Thoughts on physical pain
Updated: Aug 15
What is physical pain? Does it make a difference what we think about our pain? Does it make a difference how we relate to our thoughts? Is there hope of changing our relationship with pain through knowledge and understanding?
I have a long relationship with pain and I have accumulated some knowledge about pain since the birth of my youngest ten years ago. I want to share a few of my reflections, knowing that what I have written will resonate with some of you. I hope my words will trigger your curiosity and make you reflect on your own pain. I encourage you to read with an open and quiet mind without thinking too much about what you already know. Being curious and looking in a different direction may lead you to see some fresh hope. What if there is new information that may change something important for you? This is no recipe or quick fix, I do not believe that exists, however, this may add something other than what you are used to, which may in turn lead to change.
The experience of long-term physical pain is much more than the mere physical sensation of pain. It impacts everything in the life of the person in pain, as well as for the people close to them (Hesam-Shariat, 2021). I know first-hand this is something everyone living with long-term physical pain is familiar with. Pain is experienced in your entire being, mentally, emotionally, and socially.
All of us know a few things about physical pain, through personal experience with our own bodies and through everything we have seen, read, and heard from others. We have a large “database” in our brains filled with stories and knowledge about pain. It comprises scientific knowledge, knowledge we assume is accurate, or which was accurate at some point in time, all our memories, opinions and personal stories about what pain is and what it means to us. Everything we have experienced regarding pain, is linked to people, places, situations, sounds, smells, thoughts and feelings. In other words, our brain has a vast archive to sift through when explaining and predicting what it means when we feel pain, whether the pain is long-term or acute. Is our brain correct all the time? Does it really know what will play out when you feel pain arising in your pelvis or in other areas of your body? Will it turn out the same as the last time? Will you have to cancel your appointments? Will you have to stay in bed? Or could it be that you can be a bit suspicious about the worst-case scenarios your brain presents you with to try to predict what your pain means? Sometimes they turn out to be shadows and not real monsters, which means we do not have to believe every story it tells us.
Our brain has a negativity bias
Our brain has what we may call a negativity bias, because its main task is to keep us physically alive. Our brain does not like insecurity, and even if it does not know anything about the future, it makes predictions to make it look like it does. Once upon a time when we lived in small tribal communities as roaming hunters and gatherers, it was paramount for our survival that our brain made predictions about the nearest future. For us to be able to react in the most sensible way, the predictions tended to be negative to prepare us for the worst imaginable scenario. The worst imaginable scenario 15,000 or 50,000 years ago looked quite different from what it may look like in the modern world, but our brain still works in mainly the same way. Whether the right decision was made every time mattered less if most of us survived in the end.
Pain is similar. Pain is not about actual tissue damage, but about protection, regardless of whether there is real tissue damage or not. Our brain receives constant messages from danger receptors in and around our bodies (Moseley & Butler, 2013). Based on that information, our brain sends pain to the area in question to the extent that it thinks is needed for us to protect ourselves. This is based on everything our brain has stored in its database on pain. I am certain all of you have heard stories of people with extensive physical injuries that have not experienced pain. I am not referring to the rare among us that are born without the ability to feel pain, but the rest of us. On the other end of the continuum, there are people with little or no physical injury that experience a lot of pain. For instance, an amputee missing an arm or a leg who can still feel pain in a body part that is no longer there. It makes you wonder, does it not? I encourage you to wonder because our brain sends us pain to protect us and not in response to the actual tissue damage. The pain does not originate in the body part where we can feel the pain, it is always produced by the brain. Pain is the most powerful protective system we have (Moseley & Butler, 2013).
With super speed, our brain uses all the knowledge and experience it has about pain, as well as information from the surroundings and the situation at hand, to decide how much pain to send you. It compares the situation in which you find yourself, to any other previous situation that resembles the one at hand. It does not always match the correct pain response with the reality of the current situation. In the example of the amputated limb, mirror therapy is sometimes used to calm down the brain’s sensitivity and trick it into believing the missing body part is still there and that everything is okay. One theory is that it is too challenging for the brain to handle a missing body part and that it sends pain to make us fix a perceived problem. In many cases the pain diminishes or disappears using mirror therapy because the brain learns that everything is okay and that we are not in danger. It is a complex system, but useful to know that our brain does not always know best. We can learn to override some of the programming developed in long term pain and recognise when our brain is overprotecting us.
Long-term and acute pain
There is a difference between the acute pain that we feel when we touch a hot stove with our hand and long-term or chronic pain. In the example of the hot stove, we react instinctively by removing our hand to avoid tissue damage. The acute pain often has important information to make us act in the best way possible to survive and to not worsen the damage. Our brain does not always get acute pain right either, but as everything happens so fast and the pain often is so intense, we realise sooner and focus our attention where it is needed and automatically act in the best way, whether there is actual damage or not.
There is a story about a patient who came to hospital with extreme pain due to a nail that had gone through his shoe. When the shoe was removed, the patient and the doctor examining him, saw to their surprise that the nail was in fact placed between his toes and had not damaged his foot at all (Moseley & Butler, 2013). The pain experienced by the patient was real and true in every sense, only it did not match any tissue damage. This is an example of the brain overgeneralising. There are numerous stories like this.
It is not uncommon for people with a severe toothache to arrive at the dentist’s office and discover that their pain has gone or subsided. The problem has not suddenly fixed itself, but one may assume that the brain knows they are in the right place to get the help they need. Pretty cool! It makes sense when we know a little more about how our brain works with pain and with most aspects of our lives, to help us survive.
Our brain – a storyteller
If I have cut myself or squeezed a finger in a drawer, I am grateful when I feel pain. I can then do what is best for the injury at hand in the moment. I have been less grateful for the long-term pelvic pain which has been a near constant companion since my second pregnancy in 2010. I did many things to relieve the pain, much of which did not work very well.
My life has changed substantially in the last few years because of new knowledge and understanding about pain and how our mind works.
Like many long-term pain sufferers, I had a vast selection of aids like crutches, cushions, walker, wheelchair, stairlift and a four-wheel-scooter. In addition to that I took various pain medications and anti-inflammatories, both over the counter and prescription. I went through different treatments with various therapists as well as physical therapy. I also had other interventions such as cortisone injections to the pubic symphysis numerous times. Several of the treatments had a short-lived effect, but nothing worked well long-term.
Given the situation I was in, this is how I pictured my life would continue to be. I thought I would depend on aids, medication, and help from other people to manage everyday life with my children, partner, house and home, plus everything else that life is made up of. However, that started to change a couple of years ago.
I am currently on no pain medications and I have returned most of the aids I was totally dependent on. It turns out my brain was wrong and the stories and predictions it made up about how my future looked, were not in tune with reality. The reason being that our brain makes predictions about the future and does not really know with any certainty what will happen.
There is often little value in listening to and believing our thoughts when they concern a future that does not yet exist, or pain which can mean something other than a physical injury we must deal with. Be curious about that.
My stories about pain may be about different themes and people than your stories, but other than that, the only differences are that in my stories, I am the main character, and the topics relate to something in my life, whereas your stories are about you and people and topics relevant to your life. That does not make them any truer.
Habits and patterns are changeable
Long-term pain has often lost its value as an alarm system because it no longer points to something we need to do anything about. You might say it is your brain running the same old program on repeat, even if it does not make sense anymore. The program is likely to keep running as long as you are afraid and do not know there are other programs that could be running instead.
There are numerous other programs that could be running, but your brain likes habits, patterns, and predictability. That is useful to know.
Our brain works in a system of predictability and tends to give us what we expect. This is true for pain, as well as for other aspects of our lives. For example, when you are thirsty and have a glass of water you may feel relief shortly after drinking, even though it may take up to twenty minutes for the water to be physically absorbed into your body and reach your bloodstream (Barrett, 2020).
Much the same happens with pain and your expectations about it. If you start believing your knee is going to hurt when you step on the fifth step of your staircase, that is eventually what will start to happen. It does not happen because there is something wrong with your knee, but because that is how your brain works with your expectations. If you, on the other hand, believe that you will be okay even if you have pain, chances are you will experience less pain over time. There is a lot happening unconsciously, but by becoming more aware of how the system works, you can gradually notice that there are other stories to believe which may over time give you an easier, better life with less pain.
By increasing your knowledge about pain and how your brain works, you can gradually change your behavioural and pain patterns. When pain arises, you can begin questioning if perhaps your brain is exaggerating. In addition to knowledge about pain and how the brain works, it is clearly useful for many of us to have professional individual guidance from therapists with knowledge on physical activity and exercise we can engage in to build strength, stamina and flexibility. When some of the fear of experiencing increased pain or causing physical harm is reduced or gone, it is easier to succeed with that.
The way it looks to me, this type of fear simply means we are believing in our own scary thinking and this fear often makes pain persist and increase compared to when we let go of some or most of it.
New knowledge and understanding will most likely not cause substantial change overnight, rather it is about a gradual adaptation and retraining of your body and brain as two parts of the same whole.
I started out barely able to walk a few steps without crutches alongside our garden hedge, with my crutches nearby. In the last couple of years I have incrementally increased my walking distance, my movements have become easier and more flexible, I can sit and lie down in better ways mostly without the use of extra cushions and I experience less pain in my daily life.
I still have physical limitations and the diagnosis is still there, but I have a much better experience of life. Not everybody is meant to run marathons, cycle many miles or hike to the highest mountain tops. I am glad we can be different and still live rich fulfilling lives. I am grateful to be able to make dinner for my family every day, go for shorter walks, do voluntary work, participate in various activities and go on the odd short hike. All of which I could not do for a long time.
The shifts have come about gradually because I have challenged and stretched myself little by little, starting from walking a few metres to walking a few kilometres, from lifting a pound to lifting several pounds. I work well with my body and brain; we are a good team now that I understand more about how the system works. I have in many ways shelved my fear. When I experience pain in the pubic symphysis or the pelvic area and scary thoughts show up, I know not to take them so seriously. I know the pain may have information that I have to look at, but I am not so scared anymore. Perhaps it means I have pushed myself too hard, been a bit stressed, or perhaps I must exercise more, or less? Or maybe it is simply an old program running without it having to mean anything much.
I do not ignore pain when it shows up, but I relate to it with less fear and more curiosity.
It works well because what we give our attention to, increases. That is how our brain works. You may have some examples of your own if you think about it? Have you perhaps had a broken heart and discovered that the world is full of happy couples? Been pregnant and seen pregnant women everywhere? It is not because the picture you see of the world is correct, but rather that your brain chooses what to focus on based on what you are giving your attention to and find important in the moment.
There are always a lot of things around us which we do not pay attention to, simply because there is too much information to process simultaneously. Our brain helps us focus on what is significant, for better or for worse. It is practical to know how our brain works, because it becomes easier to join forces with it.
Mood, thoughts and pain
Pain science has discovered significant new and useful facts about the brain in recent years, which has led to the definition of pain changing. It is presently more common to describe pain as a subjective experience which is always real and true whether there is actual tissue damage or not, and fortunately less about pain being psychological or imagined. To be met with trust and taken seriously is essential, especially when we experience challenging circumstances and need support from social services, therapists, the health care system, family, colleagues and friends.
The way it looks to me, there is no separation between body and mind, they are two sides of the same coin always acting together.
Every physical symptom in our bodies and everything else we experience, is brought to us via thought. On days when your mood is low and you have a lot of thinking about everything that feels hard or unfair in your life, or you are feeling stressed about everything you think you should have done, you will often experience more physical pain and symptoms and the world appears a darker place. Any physical reasons for the pain or symptoms are unlikely, and the world most likely has not changed much, but you are more prone to notice and keep your attention there when your body is tense and you are listening to your negative thinking. You are simply experiencing the world and your pain and symptoms through dark thought glasses.
You believe negative thoughts more easily when your mood is low, as you do not have access to all your mental resources which are available to you when you are in a higher mood. Moods can be compared to a glass elevator going up and down on the outside of a tall building in a large city. When the elevator is down, all you can see are sidewalks and the nearest buildings, which makes it hard to orient yourself, whereas when the elevator is on the top floor, you have a much better view of the city and the surroundings. From up here you make the best decisions for yourself and the people close to you. Decisions that are right for you. Are you too high up, it is easy to become too impulsive and act less wisely. In my experience the feelings in your body will tell you where the elevator is and how much you can trust your thinking. Our mood goes up and down by itself and is not controlled by us. If we try, we will often find that our mood stays low longer. On the other hand, if we leave it alone, it will change by itself and before we know it the elevator is higher up and we feel more like ourselves again.
Mood is a biological process that every human being has a slightly different version of, but it is always experienced mentally as thoughts and feelings (Barrett, 2020).
The way it looks to me, we feel our thinking even if we often are not consciously aware of the actual thoughts flowing through our minds.
The way I see it, we do not have to know what the thoughts are most of the time, as they often hold little valuable information. We often feel discomfort in our chest or stomach area when the system gives us feedback that our thoughts are not helpful to us. We are believing something that is not true.
Change is possible
With a deeper understanding of what physical pain is, I have gradually learnt how to increase my physical activity and have taught my brain to be less sensitised to pain.
What I choose to believe and put my attention to, is vital to how a situation will appear to me. The truth is that the future is blank and empty, meaning that every thought about the future is made up and often based on previous incidents. That is true even if it sometimes happens to be accurate. Feel free to indulge in daydreaming when you have a good feeling in your body, but when it feels uncomfortable, to me that is a signal to not pay so much attention to the thoughts flowing by.
Two years have passed since my last appointment with a physical therapist. I do daily workouts and exercises at home; I walk as much as I can, and I am no longer so afraid when pain arises in my pelvis. Pain often still shows up when I walk and move around, but I am suspicious and curious instead of afraid. I try out different actions to see what happens, like stopping for a while to stretch or take a break. I no longer turn around to go home if I am on a walk and I do not call someone to have them drive me home. Whether it is the stretching or the break, or just the brain relaxing, I do not know, and it does not really matter once the pain has subsided. I feel the same about the placebo effect in general. If it works, there is no real need to figure out why, to me it is simply evidence of how our amazing brain works.
Learning some brain science and custom exercises with a competent therapist who specialises in my diagnosis, have deepened my understanding. I did a five-month intense program with this therapist in 2018-19 where he taught me specific exercises and workouts aimed at improving my condition. Before this deepened understanding and knowledge, I not only had pain in my pelvis, but in my back, my neck, and my shoulders as well, which I no longer consider issues for me.
Everything is connected. When our spinning minds slow down a little and we stop believing everything our brain is “talking about”, whether it is about pain or something else in our lives, our whole system becomes more relaxed, and everything becomes easier. When my mind is busy with a lot of thinking, when I feel a bit stressed or busy, my pain tends to increase, but I know that it is most likely feedback telling me I am not using my mental capacities in a good way, rather than it being a signal about an injury to be taken seriously.
Our brain uses every feedback system it can to make us focus on what it perceives to be important. Pain can work to distract your attention away from something that is emotionally difficult as well. If you are given a serious diagnosis, or someone close to you has a serious illness or dies, you may experience pain in an old fracture or other injury that healed years ago. It does not mean that the injury has resurfaced, but rather that you are in emotional pain and the system is trying to help you in some way. It is not always obvious what it is about, but pain is an important part of our alarm system, and although there are often false alarms when it comes to long-term pain conditions, it is better to learn how to relate to it in a different way, than to be annoyed with the system being the way it is. Our brain is doing the best it can.
Learning by doing
I can in all seriousness say that I would not change my experiences with pelvic pain and the mental stress that came alongside it as a “bonus”. Not because they were pleasant experiences much of the time, but because I have learnt so much about myself, about our frustrating and amazing brain, about pain, and about how all human beings work. I know I feel my thinking, I do not feel my pelvic pain, my children, my partner, or the weather, I feel my thinking about all of that. Physical sensations arise, but the way I experience that is always through thought. My thoughts depend on my mood, which I do not control, but which always corrects itself when left alone.
I know when I feel pain in my pelvis or other areas of my body, I do not have to panic or take my thoughts so seriously. I can be curious and see if the pain maybe passes. It always does, although there is no rule as to how long that takes.
I do not panic if I feel fear going through my body when I am not in a dangerous situation. I know it means that my mind is busy talking about something scary. I can let it pass and not give it any attention and it will pass all on its own. I can hardly describe how it feels to me, but my world has been turned upside down and has gradually expanded, instead of becoming smaller and smaller. My world continues to expand.
I think that is what often happens when our brain (over)protects us with pain, anxiety, or other types of mental stress – our world constricts.
When we let pain and fear govern us, our world becomes small.
I have been there for many years myself, so I know how it can feel. Your world can expand as well. My world is limitless compared to what it was.
What about your pain?
I hope you think a bit differently about your own pain after reading this article. I hope you can see that your pain is not different than my pain, even if it may appear that way. There are several ways to change the way you experience pain, but the way it looks to me, it always begins with knowledge and a deeper understanding of what pain really is. Perhaps it is right for you to try to walk a bit more? Or try to sit without a cushion, or perhaps try a thinner one? Lie in bed without extra cushions or other aids? Do some exercises? You know best where you can start to challenge your pain and your relationship with it. Perhaps you have a therapist who can guide you in modern pain science and show you how to translate that into actions that work for you? Perhaps you are like me and enjoy reading, listening and speaking to people to acquire new knowledge to challenge yourself? I believe change is always possible no matter where you start.
It has been useful for me to read up on modern pain science and I have also enjoyed listening to the podcast Changeable (Dr. Amy Johnson), which is about how we can understand ourselves in new and useful ways. The way it looks to me, understanding how our mind works is a fundamental key for lasting change to happen from the inside out whether we struggle with pain or other issues.
Please reach out to me at firstname.lastname@example.org if you want to book a free session to explore your possibilities for change, or if you have questions or reflections to share. I would love to hear from you!
Barrett, L. F. (2020). 7 1/2 Lessons about the brain. Boston, USA: Houghton Mifflin Harcourt.
Hesam-Shariat. (2021, 04 18). NeuRa - NeuroScience Research Australia. From NeuRa: https://www.neura.edu.au/project/unravelling-the-link-between-chronic-pain-and-mental-health-disorders/
Moseley, L. G., & Butler, D. S. (2013). Explain pain 2nd. edition (2.. utg.). Adalaide, South Australia, Australia: Noigroup Puclications.