“…words will never hurt me”. But can my thoughts?
“I am always going to be in pain.” “If I am in this much pain, I must be seriously ill, even if the doctors haven’t discovered what’s wrong.” “This pain is excruciating.” “I can’t bear it a moment more.” “I have irreversible nerve pain.”
For those with persistent pain these may be common thoughts.
Recent research has shown that if you expect pain, you are more likely to experience pain. American researchers (Koyama et al) experimented with 10 healthy volunteers. They were blindfolded and told to expect to experience mild, moderate or severe pain after a specific signal. After each signal a controlled heat stimulation of various intensities was applied to the subject’s legs, and at the same time his/her brain was scanned. The results showed that the subject’s experience of pain increased or reduced according to the level of pain they were expecting, even when it was not a genuine fit. For instance, when subjected to severe pain volunteers still considered it moderate if that was what they had been told to expect. In the same way, mild pain was experienced as severe if that was what they had been told to expect. Of particular interest is the fact that the activity in the pain registering regions of the brain also increased or reduced according to expectation rather than stimulus.
Pain is an unpleasant experience that causes us to take notice and respond. When damage occurs in our body, messages are transmitted from the damaged area and unconsciously processed by our brain in the context of other experiences. If the brain interprets these messages as a significant threat they are sent on to our conscious brain and we experience pain. However, the message reporting damage will be interpreted by the brain in the light of our understanding of the messages and expectation. For instance, if we have had a similar problem before and last time it got better fairly quickly we will be less concerned than if it caused us a lot of trouble, or someone we know had pain in the same area but it turned out this was caused by something very serious. The same nerve stimulation can cause very differing reactions. In the second case it will cause a much greater response, which also includes the release of adrenaline and other stress hormones, and probably considerably more muscle tension both in the painful area and beyond.
Being cautious and anticipating what might happen is a normal defensive response for humans—it prepares us for potential danger. But in the context of most persistent and recurrent back pain it is an unfortunate effect of having a highly developed brain that enables us to learn from the past and anticipate future events. This anticipation allows us to consider the worst, in order to prepare to defend ourselves, which may be beneficial to our survival. Thoughts, such as those listed at the top of this article, are common among people with persistent pain. They tend to happen automatically and many people think that if we don’t notice the thoughts they don’t matter. However, unconsciously we are aware and influenced by subconscious memories and expectations that amplify our defence reactions and stress responses. In addition they use up energy. This does not mean that our thoughts cause the problem, but they can contribute considerably to aggravating the situation.
So, can we do anything about them?
It might be an interesting exercise to try to capture these thoughts. Over the next couple of days try to notice such negative thoughts that you catch coming into your mind. You might even write them down, even if it is the same thought that is repeated. In fact, repeated thoughts are particularly significant, because they keep reinforcing the negative feeling and reaction, and increase your anxiety.
Challenge these thoughts
Pay particular attention to the content of your thoughts and decide whether they are true or if there is evidence to the contrary. For example “I am always going to be in pain”. – It’s bad now, but there are times when it went out of my mind or didn’t feel so strong.
“It’s all my fault/his fault/their fault!” – What matters is what I can do right now to alleviate the pain.
“I have irreversible nerve pain.” The nerve may not be working well (my foot is numb/weak) but I can still get around.
“It’ll never stop”. – It always gets less when I take my mind off it.
The thoughts that pop into our conscious minds are influenced by what goes on unconsciously. They may be based on past experience, but even if something has happened before it doesn’t necessarily mean it will happen again. It may help to challenge your brain by observing that this thought is only a thought and not a fact. It has not happened yet and it may not. Sometimes, if the concern is something that you cannot do anything about now it is enough to challenge the thoughts by just thinking or even saying out loud “Stop!” and deliberately thinking of something else. If you put the worrying thought aside often enough, the unconscious brain will redirect its attention.
So, although there is usually a physical trigger for pain, we may unintentionally aggravate our suffering by the way we interpret it; but by the same process we may unconsciously or consciously help to reduce it. Pain is rarely ‘all in the head’ but all pain, not just musculoskeletal pain, is modified by the way we react to it, one way or the other. Fortunately, if we are aware of this we can take more control.
These thoughts are based on some ideas from ‘How to liberate yourself from pain – practical help for sufferers’ by Dr Graham Brown, Fellow of the Human Givens Institute.
Koyama T,McHaffie JG, Laurienti PJ and Coghill RC (2005) The subjective experience of pain: where expectations become reality. Proceedings of the National Academy of Sciences, 102,36, 1290-1295.