Everyone knows what it’s like to be in pain.
Some 100 million Americans know what it’s like to cope with unremitting chronic pain: pain lasting three months or more without respite.
If you’re a therapist or health care provider, chances are high you’ve worked with a client in pain. The reason this is unsurprising and even expected is because “physical pain” is never just physical: it’s also emotional. Research shows that multiple parts of the brain process pain, including the prefrontal cortex (attentional and executive processes), the cerebral cortex (thoughts, beliefs), and the limbic system—your brain’s emotion center. In fact, neuroscience demonstrates that negative emotions like anxiety, stress, depression, and anger actually amplify pain, while relaxation, happiness, joy, and gratitude can reduce it.
This means that pain is never just physical; it’s also emotional. Indeed, this is the question I am asked most: “Do you treat physical pain, or emotional pain?” My answer is always: “Yes.” The brain-body divide created by Western medicine is just that: a creation. Physiologically, this divide does not exist. The brain and body are connected 100 percent of the time.
Therapists therefore necessarily treat “physical pain” because we treat emotional pain. Patients with depression, anxiety, stress, and anger regularly present with physical expressions of these difficult emotions, because emotions manifest in the body. Most of us know the experience of “butterflies” in the stomach, the terrible ache of a tension headache, the grey hairs that sprout in times of stress, “feeling something in your gut,” and the insidious shoulder-and-back pain from too much work and too little play.
But while it’s one thing to be familiar with this phenomenon, it’s yet another to treat it. The good news is this: research demonstrates that psychosocial treatments such as cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) can effectively ameliorate chronic pain. If pain is a “medical” condition, how can this possibly be? Decades of neuroscientific studies indicate that pain is not purely biomedical, produced exclusively by anatomical dysfunction or mechanical damage. Rather, chronic pain is biopsychosocial—the product of biological, psychological, and social factors all interacting to generate this condition. Therefore, successful treatments must be biopsychosocial, too. Victims of the opiate epidemic know all too well that a pill for pain simply isn’t enough.
Pain is your body’s warning system, an adaptive response to perceived threat. If you believe you’re in danger, your brain will make pain. The words “perceived” and “believe” are not used here coincidentally. While acute pain signals danger of harm—a broken bone in need of repair, a dangerous concussion requiring rest, an infected cut requiring attention—chronic pain is the result of a sensitive false alarm, a hyperactive car alarm ringing in the absence of a burglar. After weeks and months of pain, the nervous system can become so sensitive that the sensation of pain, while very real, is no longer a reliable indicator of tissue damage. That is: the “hurt” you feel is no longer indicative of danger, or “harm.”
CBT and MBSR offers skills that can teach chronic pain sufferers to quiet the overactive fight-or-flight response amplifying pain, desensitize the pain system, and turn off this false alarm. This is achieved via techniques like pacing, relaxation strategies, cognitive restructuring, biofeedback, and mindfulness to turn the volume down on pain, so that clients can resume functioning and return to life. If you are a therapist or health care provider, you can be part of the solution to America’s pain epidemic by learning more about psychosocial techniques for chronic pain.
For additional resources check out The Chronic Pain and Illness Workbook for Teens.
Rachel Zoffness, PhD, is a clinical psychologist, medical consultant, educator, and author specializing in chronic pain, medical illness, and injury. She provides cognitive behavioral therapy (CBT) to teens and adults, provides lectures and trainings, and serves as a consultant to hospitals and health professionals. Zoffness—also known as ‘Dr. Z’—teaches at the University of California, San Francisco (UCSF) School of Medicine, providing pain neuroscience education to medical residents and interns. She was trained at Brown; Columbia; the University of California, San Diego; San Diego State University; the New York University Child Study Center; Mount Sinai West; and the Mindful Center.