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My thoughts

Beware of alcohol and tobacco

6/5/2025

 
Many people turn to alcohol and tobacco as a way to cope with chronic pain in the short term because these substances can temporarily create feelings of pleasure. However, it is important to be cautious.

Both alcohol and tobacco can lead to dependence, more pain and, and various health risks linked to their use.

Equally, if you rely on drinking or smoking to manage or escape the pain, each drink or puff can serve as a reminder of the pain, reinforcing the pain cycle.

During my three-week stay at the Mayo Clinic Pain Rehabilitation Center, alcohol consumption was prohibited. The program also offered classes designed to help individuals quit smoking.​

Learn more
  • Chronic pain: Why does alcohol worsen it?
  • Alcohol And Chronic Pain
  • Alcohol Use Disorder and Chronic Pain: An Overlooked Epidemic (helps explain how alcohol reinforces the pain and continues the pain cycle)
  • Effects of smoking on patients with chronic pain: a propensity-weighted analysis on the Collaborative Health Outcomes Information Registry
  • Pain intensity and smoking behavior among treatment seeking smokers
  • Pain Drives Dual Tobacco and Cannabis Use, Study Shows
  • Association of Cigarette Smoking with Risk of Chronic Musculoskeletal Pain: A Meta-Analysis


You can change the pain experience

4/17/2025

 
It's important to remember that you're not alone. There are strategies and techniques that can help you take control of chronic pain and live well, despite it.
 
Empower yourself by changing your perspective about pain, altering your emotional response to it, and adjusting your actions in its presence. This shift in mindset and behavior can significantly alter your experience.

My journey took a turn for the better when I embraced the reality of the pain, ceased the relentless pursuit of a cause and a cure, and discovered the power of self-management through a structured interdisciplinary pain rehabilitation program. This acceptance and proactive approach brought a sense of relief and control.
 
Learn more
  • A few things you may not know about chronic pain that have helped me recover and live well (02:02)
  • Control what you can control
  • Self-management skills and strategies to learn, practice, and adopt
  • How to Move Patients from Passive Management to Active Self-Management
  • The Journey to Recovery
  • My Time at the Mayo Clinic Pain Rehabilitation Center
  • Central Sensitization Syndrome (CSS) - Dr. Christopher Sletten (22:19)
 

Pain rehabilitation vs. pain management

7/24/2024

 
There is a difference.
 
Pain management relies on a passive approach to reduce pain - typically service or product-driven by providers.
 
Pain rehabilitation teaches skills to actively self-manage pain, increase functional ability, and improve quality of life while living with chronic pain. It puts you in control. Not the pain. And not the treatments or the providers you see.
 
My chronic pain journey changed when I stopped focusing on the pain and fighting to reduce it.
 
I was fortunate to attend the Mayo Clinic Pain Rehabilitation Center. It helped empower me to take control of the pain and my life.
 
Below is an overview of the program from the Mayo Clinic website.
 
"Mayo Clinic's Pain Rehabilitation Center (PRC) helps people with chronic pain return to a more active lifestyle. Teams based at Mayo Clinic's campuses in Arizona, Florida and Minnesota use a rehabilitation approach that incorporates behavioral, physical and occupational therapies to help restore physical activities and improve quality of life. The program also helps participants eliminate the use of pain medications and decrease the use of other medications that can impact health and quality of life in the long run.”
 
Note that there is no mention of pain reduction in the overview.
 
Learn more
  • Not all Pain Management Facilities are the Same (my blog post)
  • Pain Rehabilitation Works (my blog post)
  • How to Move Patients from Passive Management to Active Self-Management (my article for providers)
  • 7 Things You Need to Know About Pain Rehabilitation
  • My Time at the Mayo Clinic Pain Rehabilitation Center - published in HealthCentral
  • Find pain rehabilitation programs around the globe (my website)

Our lives can become negatively centered around chronic pain

6/5/2024

 
"In a word, describe how you feel right now."

I recently saw this question asked in a 99,000-member fibromyalgia support group.
 
Almost all the 377 answers just two days after the post had negative connotations. Words like exhausted, defeated, overwhelmed, afraid, lousy, anxious, depressed, painful, lifeless, restricted, broken, irritable, lost, done, and disconnected were shared.
 
The few positive answers included words like confident, grateful, proud, and hopeful.
 
The overwhelming percentage of negative words saddens me about the level of pain care and what people living with pain are experiencing.

My answer was confident. However, there was a time in my journey with chronic pain when my answer wouldn't have been as positive.
 
That was before I attended a pain rehabilitation program, accepted the pain, and learned to live well despite it using active self-management strategies.
 
We need to stop treating chronic pain as prolonged acute pain because it's not prolonged acute pain. It is its own condition. Clinicians need to empower people living with pain – shifting from a "find-it, fix-it" mentality to a "self-management" mentality.

Learn more
  • Thoughts are powerful: we aren't our pain 
  • How to Move Patients from Passive Management to Active Self-Management
  • Tame the Beast – It's time to rethink persistent pain - Lorimer Mosely (5:00)
  • How to Move Patients from Passive Management to Active Self-Management
  • Central Sensitization Syndrome (CSS) - Dr. Christopher Sletten (22:19) 
  • Strategies for Coping with Chronic Pain - Dr. Matthew Schumann (1:02:17)
  • The Truth About Managing Chronic Pain (w/Dr. Rachel Zoffness) - ZDoggMD (1:39:10) 
  • Five things I wish I knew earlier in my journey with chronic pain 
  • Are You Missing Two-Thirds of Your Potential Pain Treatment Plan? 

DO YOU HAVE CENTRAL SENSITIZATION?

10/17/2023

 
If you live with chronic pain, the answer is probably yes.
 
As acute pain becomes chronic, it’s often less about structural damage and more about an over-sensitized nervous system maintained by maladaptive neuroplastic changes over time – putting your nervous system in a state of high reactivity.
 
Central sensitization is associated with the development, maintenance, and amplification of chronic pain.  It changes how the brain processes pain – misfiring nerve signals and continuing to tell the body it hurts. 

The official definition of central sensitization by the International Association for the Study of Pain is, “Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input.”
 
In other words, you become more sensitive to pain and other sensory stimuli – causing more pain more often.
 
You may feel it when only lightly touched or bumped. You may feel it in different areas of the body other than the spot of the original injury. You may also have different types of feelings like achiness, stabbing, tingling, or burning, for example.
 
Features of central sensitization have been identified in nearly all chronic pain conditions, no matter the underlying cause. 
 
Some of the conditions it has been tied to include fibromyalgia, whiplash, headaches, shoulder pain, osteoarthritis, chronic fatigue syndrome, non-cardiac chest pain, irritable bowel syndrome, TMJ, neuropathic pain, complex regional pain syndrome, spinal back pain, pelvic pain, inflammatory conditions like rheumatoid arthritis, and post-cancer pain.
 
Changing it
The good news is we can change our nervous system. Central sensitization can be reversed by doing things that promote positive neuroplasticity like changing how we think about pain, react to pain, and manage pain.
 
The best treatment is a biopsychosocial approach, including pain education, physical therapy, cognitive behavioral therapy, pain acceptance, sleep management, and pharmaceutical management. I got a heavy dose of all these at the Mayo Clinic Pain Rehabilitation Center.
 
Learn more
  • Dr. Sletten Discussing Central Sensitization Syndrome – A descriptive and easy-to-understand video from the Mayo Clinic. 
  • What is Central Sensitization? – A great read from the Institute of Chronic Pain.
  • Neuroplasticity – A helpful video and easy-to-read information from painHealth.
  • How to desensitize the brain and eliminate chronic pain caused by central sensitization –A comprehensive video from Dr. Andrea Furlan.
  • The neurobiology of central sensitization – A more detailed journal article.
  • Central Sensitization: A Generator of Pain Hypersensitivity by Central Neural Plasticity – A more detailed journal article.​

Self-management tools 
  • Mindful Breathing (Mayo Clinic)
  • ​Passive Muscle Relaxation to Manage Anxiety and Stress (37:28)
  • Progressive Muscle Relaxation to Manage Anxiety and Stress (15:00)
  • Find more here

Not all pain management facilities are the same

9/8/2023

 
(updated 12/12/23)

Has your doctor referred you to pain management but you’re unsure where to go and what to expect?

With all the different names such as pain clinics, pain centers, pain management centers, pain treatment centers, pain institutes, pain management programs, and pain rehabilitation programs, it’s easy to get confused.
 
I’ve tried to separate the different types of treatment facilities below into broad categories based on their disciplinary approach and treatment focus with a chronic pain rehabilitation rating.
 
GOOD
Intradisciplinary interventional pain management: Pain management physicians (typically anesthesiologists) provide an individualized approach to evaluate, diagnose, and treat all different types of pain frequently focusing on the cause of pain, pain reduction or elimination, and specific pain conditions. They primarily offer passive interventional procedures such as medications, injections, spinal procedures, nerve blocks, radiofrequency ablation, Ketamine IV therapy, acupuncture, pain pumps, spinal cord stimulators, and surgery.

​Multidisciplinary pain management: Pain management specialists provide interventional treatment with access or referral to other specialties like physical therapy, psychology, neurology, surgery, orthopedics, acupuncture, nutrition, and pharmacy with treatment customized to each patient based on their condition. While these providers may work in the same facility or for the same employer, they often operate independently with their own modalities and therapeutic goals.

BETTER
Multidisciplinary pain rehabilitation: A core provider team ​from multiple disciplines (physical therapy, psychology, rehabilitation medicine, anesthesiology, nursing, and occupational therapy) with additional involvement from surgeons, neurologists, internists, physiatrists, psychiatrists, social workers, dietitians, and pharmacists use the biopsychosocial model of medicine and standardized treatment approaches to help manage pain. Featuring psychological and behavioral therapies, traditional medicine, physical reconditioning, and educational components, these multi-week programs are more comprehensive but can be combined with interventional pain therapies for specific pain conditions. Care may or may not be coordinated or integrated with shared goals.

BEST
Interdisciplinary pain rehabilitation: Features a diverse multidisciplinary team including physical and occupational therapists, psychologists, dieticians, pharmacists, nurses, and medical doctors at one location. The providers interact with each other and the person using a shared biopsychosocial approach to pain – working together toward a common and coherent goal of pain rehabilitation teaching skills to empower the person to help themselves and actively self-manage the pain with the goals of reducing fear of exercise and activity, increasing daily activity; improving physical reconditioning;  decreasing healthcare utilization, and improving quality of life with some but less focus on reducing pain. Generally lasting several weeks, these programs are often hospital-based (6-8 hours per day) and group-based offering behavioral therapy, physical therapy, occupational therapy, relaxation training, medication optimization/management, as well as some sort of family education and counseling. 

Conclusions/thoughts
  • A lack of common terms and definitions made it hard to categorize the types of pain management facilities as there are no clearly established guidelines for pain management that are uniformly followed by every provider. Offering different treatment goals and components, they don’t fit into nice little boxes when doing an internet search.
  • International standards and classifications for pain management should be established to improve care.
  • As pain transitions from acute to chronic, passive interventions are best used in a complementary role to provide short-term relief to allow the person to participate in an active self-management program.
  • Due to their focus on rehabilitation instead of interventional, and therapeutic treatments and their time commitment, interdisciplinary programs can be challenging for people, especially those expecting a diagnosis, passive treatment, and/or a cure.
  • Interdisciplinary pain rehabilitation programs patterned like the program I attended at The Mayo Clinic are the gold standard of comprehensive care. One key attribute of the Mayo program was social modeling—seeing other people with similar pain experiences develop the skills they need to succeed. Unfortunately, there’s limited availability and access to these types of programs.
 
It was my family doctor and a local surgeon who recommended I attend the 3-week outpatient Mayo Clinic Pain Rehabilitation Center instead of going through another risky surgery to try to fix the pain. The program changed my life.

Please discuss your medical situation with your healthcare team.
 
Learn more
  • Is a Pain Clinic Right for You?
  • How to Move Patients from Passive Management to Active Self-Management (my article)
  • We Have a Chronic Pain Problem, not a Prescription Opioid Problem (my article)
  • Pain rehabilitation works (my blog post)
  • Interdisciplinary Rehabilitation Programs in Chronic Pain Management
  • Interdisciplinary Pain Rehabilitation Programs: Approach and Implementation
  • Interdisciplinary treatment for chronic pain: is it worth the money?
  • A Call for Saving Interdisciplinary Pain Management
  • The Demise of Multidisciplinary Pain Management Clinics?​
  • Mayo Clinic Pain Rehabilitation Center
  • My Time at the Mayo Clinic Pain Rehabilitation Center - published in HealthCentral
  • Find pain rehabilitation programs around the globe (my website)
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We can learn a lot from nik wallenda

8/2/2023

 
I was blessed to see Nik Wallenda (the famous tightrope walker who has walked across the Grand Canyon, Niagara Falls, and Times Square) perform while I was on vacation.
 
As impressive as Nik's balancing skill was the message he shared about not giving up and overcoming fear.
 
He almost gave up tightrope walking after a 25-foot fall during a 2017 rehearsal for an eight-person pyramid routine seriously injured five of his friends and family members. Luckily, Nik and two others were able to catch the rope and avoid falling.
 
Like Nik, it’s important for us to overcome any fears we may have about pain and keep moving forward.
 
You can see the accident and learn more here.
 
Related resources
  • Balance: A Story of Faith, Family, and Life on the Line (Nik Wallenda)
  • Fear of Pain as a Prognostic Factor in Chronic Pain: Conceptual Models, Assessment, and Treatment Implications
  • Hurt doesn’t always me harm (my blog)
  • Pain and Me: Tamar Pincus talks about chronic pain, acceptance, and commitment (3:06)

Find The Source of Chronic Pain webinar

4/9/2023

 
On Friday, April 21, I hosted Dr. Evan Parks, Chronic Pain Champions support group member, for a free one-hour live webinar.

Here is a link to recorded event: https://youtu.be/8KuUV965L1k.

What You'll Discover:
  • How chronic pain develops
  • Why standard medical care often fails to help people with chronic pain
  • How brain science can help you rewire your central nervous system
  • How our thought patterns influence chronic pain

Dr. Parks has worked at one of the largest pain rehabilitation programs in the USA and has years of experience helping suffering people find hope and freedom. He has been featured on NPR, ABC News, WebMD, and is a writer for Psychology Today. He is an adjunct assistant professor at Michigan State University School of Medicine and the author of the book Chronic Pain Rehabilitation: Active pain management to help get you back to the life you love.

Are you tired of trying? Fighting the pain?

1/23/2023

 
Does it seem like everything you do to eliminate chronic pain doesn't work or becomes less effective over time?

Are you hoping the next doctor you see will have the magical cure?

Stop treating the pain as acute
Most conventional and alternative medical treatments, including medicines, supplements, diets, massage, devices like TENS and spinal cord stimulators, heating pads, manipulation, injections, and surgeries treat pain like it is acute - aiming to reduce or manage pain sensations and fix biomedical structures.

While these treatments are typically effective for acute pain, they often have limited success for people living with chronic pain because they ignore the numerous psychosocial contributors to chronic pain.

I found relief from the pain when I changed how I think about it, feel about it, and behave in relation to it. I quit focusing on the pain, fighting the pain, and shopping for a magical medical cure.

Through pain rehabilitation, I learned how to accept the pain and how to self-manage my condition. This process led me to stop the use of medicines including opioids, benzodiazepines, anticonvulsants, muscle relaxers, amphetamines, beta-blockers, antidepressants, and over-the-counter analgesics as well as other passive interventions like supplements and injections for my pain.

I've taken control. You can do the same.

The best 22 minutes to help change the pain experience
Watch this video from Dr. Christopher Sletten from the Mayo Clinic Pain Rehabilitation Center (the program I attended). Dr. Sletten explains the differences between acute and chronic pain and the principles of pain rehabilitation. 

Other helpful related links
  • We can't treat chronic pain like acute pain - my blog post
  • Pain rehabilitation works - my blog post
  • Cognitive behavioral therapy for pain - my blog post
  • Self-management resources - my website
  • The Pain Management Workbook - Dr. Rachel Zoffness
  • Mayo Clinic Pain Rehabilitation Center

thoughts are powerful: We aren’t the pain we feel.

11/9/2022

 
It can be easy to identify ourselves by our conditions and develop a "fix me" patient mentality.
 
Change your thinking from "I’m a patient in pain" to "I'm a person living well, despite the pain." Change your thinking from "The pain controls me" to "I'm in control."
 
I no longer identify myself by my diagnosis or even as a chronic pain patient. I'm defined by who I am and what I do.
 
I’m Tom Bowen – husband, father, dog father, Iowa Hawkeye fan, clown, friend, author, educator, and pain advocate.
 
I'm not Tom Bowen – neuroma of amputation stump, post-concussion syndrome, tinnitus, hearing loss, fibromyalgia, chronic pain syndrome, chronic fatigue, irritable bowel syndrome, costochondritis, neuropathy, migraine/chronic headaches, sacroiliac joint dysfunction, anxiety, and depression.

I'm in control.
 
Need help changing/controlling your thoughts?
Check out these resources:
  • Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach
  • How Cognitive Control Can Boost Well-Being
  • Replacement Thought Examples
  • Positive thinking: Stop negative self-talk to reduce stress
  • Doing What Matters in Times of Stress: An Illustrated Guide
  • DIM SIM Therapy
  • The Pain Management Workbook
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Do you talk about pain?

8/11/2022

 
It’s common for patients to talk about pain levels and treatments with family and friends. Although talking about pain can help us validate our experience, it can actually worsen our symptoms by adding more attention to the pain.

You can’t make positive steps in your life when surrounded by negativity 
Stay away from people who only want to complain about pain, and avoid sharing the pain with others unless there is a positive goal associated with the conversation. Talk instead about things you enjoy and find meaningful. Fill your life with joy and hope!

It’s natural for people to ask about the pain, but you have the power to change the discussion. Thank them for asking but explain that you’d rather focus on something else. Suggest a more life-affirming topic of conversation. Maybe say something like, “I live with chronic pain but have learned to live well despite it and prefer talking about other things that we both find more meaningful and enjoyable. Can we please change the conversation.”

I choose not to talk about the chronic pain I feel to myself or with others, including my doctors, unless there is a new symptom that needs acute treatment.

Learn more
  • Should You Stop Talking About Your Pain? (Dr. Evan Parks)
  • Reducing Pain Talk: Coping with Pain Series (Institute for Chronic Pain)

The importance of forgiveness and gratitude

8/4/2022

 
"Pain is physical AND emotional 100% of the time."
​- Dr. Rachel Zoffness

Pain is an experience with biopsychosocial factors, including our emotions.

Often times, people living with chronic pain can become angry and less thankful. There may even be some perceived misjustice, as was in my case.
 
It can be helpful to let go of the unpleasant emotions like anger, unappreciation, and blame as they can negatively affect the chronic pain experience, disrupt relationships, and worsen our symptoms – turning up the pain volume.
 
While being forgiving, kind, and grateful won’t magically make the pain disappear; they can help lessen the pain and suffering, foster better health, build self-efficacy, and make life more enjoyable.
 
Learn more and learn how
  • The power of forgiveness (3:28)
  • 13 Most Popular Gratitude Exercises & Activities
  • A Grateful Day with Brother David Steindl-Rast (5:22)
  • How to Forgive Someone Who Traumatized You 
  • Your 5-day gratitude challenge: 5 exercises to increase your gratefulness
  • How to Forgive in Six Steps
  • Jack Kornfield: 12 Principles of Forgiveness (13:42)
  • The power of forgiveness (3:28) - I saw this while as a patient at the Mayo Clinic Pain Rehabilitation Center
  • A Grateful Day with Brother David Steindl-Rast (5:22)
  • How to let anger out | Thich Nhat Hanh answers questions (9:18) - listen to what he tells a little girl how to deal with anger
  • Taking the Steps to Forgive Yourself
  • Forgiveness: Letting go of grudges and bitterness
  • Control anger before it controls you
  • 10-minute meditation: Loving kindness (10:07)
  • Practicing Gratitude Is More Important Now Than Ever
  • Your 5-day gratitude challenge: 5 exercises to increase your gratefulness
  • How Cognitive Control Can Boost Well-Being
  • Positive thinking: Stop negative self-talk to reduce stress
  • Doing What Matters in Times of Stress: An Illustrated Guide
  • The Pain Management Workbook - A book authored by Dr. Rachel Zoffness based upon Cognitive Behavioral Therapy ​
 
Read the research
  • Forgiveness is an emotion-focused coping strategy that can reduce health risks and promote health resilience: theory, review, and hypotheses
  • Forgiveness and chronic pain: a systematic review
  • Forgiveness and chronic low back pain: a preliminary study examining the relationship of forgiveness to pain, anger, and psychological distress
  • Associations between anger and chronic primary pain: a systematic review and meta-analysis
  • Loving-kindness meditation for chronic low back pain: results from a pilot trial

medical cannabis for chronic pain?

7/8/2022

 
Updated 3/27/24
​

Some people find medical cannabis helpful for chronic pain, especially in the short term, but there are questions about long-term effectiveness and safety.  Cannabis wasn’t recommended by Mayo Clinic when I attended their Pain Rehabilitation Center in 2018 nor is it recommended by the International Association for the Study of Pain.

A new systematic review and meta-analysis published November 28, 2022, in the Journal of the American Medical Association, suggests cannabis is no better at relieving pain than a placebo.  And relying on any sort of passive treatment like medicines and supplements can create dependence on the agent - producing a sense of helplessness and reminding the user of the pain.

I have found I don’t need medicine or supplements to manage my chronic pain. Of course, your experience may differ. I know mine did earlier in my pain journey. My relief came by changing how I think about, feel about, and behave around the pain with pain rehabilitation using self-management.
 
Learn more
  • Cannabis is no better than a placebo for treating pain – new research
  • Cannabinoid Non-technical Summary 2021 (International Association for the Study of Pain)
  • Cannabis for chronic pain: New research questions its effectiveness
  • International Review finds lack of evidence to endorse clinical use of medical cannabis for pain
  • Cannabis For Smart Consumers: What The Industry Does Not Want You To Know.
  • Cannabidiol (CBD) Products for Pain: Ineffective, Expensive, and With Potential Harms
  • What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD
  • Cannabis is no better than a placebo for treating pain – new research​
  • Labeling Accuracy of Cannabidiol Extracts Sold Online
  • Beware of supplements (my blog post)
  • We Have a Chronic Pain Problem, Not a Prescription Opioid Problem (my article)
  • The power of the placebo effect
  • How to Move Patients from Passive Management to Active Self-Management (my article)

Do you have back pain?

7/3/2022

 
Updated 05/01/2025
 
Did you know?
  • 84% of all adults will have low back pain.
  • 85% of elite athletes will have low back pain.
  • 85% of back pain is classified as non-specific.
  • Less than 1% of back pain is due to serious pathology.
  • 0% of disks slip.
  • 90% of herniated disks heal on their own.
  • Depression is more predictive of future low back pain than MRI results.
  • Most back pain will improve at home.
  • Recurrence of low back pain is very common, with more than two-thirds of individuals having a recurrence within 12 months after recovery (da Silva, et al, 2019). 
  • Back surgery can lead to failed surgery syndrome.

Back pain can be scary, especially when an MRI finds something abnormal. While they can seem scary, structural findings on a diagnostic scan don’t always equate with pain or are the cause of the pain.

Abnormal MRI findings are normal in people without pain, especially as age increases. Over 50% of 30-year-olds with no pain show signs of disk degeneration increasing up to 80% at age 50 (
Brinjikji, et al, 2015).

And although chronic back pain is a common medical complaint, no specific cause is found in up to 85% of cases with central sensitization as a potential contributing factor (Sanzarello, et al, 2016) along with fear of pain and activity as maintaining factors.

Remember, all pain is biopsychosocial contributors Research has found that "when individuals with low back pain consider they have a flare, they do not always have greater than average pain, but have worse psychosocial features" (Costa, et al, 2021).

Read the World Heath Organization's guideline for non-surgical management of chronic primary low back pain.

Check out these back facts from OSullivan, et al, 2020:
  1. Persistent back pain can be scary, but it’s rarely dangerous
    Persistent back pain can be distressing and disabling, but it’s rarely life- threatening and you are very unlikely to end up in a wheelchair.
  2. Getting older is not a cause of back pain
    Although it is a widespread belief and concern that getting older causes or worsens back pain., research does not support this, and evidence-based treatments can help at any age.
  3. Persistent back pain is rarely associated with serious tissue damage
    Backs are strong. If you had an injury, tissue healing occurs within three months, so if pain persists past this time, it usually means there are other contributing factors. A lot of back pain begins with no injury or with simple, everyday movement. These occasions may relate to stress, tension, fatigue, inactivity or unaccustomed activity which make the back sensitive to movement and loading.
  4. Scans rarely show the cause of back pain
    Scans are only helpful in a minority of people. Lots of scary -sounding things can be reported on scans such as disc bulges, degeneration, protrusions, arthritis, etc. Unfortunately, the reports don’t say that these findings are very common in people without back pain and that they don’t predict how much pain you feel or how disabled you are. Scans can also change, and most disc prolapses shrink over time.
  5. Pain with exercise and movement doesn’t mean you are doing harm
    When pain persists, it is common that the spine and surrounding muscles become really sensitive to touch and movement. The pain you feel during movement and activities reflect how sensitive your structures are – not how damaged you are. So it’s safe and normal to feel some pain when you start to move and exercise. This usually settles down with time as you get more active. In fact, exercise and movement are one of the most effective ways to help treat back pain.
  6. Back pain is not caused by poor posture
    How we sit, stand and bend does not cause back pain even though these activities may be painful. A variety of postures are healthy for the back. It is safe to relax during everyday tasks such as sitting, bending, and lifting with a round back – in fact, it’s more efficient!
  7. Back pain is not caused by a ‘weak core’
    Weak ‘core’ muscles do not cause back pain, in fact people with back pain often tense their ‘core’ muscles as a protective response. This is like clenching your fist after you’ve sprained your wrist. Being strong is important when you need the muscles to switch on, but being tense all the time isn’t helpful. Learning to relax the ‘core’ muscles during everyday tasks can be helpful.
  8. Backs do not wear out with everyday loading and bending
    The same way lifting weights makes muscles stronger, moving and loading make the back stronger and healthier. So, the activities, like running, twisting, bending and lifting, are safe if you start gradually and practice regularly.
  9. Pain flare-ups don’t mean you are damaging yourself
    While the pain flare-ups can be very painful and scary, they are not usually related to tissue damage. The common triggers are things like poor sleep, stress, tension, worries, low mood, inactivity or unaccustomed activity. Controlling these factors can help prevent exacerbations, and if you have a pain flare-up, instead of treating it like an injury, try to stay calm, relax and keep moving up.
  10. Injections, surgery, and strong drugs usually aren’t a cure
    Spine injections surgery and strong drugs like opioids aren’t very effective for persistent back pain in the long term. They come to risks and can have unhelpful side effects. Finding low-risk ways to put you in control of your pain is the key.
 
Learn more
  • Surgery won’t fix my chronic back pain, so what will?
  • Endless pain
  • Spinal cord stimulation doesn't help with back pain, says new review
  • The chronic pain sufferers living with the impacts of failed spinal cord stimulators and surgery
  • WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings
  • ANZBACK Public Lecture 2023: Rethinking How Low Back Pain is Treated (1:05:47)
  • RESTORE Clinical Trial for Back Pain
  • Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews
  • Dr. Peter O'Sullivan: Disabling Chronic Back Pain - The Mechanical Care Forum (47:32)
  • Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations (sourced in article)
  • Central sensitization in chronic low back pain: A narrative review (sourced in article)
  • Low Back Pain Flares: How do They Differ From an Increase in Pain? (sourced in article)
  • Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis
  • Back to basics: 10 facts every person should know about back pain (sourced in article)
  • 10 Facts every person should know about back pain. Presented by patients (4:15)
  • Patient Stories Behind the 10 Back Pain Facts Every Person Should Know (9:40)
  • Making Sense of Disabling Back Pain - Peter O’Sullivan Koadlow Lecture 2021 (1:30:29)
  • The Empowered Beyond Pain Podcast (includes several discussions about back pain and back pain myths/facts)
  • Communicating with people seeking help for lower back pain (a quiz for providers but also beneficial for patients)
  • Pain-Related Fear, Disability, and the Fear-Avoidance Model of Chronic Pain
  • Your Back Is Not Out of Alignment
  • Low Back Pain​
  • Central Sensitization Syndrome (CSS) - Dr. Christopher Sletten (22:19) 
  • 3 orthopaedic surgeries that might be doing patients (and their pockets) more harm than good
  • Benefits and Harms of Interventions With Surgery Compared to Interventions Without Surgery for Musculoskeletal Conditions: A Systematic Review With Meta-analysis
  • DIM SIM Therapy 
  • Back in Control (a resource center created by a retired spine surgeon)

​Research
  • https://effectivehealthcare.ahrq.gov/products/back-pain-treatment/clinician
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345455/
  • https://pubmed.ncbi.nlm.nih.gov/27062464/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9526366/
  • https://www.physio-network.com/blog/discs-dont-slip-dammit/
  • https://www.health.harvard.edu/pain/will-my-herniated-disc-heal-on-its-own
  • https://www.jospt.org/doi/10.2519/jospt.2011.3618
  • https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906
  • https://www.ncbi.nlm.nih.gov/books/NBK539777/
  • https://pubmed.ncbi.nlm.nih.gov/31208917/

My thoughts about opioid therapy

6/22/2022

 
(Updated 06/10/2024)

My article published in Health Central (formerly Practical Pain Management)  "We Have a Chronic Pain Problem, Not a Prescription Opioid Problem" explored the efficacy and safety of opioids for chronic pain as well as the need for more pain rehabilitation programs.

Below is some of the original content I submitted that didn't make the published version of the article which helps provide some additional context.


The rise of prescription opioids
In the 1990s and the next two decades, opioid prescriptions became the quickest and least expensive treatment option for chronic noncancer pain.

Their rise in popularity was due to a mix of factors, including:
  • Good intentions to improve pain management.
  • Pain is positioned as the 5th vital sign with a focus on pain intensity.
  • Aggressive, if not, fraudulent pharmaceutical company marketing.
  • incentives based on patient satisfaction.
  • The desire for a quick and easy fix.
  • The structure of our healthcare system and insurance reimbursement.
  • A reduction of interdisciplinary pain rehabilitation programs.

With the increase in opioid use came an increase in opioid use disorders and opioid deaths.  Then came a hard push to reduce opioid prescriptions following the 2016 Centers for Disease Control (CDC) guidelines for prescribing opioids.

The 2016 CDC guidelines indirectly led to many chronic pain patients being forced to lower their medicine doses or to stop them completely. Often with little or no tapering and no alternative treatments offered or covered by insurance. Pushing patients to undergo invasive procedures like injections or surgery. And labeling patients as “addicts” for wanting pain relief. Which all led to increased tension between patients and providers, more patient suffering, illegal drug use, or, even worse, suicide.  

Opioid users don’t know what they don’t know – “try it, you may like it”
Unfortunately, there isn’t a crystal ball when it comes to pain treatment. There's no way of knowing how a patient will respond to any specific type of therapy. And tapering can be hard. Chronic pain patients can be weary of tapering opioids for fear of increased pain and the general fear of the unknown. 
 
Patients need to accept the possibility of worse pain and other symptoms during a taper. It’s also important for providers to remember to treat the entire person in pain and not just manage the taper.
 
Transitioning to self-management built around pain rehabilitation takes time. It’s a marathon, not a sprint, and requires work from both the provider and the patient. It’s like the old joke “How do you get to Carnegie Hall? Practice, practice, practice.”
 
Opioid treatment is a decision between the provider and patient
The use of opioids is a shared provider-patient decision based on risk and reward including the history and needs of the patient and should be applied on a case-by-case basis.
 
If the decision is to reduce or stop opioid therapy, tapering should be done with education about the benefits of opioid reduction and provider oversight. If the decision is to use opioids, they should be prescribed at the safest lowest dose. Either decision should include pain rehabilitation and self-management strategies.
  • Read this latest research: Does opioid therapy enhance quality of life in patients suffering from chronic non-malignant pain? A systematic review and meta-analysis
  • Read my article for clinicians about transitioning from passive treatment to active self-management
  • ​Read my blog post about pain rehabilitation
  • Find pain rehabilitation programs around the globe (my website)
  • Read about my experience at the 3-week Mayo Clinic Pain Rehabilitation Center
  • Learn more about opioids, pain management, and the Compass Opioid Stewardship Program
  • Listen to my Compass Opioid Stewardship program interview

Personal note
My chronic pain recovery started after I accepted the pain and stopped doctor-shopping to find pain relief and a medical cure (many praises for the Mayo Pain Rehabilitation Center). Through pain rehabilitation, I learned how to self-manage my condition. This process led me to stop the use of medicines including opioids, benzodiazepines, anticonvulsants, muscle relaxers, amphetamines, beta-blockers, antidepressants, and over-the-counter analgesics as well as other passive interventions like supplements and injections for my pain.

Read my published articles. Hear my story.

6/16/2022

 
  • We Have a Chronic Pain Problem, Not a Prescription Opioid Problem
  • A Letter to Pain Providers: 10 Do and Don’t Tips from a Chronic Pain Patient 
  • Are You Missing Two-Thirds of Your Potential Pain Treatment Plan? 
  • Five things I wish I knew earlier in my journey with chronic pain 
  • Hopping Off the Pain Merry-go-round
  • My Time at the Mayo Clinic Pain Rehabilitation Center 
  • Stop Whining and More No-Nonsense Tips from a Chronic Pain Champion​​ ​
  • Compass Opioid Stewardship - Learning to Champion Chronic Pain

Be kind to yourself

6/15/2022

 
There's still a core you despite the pain.

What you can do
  • Write down your positive qualities and accomplishments – what’s good about you. Sometimes we can be own worst critics.
  • Balance expectations.
  • It’s okay to not be perfect – everything doesn’t have to be in place.
  • Say “no” if you need to.
  • Accept help.
  • Forgive yourself (sometimes we are our own worse critics).
  • Eat healthy.
  • Sleep better with these tips.
  • Talk with your loved ones about your needs and challenges without complaining. We don’t want sympathy, we want understanding.
  • Reward yourself and celebrate your successes, no matter how small.
  • Check out these helpful self-compassion exercises and practices from Dr. Kristin Neff.
  • Read this article "The Role of Self-Compassion in Chronic Illness Care".
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Beware of supplements

6/13/2022

 
Updated 6/5/25

Do you know?
  • Not intended to treat, lessen, prevent, or cure disease
  • Supplements aren’t regulated by the FDA.
  • Comes with risks related to contamination with toxins, interactions with conventional medicines, unwanted side effects, and health problems
  • There isn't high quality evidence regarding diet supplements.
  • Products labeled natural aren’t necessarily safer.
  • Can create dependence on the agent - producing a sense of helplessness and reminding the user of the pain

​Editor’s note: This article was written based on my experience and what I have researched about the topic.  Everyone is different. The decision to use supplements should be a decision between you and your doctor.

Many people use supplements as part of their pain treatment plan, often as substitutes for prescribed medication that aren't often effective or well, tolerated.

However, supplements come with risk, including contamination with toxins, health problems, unwanted side effects, and interactions with conventional medicines. 

Unlike prescription or over-the-counter drugs, which must be approved by the Federal Drug Agency (FDA) before they can be marketed, the FDA doesn’t review supplements for safety and effectiveness before they are sold.
 
We don’t know where the products are made, how they are made, what is in them, and if the dosage is appropriate.
 
Safety is left up to the manufacturers and distributors of the supplements.  

Taking pills can reinforce the pain

besides the safety concern, each time you take a pill or supplement, you're reminding yourself you're in pain - reinforcing the neural pathways and keeping you in the pain cycle.

My experience
As part of the multi-day Mayo Clinic fibromyalgia program I attended in 2016, I met with a pharmacist to review the long list of prescription medicines, over-the-counter medicines, and supplements I was taking at the time. My medicine cabinet looked like a GNC store.
 
I was instructed to bring the actual bottles with me to the appointment, so I packed the bottles into a gym bag (yes, I was taking a lot of medicines and supplements) and went to see her.
 
I was surprised as she read each bottle, making comments and recommendations about each pill – including product quality, labeling issues, ingredient safety, and dosing.  
 
When the appointment ended, my medicine and supplement list was much shorter with her recommending stopping most of the supplements and my gym bag much lighter – throwing away the pills was going to stop taking. I kept only one supplement - Vitamin D, which I no longer use.

Bottom line
You assume all risk when using supplements. While some may be helpful, many aren’t and some may even be harmful. And they can become a unhelpful pain behavior - reminding you of the pain.

Review any supplements with your medical team to help you make an educated decision.
 
Learn more
  • American Roulette — Contaminated Dietary Supplements
  • Supplements: They’re Not As Safe As You Might Think
  • The role of diet and non-pharmacologic supplements in the treatment of chronic neuropathic pain: A systematic review
  • Harmful effects of supplements can send you to the emergency department
  • Natural supplements can be dangerously contaminated, or not even have the specified ingredients
  • Hundreds of Dietary Supplements Are Tainted with Prescription Drugs
  • Herbal Medicine for Pain Management: Efficacy and Drug Interactions
  • Dr. Pieter Cohen Explains Dietary Supplements and Regulations
  • Cannabidiol (CBD) Products for Pain: Ineffective, Expensive, and With Potential Harms
  • What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD
  • Central Sensitization Syndrome (CSS) - Dr. Christopher Sletten (22;19)
  • Medical cannabis for chronic pain? (my blog post)
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Stop the pain talk

6/9/2022

 
Do you talk about the pain or complain about it? What do you do if other people ask you about the pain?

Pain talk is a maladaptive pain behavior – worsening symptoms by adding more attention to the pain.
We can't move forward if we're constantly reminding ourselves of the pain or if we 're surrounded by negativity.

I choose not to talk about the chronic pain i feel to myself or with others, including my doctors (unless there is a new symptom that need acute treatment).

Learn more​
  • Should You Stop Talking About Your Pain? (Dr. Evan Parks)
  • Reducing Pain Talk: Coping with Pain Series (Institute for Chronic Pain)
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cognitive behavioral therapy for pain

6/5/2022

 
​Updated 09/23/2023
Our thoughts, emotions, and behaviors can make pain worse or more manageable.
​​
We can change the chronic pain experience and retrain our overprotective pain systems by changing how we think, feel, and behave using a form of biopsychosocial treatment called Cognitive Behavioral Therapy (CBT).

CBT reprograms our minds and bodies to help us feel safe and confident in our ability to manage pain and do the things we enjoy — improving the body’s natural pain relief mechanisms, increasing function, and breaking the chronic pain cycle.

.CBT is based on the core principles that our thoughts, emotions, and behaviors interact together with the pain; that we can become trapped in unhelpful thoughts, emotions, and behaviors; and that we can modify our thoughts, emotions, and behaviors to make our experience more manageable. 

It's what changed my pain experience and my life by giving me tools to:
  • Accept the pain and live in the present.
  • Identify, challenge, and change unhelpful negative thoughts and behaviors.
  • Actively self-manage the pain.

Best yet, CBT is a do -it-yourself therapy. You can use it anytime. You don’t need help from anyone once you learn it. And there are no negative side effects.

I learned CBT while attending the prestigious 3-week interdisciplinary Mayo Clinic Pain Rehabilitation Center.  

Find a CBT pain therapist
It can be hard to find psychologists trained in cognitive behavioral therapy for pain. Ask them about their approach to treatment. You might want to use the content from my pain truths to see if their practice beliefs matches the latest pain science. There are links to therapist search tools and pain rehabilitation programs below.

Learn more and do more
  • What is CBT?  (McGovern Medical School)
  • Cognitive Behavioral Therapy for Chronic Pain (4:29)
  • ​A Magical Cure for Pain? No – it’s just Cognitive Behavioral Therapy 
  • Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach​ 
  • Reframing unhelpful thoughts
  • How To Use CBT Thought Records To Change The Way You Feel
  • How to recognize and tame your cognitive distortions​
  • 15 Cognitive Distortions To Blame for Negative Thinking
  • Cognitive Restructuring Worksheet
  • Replacement Thought Examples
  • The Pain Management Workbook
  • American Association of Pain Psychology​ - offers a search feature to connect with a pain psychologist
  • Psychology Today - offers a search feature to connect with a psychologist (be sure to look for a provider familiar with chronic pain and CBT)
  • Find a pain rehabilitation program - links to programs around the globe. 
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Image courtesy of McGovern Medical School

Don't count spoons...Recharge!

5/29/2022

 
(Updated 5/16/25)

INSTEAD OF STARTING YOUR DAY WITH A LIMITED NUMBER OF SPOONS, YOU HAVE THE ABILITY TO SELF-CHARGE THROUGHOUT THE DAY TO BOOST ENERGY AND IMPROVE MOOD.
​

Christine Miserandino's spoon theory has become popular with people with chronic pain to explain their pain and plan their days so they don't over-extend themselves..

The theory assumes people with chronic pain have only so much emotional and physical energy each day to do the things they want to do. You start each day with a finite number of spoons. Each spoon represents a unit of energy. As you use up your energy, you take away a spoon. 

The problem with the theory: there isn't a way to add more spoons (energy) or to make each spoon last longer than expected.

Therefore, it can be self-limiting - focusing on what we can’t do instead of the things we can and leading us to avoid activities that could make us feel worse but may very well help us in terms of giving us more energy and improving our mood. For instance, we may choose to save spoons by not joining our friends for lunch or going on a much-needed walk.

Recent research "demonstrated that on mornings when patients catastrophized more than usual about their pain in the day ahead, they spent more time in sedentary behavior and engaged in fewer minutes of moderate to vigorous physical activity that day. Cross-day lagged analyses further showed that the effect of morning pain catastrophizing on subsequent sedentary behavior extended to the next day. More time spent in sedentary behavior, in turn, contributed to greater pain catastrophizing the next morning" (Zhaoyang et al 2020). 

Another idea: Think of your day like a battery system in a car.

If you don't use a car or if you leave on a car's lights or radio without the engine running, the car battery will eventually run out of energy. But if you drive the car, the alternator will recharge the battery as you drive.
​
Just like a car's battery system, we can add more energy to our days by doing things like:
  • Changing how we think about pain to not be so afraid of it and minimize the suffering.
  • Incorporating activities like deep breathing, tai chi, mindfulness, yoga, and muscle relaxation.
  • Playing games and doing hobbies.
  • Laughing - Watch a funny movie or TV show and give yourself permission to be silly.
  • Getting outside for a walk and enjoying nature.
  • Listening to music - Music has an analgesic effect to help us feel better.
  • Modifying and moderating activities to make things easier, not harder.
  • Spending time with people who don't drain our energy with pain talk, negativity, and complaints.
  • Being grateful - Focusing on what you have, not what you’ve lost.

Check out 50 ways to live well, despite chronic pain. 

Note: This is just another tool to add to your chronic pain toolbox. If the spoon theory or another approach works for you, please continue using it. 

PACING ISN’T AN EXCUSE TO AVOID ACTIVITY AND PAIN

5/28/2022

 
People with chronic pain often do too much when they’re having good days and not enough when they’re having bad days.

Chronic pain can cause us to overprotect ourselves. Our natural reaction to pain is to avoid activities that worsen our discomfort or increase our perceived risk of further damage. When we become overly fearful and stop doing things in anticipation of pain, we can make things worse.

Inactivity reduces our functional ability and decreases our strength and stamina. It also prevents us from getting involved in the social, leisure, and work activities we enjoy.
 
Pacing/moderation has become a helpful tool for people living with chronic pain to help provide them with balance. It includes setting time limits, slowing down (start low, go slow), breaking up tasks, and taking frequent short breaks.
 
But be careful not to let pacing become an excuse for not being active or avoiding pain. Doing so can add more focus to the pain, worsen symptoms, and reduce physical stamina.

Pacing should instead be used to gradually increase what we can do, despite the pain. Stay consistent with your activity. 
 
The difference is in the goal and execution. Keep moving forward.
 
Learn more and do more
  • Activity pacing: moving beyond taking breaks and slowing down
  • The role of avoidance, pacing, and other activity patterns in chronic pain
  • Activity Pacing
  • Pacing and Goal Setting
  • Tools for recovery – Boom or bust vs pacing
  • Pacing For Pain
  • Chronic pain self-management: Pacing and goal setting
  • Goal Setting for Pain Rehabilitation​
  • Pacing – how to manage your pain and stay active
  • What Goals Have You Set Recently? 
  • Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain
  • Activity Pacing is Associated With Better and Worse Symptoms for Patients With Long-term Conditions​
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Cooper, Booker and Spanswick, 2003

Resilience is important

5/22/2022

 
I just watched a great TEDx Talk from Dr. Trung Ngo about resilience that everyone who lives with chronic pain or treats chronic pain should watch.  

He talks about how there are three types of people:
  1. Those who are victims
  2. Those who are catastrophizers
  3. Those who are resilient

I can identify with all three types during my personal journey with pain. Early in my journey, I was the victim. It was the surgeon's fault for the pain. I was set on making that doctor pay for his mistake and make the pain go away.

As the pain continued, I became the catastrophizer. It quickly became gloom and doom. I become fearful of the pain. I worried about all the terrible things that might happen because of the pain. And I worried about my future and the future of my family. 

Fortunately, my mindset changed to resiliency. Many thanks to the Mayo Clinic Pain Rehabilitation Center for helping me transition to that stage.

How to be resilient
According to Dr. Ngo, the keys to being resilient:
  • Be interdependent
  • Prioritize your own well-being
  • Let go
  • Take ownership

 Learn more
  • 10 Habits of Highly Resilient People
  • How to Build Resilience and Boost Your Mental Health

* Ojala, T., Häkkinen, A., Karppinen, J., Sipilä, K., Suutama, T., & Piirainen, A. (2014). Chronic pain affects the whole person – a phenomenological study. Disability and Rehabilitation, 37(4), 363–371. doi: 10.3109/09638288.2014.923522

Take control

4/28/2022

 
Pain doesn’t have to determine your life.

I love this metaphor I first heard when I attended 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

We can’t treat chronic pain like acute pain

4/19/2022

 
If biomedical treatments like medicines, rest, supplements, ice, heat, injections, and physical therapy didn’t resolve pain when it was acute, is it reasonable to expect using only the same treatments to change our symptoms when the pain becomes chronic?

It's not.

We must change the paradigm. Pain is more than a biomedical condition. We need to treat both mind and body. As Dr. Rachel Zoffness reminds us, " Because pain is biopsychosocial, treatment must be, too."

Comprehensive pain treatment that addresses the biopsychosocial aspects of a person's pain experience is not only more clinically effective than conventional medical treatment by itself, it’s also more cost-efficient.

Acute pain vs. chronic pain
There are two types of pain: acute and chronic.

Acute pain is the body’s normal response to tissue damage or injury. The pain matches the damage and treatment works - lasting less than three months.  

Chronic pain is an abnormal response, becomes its own disease/condition, and doesn’t improve over time.  It can happen long after an injury or illness heals. Treatments don’t always work or stop working and symptoms can change and grow over time.

The longer we have pain, the less likely it is related to tissue damage or injury and the better our bodies can become at creating it and turning up the pain volume. It’s a process known as central sensitization. 

Sensitization can happen in all chronic pain conditions, no matter the underlying cause, including 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) does an awesome job explaining 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.

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) 
  • Central sensitization: implications for the diagnosis and treatment of pain
  • The Truth About Managing Chronic Pain (w/Dr. Rachel Zoffness) - ZDoggMD (1:39)
  • Neuroplasticity​
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