Pain doesn't have to determine your life.

I love this metaphor I first heard at the Mayo Clinic Pain Rehabilitation Center: Imagine being in a car with chronic pain. Where is the pain?  Who's in control? Is pain behind the steering wheel - determining where you go and what you do in life? Or are you driving? Put pain in the back seat, or even better yet, the trunk.

Things you can control - Focus on these

• Understanding how pain works
• Changing how you think and feel about pain, and how you respond to it
• Accepting the pain
• Not being afraid of the pain
• Being aware of what you listen to, read, and watch to avoid negativity and drama
• Being kind to yourself and others
• Taking active responsibility for your care
• Not verbally expressing or complaining about the pain
• Not wallowing in the pain
• Not placing blame for the pain
• Staying away from people who only want to complain about pain
• Not sharing your pain with others
• Reducing stress
• Eating right
• Moving more and increasing your activity level
• Moderating what you do
• Modifying what you do
• Being grateful – focus on what you have, not what you’ve lost
• Developing better sleep habits
• Preparing for a flare in advance so it doesn’t overwhelm you

 
Things you can’t control - Don’t focus on these

• Pain
• Imaging test results
• Past medical interventions
• Past painful experiences
• What other people say or do
• Weather
• Cultural and family norms
• Socio-economic background
• Demographics (sex, age, ethnicity, etc.)
• Genetic make-up

If biomedical treatments alone didn't resolve pain when it was acute, is it reasonable to expect the same treatments alone to change our symptoms when pain becomes chronic?

It's not.

We must change the paradigm. Pain is more than a biomedical condition. We need to treat the whole-person care.. As Dr. Rachel Zoffness reminds us, " Because pain is biopsychosocial, treatment must be, too."

As pain persists, its relationship to the original injury or tissue changes can become more complex. Biological, psychological, and social factors can all influence how pain is experienced and maintained. Changes in nervous-system sensitivity can also contribute in some people.​

Acute pain vs. chronic pain
Pain can be described by how long it has been present.

Acute pain is generally short-term and often associated with actual or potential tissue injury, illness, surgery, or another identifiable cause.

Chronic pain typically persists or recurs for more than three months. It can result from an underlying disease or condition, injury, medical treatment, inflammation, or sometimes an unknown cause. It can continue after an injury has healed, and its intensity and impact can change over time.

As pain persists, its relationship to the original injury or tissue changes can become more complex. In some people, changes in nervous-system sensitivity can contribute to increased pain sensitivity. One mechanism that can contribute to this increased sensitivity is called central sensitization. 

Features associated with increased pain sensitivity have been described in a range of chronic pain conditions, although the mechanisms involved can differ from person to person and condition to condition. Conditions include fibromyalgia, whiplash, shoulder pain, neuropathic pain, chronic fatigue syndrome, non-cardiac chest pain, irritable bowel syndrome, temporomandibular disorders, post-surgical pain, complex regional pain syndrome, low back pain, osteoarthritis, pelvic pain, and headache.

This 22-minute video from Dr. Sletten with the Mayo Clinic Pain Rehabilitation Center (PRC) provides a helpful explanation of pain and sensitization, why traditional medical treatments don’t always work for chronic pain, and their approach at the PRC. I encourage you to watch it.

​Biomedical treatments may still have an important role, but chronic pain often requires a broader approach than treating the presumed physical source alone.

Learn more

• We Have a Chronic Pain Problem, Not a Prescription Opioid Problem (my article)
• Are You Missing Two-Thirds of Your Potential Pain Treatment Plan? (My article) 
• Central Sensitization Syndrome (CSS) - Dr. Christopher Sletten (22:19) 
• The Truth About Managing Chronic Pain (w/Dr. Rachel Zoffness) - ZDoggMD (1:39)​