People react differently to pain. How you cope with your pain is largely based on how functional you are physically and psychologically. The more you are able to do the things you want, the easier it is to cope with pain. The more you are able to view your self as healthy, the more sound your ideas and thoughts about living with pain. Conversely, the more you see yourself as sick, injured, or damaged, mentally or physically, the harder it is to cope with life. In short, the higher your psychological and physical function, the better you do. Your thoughts and ideas about having pain can play a major role in determining how well or how poorly you cope with pain.

Ellis and Harper (1975) introduced an important way of looking at how thoughts and beliefs influence behavior in their work helping people with problems other than chronic pain. However, many pain management centers around the world have adapted this model to evaluate how people’s thoughts and beliefs shape the chronic pain experience.

Ellis and Harper used the phrase “irrational beliefs and dysfunctional thoughts” when they introduced this cognitive behavioral approach. Cognitive behavioral techniques are very helpful for people in pain. However, saying that someone has irrational beliefs and dysfunctional thoughts may be counter-productive, since these words tend to put people off.

Beliefs may be much harder to change than ideas about pain. People tend to defend their beliefs possessively and protectively, as they would their flag or country. When you change your perspective and move from the notion of having “irrational beliefs and dysfunctional thoughts” about living with pain to having “ideas” about living with pain, you make a positive shift toward a more flexible, adaptable, and accepting perspective.

The important consideration about your thoughts and ideas about pain is whether they are working for or against you. Therefore, I will be talking about the ideas you have about living with chronic pain, rather than any irrational beliefs and dysfunctional thoughts. A subtle difference, I know, but an important one.

The cognitive behavioral model of changing ideas can be summarized in the acronym ABCD. A stands for the activating event or stressor. An event doesn’t have to be physical; it can be an emotional, social, or environmental occurrence, but it is some thing to which you could have a reaction. For example, the activating event could be a pain flare-up. B stands for the belief (or, as I prefer, idea) that you have about the event. For example, in response to the pain flare-up, you may have the idea that it is awful to suffer from chronic pain. C stands for the consequence of your idea about the event. The consequence is frequently an emotion or feeling state. For example, as a consequence of the idea that living with chronic pain is awful, you might feel anger, resentment, and depression. This ABC pattern typically occurs almost instantaneously, with out thought, and you may start to believe that it is instinct, something you can not influence. But here is where the intervention is launched. D represents an attempt to dispute any false hoods or errors about your ideas related to the event. Challenging or disputing inaccurate ideas about pain can lead to new feelings and emotions about the event. Let me share a story that illustrates the importance of the last step.

John

John was a young man who came to me for help with chronic debilitating migraines. He was a nine teen-year-old college student when he was walking on a bridge between two buildings on campus. It was night, very cold, and he thought no one was around until he heard a commotion below him. Leaning over the railing of the bridge, he saw what appeared to be a homeless man being beaten by two younger men with base ball bats. Transfixed by panic, John watched the homeless man being beaten until he finally stopped moving. Only when the attackers had run away did John break his paralysis and run to the man’s side. Though the man was still alive, he was beaten beyond recognition.

John could not stop thinking about the beating. Even after the men were caught, tried, and convicted, he continued to be tormented by the memory. Just like the security video tape that had been used to convict the two men, John kept replaying the events of that night over and over, frame by frame, his guilt growing each time. And just like the security video, John’s thoughts stopped when he got to the part where he rolled the man over and saw his horribly beaten face.

John was in terrible emotional pain. He had dropped out of college and was living with his parents. He couldn’t work, couldn’t sleep, and was plagued by the recurring migraines. All medical reasons for the migraines had been ruled out.

As we discussed what had happened, as John referred again and again to the video and how his memory was just like the video tape, I began to see a way into his guilt, a way to help him out.

“What happened to the man?” I finally asked one day.

John startled and looked blank for a moment. “Oh, um, he spent some time in the hospital.”

“How’d he get there?”

“I called 9-1-1.”

“And how is he now?”

“Uh, fine. He spent a few days in the hospital and then moved home to Jersey to live with a cousin.”

I was stunned, but didn’t say so. After all John had said, I was sure the man had died. John had been hitting the pause but ton when ever he played back his memory of that night, stop ping it at the worst moment—the moment when he thought the man would surely die. He never played out the memory to when he saved the man’s life, served as a witness during the trial, and learned that the man had gone on with life. He was reliving the negative emotions of the memory but not allowing him self to move past it.

With time and effort, John learned to release the pause button and play the memory to its conclusion. Once he started to allow the memory to complete itself, to go through the beating and the phone call for help and the subsequent trial, his migraines began to subside. He stopped seeing himself as the man who had let another man be beaten and began to believe that maybe he had saved the man’s life after all.

John’s story is rather extreme, but it’s a powerful example of the connections between thoughts, emotions, and pain. The activating event does not have to be traumatic to cause pain. With practice, you can learn to challenge and alter ideas about pain that are causing you emotional distress and compromising your quality of life.

excerpt from The Chronic Pain Care Workbook: A Self-Treatment Approach to Pain Relief Using the Behavioral Assessment of Pain Questionnaire by Michael J. Lewandowski Ph.D., Richard J. Kroening M.D., Ph.D.