“Your Pain is Real: An Introduction to Chronic Pain”

“Your Pain is Real: An Introduction to Chronic Pain” #painmanagement

By: Rebecca Stein, ASW


Physical pain is REAL, even if it’s invisible. Yet, despite what anyone may tell you, your experience is unique to you and you alone. It can impact everyone differently so making sense of it by comparing your pain with someone else’s and how they’re dealing or handling is self-inflicted Jiu-jitsu on your self-esteem.

There are two types of physical pain:

  1. Structural pain, caused by the body
  2. Psychosomatic, pain caused by the mind. Yes, that’s right, your psyche can express its self through years of trauma in your body.

But pain is pain in the mind.  A level 10 pain for someone who broke his leg may also be a level 10 pain for someone who was in a car crash but showed no signs of a structural break. Both types of pain can be isolating. PERIOD. So when medical professionals, parents, teachers, and therapists can’t identify the pain you feel or worse, diminish it as either “all in your head” or discount it with “just push through it,” the pain typically intensifies due to the lack of support from others.


What is Pain?

Okay, so you learned to not put your hand on a hot stove because your brain sends pain signals to your hand so that your hand reacts by removing itself from the stove. The message is then relayed back to your brain as “ouch.” This is a GOOD thing! It’s your protection. When you have psychosomatic pain, the brain is in overdrive and sends these danger signals over and over again to the body causing significant distress. Only, there’s no visible fire.  Leaving you and others to doubt or question the pain. But it’s there even when you try to ignore it. When you can change your relationship with the pain to one of protection, you no longer see the pain as dangerous.  Instead, it’s a friend helping you remove your hand from the stove and prevent “emotional “scarring.


The Connection between the Mind and the Body:

Maybe you’ve been working in a toxic work environment, and even though you’re thriving, always having to defend and protect yourself and your subordinates from the political jousting has finally taken its toll, mentally and physically.  Or maybe you’re the golden child of your family and you’ve been showered with love your whole life because you’ve performed to the highest levels, academically and professionally but you’re run-down and running to the doctor monthly with new symptoms.  Or maybe you find yourself in a state of “panic” in social situations and experience frequent panic attacks, preventing you from making the connections you desire. Likewise, you may find yourself “at a loss for words” when put under pressure to meet a specific deadline.

Consciously, you may find yourself still able to go about your daily tasks, while the smooth muscles in your stomach are actively churning and struggling to digest properly due to the repressed, unconscious thoughts you are having. How could you blame yourself when 95% of your thoughts are in your unconscious awareness? Yes, you are only conscious 5% of the time! This is why Mr. Insomnia may come creeping in under the covers at night to awaken you of your unconscious, despite consciously not thinking of anything in particular. If you’re lucky, Mrs. Nightmare will come to join you!

All jokes aside, we have all experienced The Mind Body Syndrome (TMS), also known as Tension Myoneural Syndrome by Dr. John Sarno from New York Medical Center. Maybe you found your face blushing or “butterflies” in your stomach from a first date. Possibly, you felt your hands become sweaty, your heart rate increase, or your stomach churn prior to a test, speech, competition, or performance. In all of these instances, your mind told your body it was in danger (‘thrill’ of falling in love!) which created a psychosomatic response in your body. In all of these situations, your brain’s perception of the stress-inducing stimuli creates a “danger signal” in the body or an unconscious sensation rise in your body.


What happens when these Danger Signals can’t stop firing?

Chronic Pain. And yes, typically highly intelligent people experience this type of pain since their “smart brains” are constantly thinking and firing neurons but cannot figure out a way to calm down. As a result, tension headaches, back pain, neck pain, fibromyalgia, thyroid issues, temporomandibular joint syndrome (TMJ), piriformis syndrome, repetitive stress injury, irritable bowel syndrome (IBS), interstitial cystitis (Irritable bladder syndrome), chronic regional pain syndrome (CRPS), chronic fatigue syndrome (CFS), chronic hives, panic disorder, insomnia, obsessive-compulsive disorder, multiple chemical sensitivities and many other Mind-Body Syndromes can result.


The Good Thing/ The Light Switch

Your brain had to learn these neural pathways of fear and danger, and just like it took years to learn them, your “smart brain” can unlearn them. For someone with TMS, this could mean a life with no chronic pain. For someone with a structural based condition, this could mean reduced flare-ups, increased immune functioning, and overall better quality of life.


Take-Home Messages:

  • When your brain thinks there is a tiger in front of you, it responds by fighting, fleeing, or freezing. What happens when your brain chronically believes there is a tiger in front of you? It becomes overwhelmed with uncomfortable emotions that may get repressed and are only seen through the expression of pain and/or anxiety.


  • Even in structural pain cases, the mind has a powerful effect on the interpretation of the pain and body as well as the interpretation of environmental stimuli as dangerous, causing stress on the body, which leads to increased flare-ups.


  • The goal is not to get rid of good stress. Good stress (known as Eustress) is inevitable and useful. It can motivate us to initiate and achieve! Conversely bad stress, Distress, causes damage and harm, mentally, emotionally, and physically. When we avoid pain, physically and emotionally, in our lives, stress can reach above a threshold of distress, leading to a state of shut down. With the help of a trained therapist, you can learn to approach physical and emotional pain.


  • If you can change this message of danger to one of safety, the brain no longer registers the stress stimuli as a threat but of something that you can get curious about and even move towards!


  • Knowing the source of your mind-body pain is caused by an overactive nervous system will stop you from going through unnecessary medical procedures, pain medications, injections, increased substance use, medical visits, and an unlimited number of expenses.


You are Not Alone:

As a therapist trained in pain management as well as someone who personally has overcome both structural and psychosomatic pain, I really do “get it.” In seeking my own counseling as a  young adult, I quickly felt like even the most seasoned therapist did not do justice to the pain I was experiencing, simply because she didn’t get it.   She’d never been through it and was well-intentioned but misguided.

I have too often seen extremes in opposite directions where the therapist takes on too much of an empathetic role, which places the client as “the sick one,” recreating previous familial roles the client is too familiar with, or therapists who believe there is a step-by-step protocol to treating chronic pain and therefore treat the client like another number in the system instead of an actual person who deserved validation for what they are feeling. Balancing compassion and empathy with a bit of nudging is truly the therapeutic art in pain management. As a therapist, I use cognitive-behavioral, somatic, psychodynamic, experiential, and exposure-based therapies to treat the person as a whole.  Much like the way I approach you in session,  you too will learn to approach the pain, from a place of compassion and curiosity with an attentive ear. From there, you will find the strength and empowerment to truly heal.

Mastering Difficult Conversations – Part 2


There are two parts to mastering difficult conversations. In this second part, we will focus on asking for positive change. This requires honesty and compassion, otherwise, your honesty will present as brutality.

There are 5 Steps to asking for Positive Change. Remember, honesty is important, but honesty without compassion is brutality, so you always want to approach a difficult conversation with compassion.

Step 1, observe. State what you are observing. This includes facts, this does not include evaluation, judgement, and generalizations. It’s a huge relationship killer to tell your coworker something like, “You are always late to the office”! That is generalizing a behavior that automatically makes someone on the attack. Instead, address the situation, “I frequently notice you are late to the office. Can you tell me about what’s going on with you?” So we need to externalize the problem. Make sure that it is separate from the person. Because the person is not the problem, the behavior is. A couple of examples of the difference between what it means to state the observation versus including evaluation. At home is might look something like, “You have 5-10 pairs of shoes at the front door.” At the office, it’s something like, “I noticed that you’ve just finished the presentation for the meeting this morning, just right before the meeting.”

Step 2 is to identify your feelings. Remember, part of this process is staying cool, calm, and collected. You are asking for positive change. So when you identify your feelings, it’s okay if you are frustrated, but keep the frustration contained, not, “I feel so frustrated!” You want to open the conversation and say, “I feel frustrated that…” Make sure you know what you’re feeling, and keep it simple, happy, sad, mad, glad. As long as you can deliver it with, I have this feeling but contain it in a way that allows the other person to hear it. That’s what is going to make this a productive conversation.

Step 3 in asking for positive change is clearly stating your need for change. When we ask for the need and positive change, speak clearly, firmly, and positively. An example of asking for the positive change and the need portion is, “I need to trust. I need to trust that you are going to show up on time for office meetings. I need to trust you’re going to show up to dinner on time because it’s important to me.” Remember, this is your need, so don’t externalize or project it onto them. It is your need, so own it.

Step 4 is to state your request. Give them a roadmap of what you need from them. “I want you to show up five minutes before the meeting every time.” or “I want you to be home three days a week in time for dinner.” State exactly what it is you are asking from them and remember, you are asking from them. They still get to decide whether they agree or not.

Step 5, ask for feedback as you are going through the conversation. Ask things like, “How are we doing? Are you good with this conversation? Is there more that you want to get through?” Make sure you address one point at a time. Too many points that you are trying to make and asking for positive changes completely emotionally floods the other person. They don’t even know where to start, they feel like they are drowning in emotion. It just creates a lot of anxiety for people or makes them want to shut down. So remember, ask for feedback as you go along in the conversation so that you get to be heard, and the other person doesn’t feel flooded. For example, asking for feedback at work might sound like, “How are we doing here? Are we on the right track for this conversation?” At home, it may sound something like, “I’m feeling understood. How are you doing? Is there something more you want to say to make sure that we’re good?”

Difficult conversations don’t have to be so difficult if you develop the skills to have them.

Mastering Difficult Conversations – Part I

There are two parts to mastering difficult conversations. In this first part we will focus on effective listening. This requires empathy.

There are three parts to effective listening. Remember, you have two ears and one mouth for a reason. Listen twice as much. First, tune out the noise. Put your technology down, get present with the person you’re trying to have a conversation with. Close the office door. Put the computer aside. Give them the gift your presence. Quiet the noise on the outside so you can be present with them in that moment. Then, remember while you are also paying attention to what’s happening inside of yourself, attune to the other person’s needs. What is their core message. What are they trying say. Not everybody is very direct and clear with what it is that they need. So being able to really attune to the feeling or the message they are trying to get across is really critical. Ask yourself in that moment what it is that they are really trying to tell me. What do they need from me.

Let’s give a quick example of what it looks like to attune to the underlying message. Say your assistant comes and says: “Hey I heard we are doing a whole office redesign. I have my undergrad in ergonomics. Can I be a part of the project?” What do you think she is really trying to say? Maybe she’s really trying to say, I’m looking for more responsibility. I’m wanting to participate more and be more engaged. So it’s important that you pay attention to the underlying messaging not just the content of what’s being said. What does it look like to attune to your partner at home? Let’s just say your wife says: “I can’t believe you’re working again late tonight.” What is her underlying need? In that moment it might be she misses you and she don’t know how to say I miss you and instead she comes at you with a little bit more of what might feel like an attack. So pay attention where you can, what the underlying need is and that’s gonna help you have a more productive effective difficult conversation. So step number two is summarize what you heard them say. It’s really important that you just state the facts as you heard them not filter it with your opinions and combating with what you think you need to say in order to defend yourself. That’s gonna cause a really difficult conversation to ensue. So just take it one step at a time. Maybe have only one or two bullets of what it is that you know that you would need to sit with and process.

So again, summarize what you heard them say and ask them is that accurate? Did I get you? Ask them to clarify. The asking for clarity instead of making an assumption of what it is they’re trying to say. It’s really important and making sure that the other person feels heard. It’s gonna help you respond to exactly what it is that they’re trying to communicate. So difficult conversations don’t have to be quite so difficult if you develop the skills to have them.