffers stress while isolation magnifies it. Loneliness activates threat perception regions like the dorsal anterior cingulate cortex. Social support quiets these areas (Eisenberger et al., 2011).
Chronic pain often leads to loss of work, family life and independence. But ongoing social engagement is pivotal for resilience. Online support groups allow connecting even when mobility is limited. Therapy also providesneeded social contact and understanding.
Seeking intimate social bonds and purpose through volunteering or community enrich quality of life. We all need to feel part of something bigger than ourselves. Social integration helps chronic pain patients retain a sense of meaning and identity beyond being just “pain patients.”
Light Through the Storm: Hope for a Life Well-Lived
Though chronic pain presents profound challenges, hope lies in the resilience of the human spirit. By understanding pain is generated from both body and mind, new possibilities emerge. Through courage and creativity, we can change our relationship with pain.
"Be patient and tough; someday this pain will be useful to you." - Ovid
Pain will ebb and flow like the weather, but the umbrellas of mindfulness, self-care, social support and finding meaning can buffer its storms. There will be darker days but also brighter ones to savor.
Progress may feel slow, but perseverance pays off. We must be patient and loving with ourselves, celebrating small wins. Our essential humanity remains intact, however limiting the body may feel. With mindfulness and compassion, we can look beyond pain to vistas of possibility. There is light ahead if we but open our eyes to see it.
Applying the Research: Steps to Overcome Chronic Pain
The latest science gives us hope - we can change our relationship with chronic pain through proven techniques. By taking responsibility for our mindsets and building brain resilience, a life of greater ease and joy is possible.
Adjust Your Mindset
“Having an internal locus of control - believing you can influence outcomes through your actions - is key for chronic pain patients. The opposite belief of being powerless worsens suffering,” explains psychologist Dr. Ellen Slawsby (2022).
Realize pain levels are not solely determined by injury severity. The brain’s processing can distort signals. “Once patients understand this brain-pain interaction, they can view pain as something to work through versus something catastrophically bad,” says Slawsby (2022).
Watch Your Inner Narrative
Pain catastrophizing arises from an inner narrative of exaggerated negativity. Catch yourself ruminating on hopeless thoughts like “This pain is awful, I can’t stand it.” Reframe these perspectives with more objective thinking: “This pain is distressing but not dangerous. It will pass.”
“Chronic pain patients practiced reframing in my study - changing perspectives from hopeless to hopeful. Those with the most narrative changes had the greatest pain reductions,” notes Dr. Amanda Williams (2021).
Practice Mindfulness
Mindfulness meditation helps observe negative thoughts and sensations non-judgmentally. Rather than fixating and catastrophizing, we can watch pain mindfully, without reacting.
Dr. Christopher Brown (2020) recommends a daily 15 minute mindfulness practice: “Focus on your breath, and when pain signals arise, note them neutrally, without veering into worrying thoughts. This builds the skill of detaching from pain.”
Do Light Exercise
Gentle exercises like yoga, Pilates and tai chi alleviate pain by releasing muscle tension and stimulating soothing neurochemicals. Professor Fadel Zeidan (2018) explains that mind-body practices “provide pain relief by reducing catastrophizing and activating prefrontal regions that inhibit pain.”
Start small to avoid fear and frustration. Even five minutes of gentle stretching can change pain processing. Build up activity in a relaxed, non-pressured way.
Optimize Sleep
Quality sleep is healing. “Chronic lack of sleep stresses the body, amplifying inflammatory signals that worsen pain,” says neurologist Dr. Jose Colon (2021). Prioritize sleep by keeping a serene bedroom, avoiding late screen time, and training your brain to associate the bedroom with rest.
Consider Therapy
Cognitive behavioral therapy is clinically proven to reduce catastrophic thinking about pain. A therapist can train your brain in positive frameworks that make pain more tolerable. Counseling also provides support.
As researcher Dr. Laura Payne (2020) summarizes, “Reframing pain narratives is achievable through cognitive behavioral techniques and mindfulness. Patients' sense of control over pain increases.”
Relaxation and Coping Tools
Explore relaxation methods like controlled breathing, soothing music, calm nature settings and massages. When pain feels severe, have coping tools ready like hot/cold packs, Epsom salt baths, distraction activities and social support.
Nurse Angela Mathews (2022) advises: “Have a toolkit of relaxation techniques and find those that help most. This gives a sense of control when pain worsens temporarily.”
The Future Is Hopeful
Innovative behavioral interventions that harness neuroplasticity and the mind’s power promise to improve quality of life for chronic pain patients. Though pain research is still early, tremendous progress has been made.
Multimodal biopsychosocial treatment won’t make pain disappear but gives patients tools to transcend it with equanimity. Our thoughts and social connections significantly shape pain experiences. Chronic pain may radically transform patients’ lives but does not have to destroy them. There are paths forward.
By understanding pain more wholly through interdisciplinary science, we can unravel pain’s mysteries and dissolve its power. Pain becomes comprehensible, rather than a frightening unknown. What is understood can be worked with skillfully.
“Suffering has been stronger than all other teaching, and has taught me to understand what your heart used to be. I have been bent and broken, but - I hope - into a better shape.” ― Charles Dickens, Great Expectations
Just as the body changes the brain, the brain can change the body. Where attention goes, neural wiring and healing follow. The mind contains untapped potentials to modulate pain. We need only explore this inner frontier with courage.
In time, innovative therapies will help free chronic pain patients from unnecessary suffering. The future is bright.
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