According to , more than 20 percent of Americans experience persistent physical pain that interfereswith their daily life. More thanof Americans also experience chronic psychological painin the form of depression, anxiety, and other mental-health disorders.
Unfortunately, we’ve largely got chronic pain wrong. “Conventional thinking on pain may be incorrect at best and harmful at worst,” says Kelly Starrett, a doctor of physical therapy and founder of the, a gym and online resource dedicated to helping people relieve pain, prevent injury, and improve their physical performance.
The first way we get chronic pain wrong, says Starrett, is that we assumeit occurs in the muscles or bones or, in the case of psychological disorders,the mind. However, more recent work in the field of pain science this isn’t the case. Persistent chronic pain is a bio-psycho-social phenomenon. In other words, it manifests from a combination of issues arising in our bodies, minds, and communities. While acute pain (e.g.,a broken wrist, a sprained ankle, or transient anxiety or depression) recedes with targeted treatments, chronic pain does not. Thus, Starrett says, it requires a muchmore holisticview.
Consider the following examples: mental illness, whilepersistent physical pain can be alleviated with psychological training, such as. In order to address chronic pain in a meaningful way, explains Starrett, we’ve got to focus on the entire system.
The second way we get chronic pain wrong is that we assume pain is always a bad thing, and thus we come to fear it. However, this couldn’t be further from the truth, says , a performance coach (and also my ). “Pain is a dramatic evolutionary advantage,” Magness says. “It is information. It tells us that something is wrong, or that something could go wrong. But sometimes a little bit of pain also tells us that we’re on the right track.” Just think about it. Any meaningful attempt toward improvement—be it physical, psychological, emotional, or social—usually involves at least some discomfort, if not pain.
According to , a professor of surgery and anesthesiology at Northeast Ohio Medical School and chairman of the pain center at WesternReserve Hospital, persistent chronic pain that has no underlying current pathology (i.e.,whatever was wrong in the body has been fixed) is often perpetuated for two reasons: we become eitheroverly sensitiveto that discomfort and pain or insensitiveto it, both of which can lead to more long-standing and severe issues.
On the oversensitive side, at the slightest bit of pain, our mind-body system freaks out, which in turn causes more pain. We enter into a vicious cycle of hypersensitivity, with pain begetting more pain. This is common to and . On the insensitive side, we endure too much pain without changing our approach or asking for help. The result, explains Narouze, is that the pain often gets worse. “One of the strongest predictors of persistent chronic pain is how long a person has gone without getting help. The longer that period, the more likely the pain will become chronic,” he says. Learned helplessness is also common to , which, unsurprisingly, is associated withand.
When we become oversensitive to pain, the solution is often forcing ourselves to experience it, so that we can retrain our mind-body system not to freak out.A person undergoing this kind of learns that sometimes it is their fear and avoidance of experiencing pain that is causing their distress more than the actual pain itself. Exposure therapy is part of a broader model called cognitive behavioral therapy, which, according to Narouze, “has the highest level of evidence, even more than medications, for helping with persistent chronic pain.”
When we accept too much pain, the solution generally involves learning that it’s OKto ask for help, that pain neednot be a given, and that we can take action to improve our situations. This is also a cornerstone of cognitive behavioral therapy and other evidence-based therapies, such as .
In both circumstances—oversensitivity and insensitivity—problems arise when we respond inappropriately, either by not tolerating any pain or by tolerating too much of it. In both cases, pain tends to become worse.
In the final analysis, perhaps we need to stop thinking about persistent chronic pain in a vacuum and start addressing it more holistically; if westop focusing solely on the sensation of pain itself, we can start focusing on what it is telling us and how we respond to it, as individuals and communities.
Brad Stulberg () coaches on performance and well-being and writesϳԹ’sDo It Bettercolumn. He is the bestselling author of the booksand. Subscribe to his newsletter.