Chronic Pain Blog

Updated September 4, 2026

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

In his talk, Dr. Ngo describes three ways people may respond to adversity:

1. Those who are victims
2. Those who are catastrophizers
3. Those who are resilient

I can identify with all three during my personal journey with chronic pain.

When I felt like a victim
Early in my journey, I felt like a victim. I believed the surgeon was responsible for my pain, and I was focused on making that doctor pay for his mistake and making the pain go away.

I was angry, frustrated, and focused on what had happened to me.
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Those feelings were understandable. But eventually, I realized that continuing to focus on what I couldn't change wasn't helping me move forward.

When I became a catastrophizer
As the pain continued, my thinking became increasingly negative.

It became gloom and doom.

I became fearful of the pain. I worried about all the terrible things that might happen because of it. I worried about my future and my family's future. I began imagining the worst possible outcomes.

Looking back, I can see how much of my life had become organized around pain and the fear of what might happen next.

Becoming more resilient
Fortunately, my mindset eventually shifted toward resilience.

Many thanks to the Mayo Clinic Pain Rehabilitation Center for helping me make that transition.

Resilience doesn't mean that pain isn't real or that difficult emotions disappear. It doesn't mean pretending everything is okay.

For me, resilience meant learning that I could respond differently to the challenges chronic pain created. I could focus on what I could influence rather than spending all my energy on what I couldn't change.

I learned to become more active in managing my life rather than waiting for someone else to fix me.

That was a major turning point.

How to be resilient
According to Dr. Ngo, there are four important keys to resilience:

• Be interdependent — We don't have to face difficult situations alone. Asking for help, accepting support, and working with others can be part of becoming more resilient.
• Prioritize your own well-being — Taking care of yourself isn't selfish. Physical, emotional, and social well-being all matter when living with chronic pain.
• Let go — Letting go doesn't mean forgetting what happened, saying it was okay, or giving up accountability. It can mean deciding that carrying anger, blame, or resentment isn't helping you move forward.
• Take ownership — Taking ownership doesn't mean that you caused the pain. It means recognizing the things you can influence — including how you respond, where you focus your attention, and the choices you make each day.

Resilience is a process
I don't think resilience means that you never have a bad day, feel angry, become discouraged, or worry about the future.
I still have difficult days.

The difference is that I don't have to let those feelings determine what I do next.

Resilience is the ability to adapt to difficult circumstances and continue moving toward a meaningful life. Sometimes that means pushing forward. Sometimes it means asking for help. Sometimes it means accepting that something cannot be changed and focusing your energy somewhere else.
For me, resilience meant changing the question.

Instead of continually asking, "How do I make this pain go away?", I began asking, "How can I live the life I want while managing this pain?"
That change in perspective didn't make my pain disappear.

It changed how I responded to it.

What resilience taught me
Chronic pain can affect much more than the body. It can influence our emotions, relationships, activities, expectations, and sense of who we are.

Research has described chronic pain as an experience that can affect the whole person, not simply a physical symptom.

That's one reason I believe resilience is so important.

We may not be able to control everything that happens to us. We may not be able to control whether pain is present on a particular day.
But we can work on how we respond.

I learned that I didn't have to wait for pain to disappear before I started living again.

I could build the skills and confidence to move forward with my life — pain included
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The bottom line
Resilience isn't about denying pain, thinking positively all the time, or doing everything on your own.

It's about learning to adapt.

It's recognizing what you can change, letting go of what you can't, accepting support when you need it, and continuing to participate in the things that give your life meaning.

I spent years looking for someone to make my pain go away.

Eventually, I learned that becoming more resilient wasn't about finding someone to fix me.

It was about learning how to move forward.

 Learn more

• What Chronic Pain Has Taught Me About Resilience — Dr. Trung Ngo's TEDx Talk
• Broadening the Scope of Resilience in Chronic Pain — Sturgeon et al.
• Chronic Pain Resilience Across Clinical Populations — Kinnie et al.
  

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)​

Chronic pain appointments can be difficult for both doctors and patients. 

For patients, doctor visits can be intimidating and create anxiety.  We want validation of our pain, empathy, answers, and support.  
 
For doctors, chronic pain patients can be more challenging to treat than other patients.  We can be demanding of their time, attention, and patience.
 
While they genuinely want to help, doctors often have limited training (typically only 11 hours of pain education in medical school); limited time (typically only 15-20 minutes per appointment); limited options due to government, health system, and insurance guidelines; and limited internal resources to treat chronic pain patients.
 
So how do you make the most of your appointment time and get the best treatment when you visit the doctor?
 
Below are 25 suggestions to help maximize the patient-doctor experience (thanks to the many ideas provided by members of the Chronic Pain Champions – No Whining Allowed Facebook support group):
 
 
In general

1. Don’t bring any bad experiences you may have had with other doctors in the past to your appointment.  You don’t want to muddy a new doctor relationship.
2. Go with a stated purpose but don’t go with any pre-conceived expectation about getting a certain treatment or continuing a specific treatment, like opioid therapy, or a specific diagnostic test, like an MRI.  Unfortunately, there isn’t an easy answer for chronic pain.  It’s not like prescribing an antibiotic that will cure an infection.  Most chronic pain doesn’t have a cure.  You may not be able to be fixed.
3. Let your doctor determine the best course of action.  That is why you’re there.  To get the help you need, not necessarily the help you think you need.  Be open to any suggested treatment recommendations.  Any treatments should be a shared-decision.
4. Ask your doctor about arranging recurrent appointments (quarterly, etc.) just for pain management as well as scheduling extra time, if needed, for those appointments.
5. If you’re seeing the doctor about other medical conditions unrelated to your regular chronic pain, don’t talk about pain.  Keep it for your regular pain visits.
6. Confirm your doctor is up-to-date with the latest pain science, and treatments.  They should be able to correctly answer the questions from my pain quiz.
7. Reduce your reliance on doctors and use of the medical system as your self-management skills grow.

 
 
Before the appointment

1. Make a prioritized list of topics/questions you want to cover at the appointment.  That way you won’t forget things and you’ll stay on topic.  You might also want to practice going over the list and what you want to say to help capitalize on your discussion time at the appointment. 
2. Draft an alphabetical list of medications (including over-the-counter medications/supplements).  Include the medication name, the dose (such as 5MG), how many pills you take and how often you take them, as well as the name of the doctor who prescribed them.  Include any allergies on this list.  Download this free template.
3. Put together a medical summary of major health events, medical conditions, surgeries, and special treatments related to your pain condition.  Make it easy to read and keep it short, one- or two-pages so the doctor can get a quick snapshot of your history. Download this free template.
4. Arrange for a family member or other trusted support person to go with you to the appointment to be a second set of ears and take notes.

 
 
At the appointment

1. Arrive early with your insurance card and payment method.
2. Bring your prescription list.  Give this list to the nurse at the beginning of each appointment to help them reconcile your medicines.
3. Bring copies of your prioritized list of topics you want to cover at the appointment.  Share with your doctor and support person at the beginning of your visit. 
4. If visiting a new provider, also bring your medical summary and any relevant x rays, CT scans, MRIs, ultrasounds along with their radiological reports.
5. If you heard something you think might be helpful in your diagnosis or treatment, take time before your appointment to look at evidence-based scientific research that may support it (try searching on Google Scholar) and bring a copy of the research with you to share with your doctor. Be prepared to talk about it.  Don’t say you Googled some information.
6. Stay non-emotional, calm, and factual.  No drama, whining or catastrophizing about the pain.  And don’t get angry or be rude.  
7. Talk to your doctor about what is happening in your life and how your chronic pain is affecting it.  Pain isn’t just a number on a pain chart.  It’s a biological, psychological, and social experience.  Talk about your emotions, your ability to work, your relationships, and your ability to do daily activities.
8. Be specific when describing your pain symptoms.  Tell the doctor when the pain started and how it started, what kind of pain you’ve been feeling (aching, dull, throbbing, sharp, burning, radiating, pins and needles, electrical, numb, etc.),  how often you experience the pain, where the pain is located (lower back, head, etc.), what you’ve done to help reduce the pain (ice, heat, analgesics, etc.), and how successful those treatments have been.
9. Talk to your doctor about treatment goals.  Once pain becomes chronic, the goal of treatment is often increasing functional ability and quality of life, not pain elimination.
10. Talk to the doctor about the psychosocial components of pain and recommended treatment.  Opioid pain medicines and other medical interventions aren’t always the best or only treatment options.  Explore comprehensive multidisciplinary pain management and rehabilitation.  Ask about other treatments.  If there isn’t a cure, how can you manage the pain?
11. Clarify and confirm.  Ask questions if you don’t understand something.  Repeat what you heard to make sure you heard it correctly.
12. Be respectful.  Listen to what the doctor says and do what they recommend, even if they may involve behavioral changes or other treatments you may have already tried or don’t think are valuable.  If you want them to listen and respond to you, you need to do the same to them.
13. Be patient as a patient.  It may take several doctor visits and/or different treatments before you recognize improvement.
14. Be grateful.  Thank the doctor.

 
 
Bottom line
To get the best treatment from your doctor, be prepared, calm, engaged, insightful, and open to self-management.  It’s harder for doctors to treat patients who are negative or expect the doctor to fix all their problems.
 
I hope you find these tips helpful.

Chronic pain can make it easy to feel overwhelmed, reduce our activity levels, and become isolated.  Goals help restore a sense of order, build self-efficacy and sense of control, improve mood, and provide direction by helping with planning daily activities.
 
One of the tools we learned at the Mayo Clinic Pain Rehabilitation Center was goal setting to help us plan our days and keep us on track. We set goals each day. They didn't have to be massive, but they had to be SMART - specific, measurable, achievable, relevant, and time-bound.
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• Specific – What do you want to do?  What action will you take?
• Measurable – How will you track progress and know when you’ve reached the finish line.
• Achievable – Is it something you can do? Do you have the necessary skills and resources?
• Relevant – Why is it important to you?
• Time-bound – When do you want to accomplish it?

Some SMART goal examples:

• Increase my step count by end of week to 5,000 steps a day.
• Do deep breathing for three minutes three times each day for the next week.
• Read three articles about cognitive behavioral therapy by end of the week.
• Plan a social event to visit in-person with friends and family this week.
• Lose 4 to 8 pounds of weight in the next 30 days.
• Volunteer 10 hours a week at the community center for the next month.

 
Did you notice none of the goal examples included pain reduction?
Our focus should be on reducing stress, improving our quality of life and increasing functional ability and activity, not pain reduction. Focusing on pain reduction is an easy trap to fall into - leading to frustration and depression.  Just as the homepage of my website says - we can live well, despite the pain. 

Celebrate!
While it's natural to celebrate big goals, be sure to celebrate milestones along the way, as well as smaller victories. These celebrations keep us motivated along the way and help instill confidence.

Resource

• Goal Setting for Pain Rehabilitation​

Pain is the body’s alarm system.  It’s designed to protect us from danger just like a home security system or a smoke detector.  It’s the body’s normal response to acute tissue damage or injury and heals in normally 3-6 months.
 
But what happens when pain doesn’t go away?
 
Once pain persists beyond the normal healing time, it becomes chronic - losing its warning function and becomes its own disease/condition.  It’s an abnormal response (with or without obvious pathology). 
 
Although all pain hurts, not all pain indicates damage. We know what to expect from our pain by the very nature of it being chronic or ongoing.  It’s not like getting burnt, twisting an ankle, or getting stung by a bee that needs protection until the injury has heals.  Of course, any unexpected new pain should be investigated.
 
Learn more

• Central Sensitization Syndrome (CSS) - Dr. Christopher Sletten (22:19) 
• Understanding pain & what to do about it in less than 5 minutes - VA (5:00)
• A Tale of Two Nails 
• How your brain creates pain – and what we can do about it
• Tame the Beast – It's time to rethink persistent pain - Lorimer Mosely (5:00)
• Are You Missing Two-Thirds of Your Potential Pain Treatment Plan?  (my article)
• The Truth About Managing Chronic Pain (w/Dr. Rachel Zoffness) - ZDoggMD (1:39:10) ​
• Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability
• Fear-Avoidance Beliefs and Chronic Pain

Pain, stress, and tension are closely related. Muscles tighten and put pressure on nerves resulting in even more pain.

It’s possible to activate your body’s natural relaxation response to help reduce the tension using mind-body tools like:

• Deep breathing (also called diaphragmatic breathing, abdominal breathing, and belly breathing) – easy to learn and can be done anywhere.
• Yoga and tai chi – can be modified, if needed, to accommodate individual needs, like chair yoga or tai-chi chih (a simplified version of tai chi).
• Mindfulness and meditation – require you to redirect your attention.
• Passive muscle relaxation – mentally relax your muscles from head to toe.
• Progressive muscle relaxation – actively tense and relax your muscles from head to toe.

Helpful videos

• Deep Breathing Exercises for Beginners
• Breathe to Heal | Max Strom | TEDxCapeMay (18:32)
• Mindfulness
• ​Passive Muscle Relaxation to Manage Anxiety and Stress (12:40)
• Progressive Muscle Relaxation to Manage Anxiety and Stress (15:00)
• ​Tai Chi Chih - Joy Through Movement (50:08)
• Yoga For Chronic Pain | Yoga With Adriene (25:33)

Free Apps

• Bellybio
• Breath2Relax
• Mindfulness Bell
• ​The Breathing App

 
FIND MORE TOOLS AND APPS
 

Updated 3/1/24

Pain rehabilitation goes beyond medicine and medical interventions – and crosses different disciplines. It doesn’t just focus on removing the pain.  It focuses on the patient and how they can play a role in their own pain management - giving them control over the pain instead of letting the pain control them..
 
It’s a proven approach based on the biopsychosocial model of medicine – benefiting patients while reducing costs and reliance on the medical system.  
 
In addition to their general efficacy, these types of programs using interdisciplinary chronic pain rehabilitation can be effective at weaning patients off opioid therapy with long-term improvements in pain, mood, and function.
 
I was fortunate to be able to attend the 3-week interdisciplinary Mayo Clinic Pain Rehabilitation Center – not just once, but twice.  It was both a game-changer and lifesaver for me.  I highly recommend the program to anyone interested in taking an active role in managing their own care.  Read about my Mayo experience in this article.
 
More programs like this are needed to shift the current reliance on biomedical therapy towards a greater reliance on provider-supported patient self-management and true biopsychosocial treatment. .
 
Availability is important but so is accessibility. These programs aren't cheap, and insurance can be hesitant the pay the price tag. What payors need to remember is that these programs are cost-effective with a 68% reduction in medical cost spending.
 
Find links to rehabilitation programs in the U.S. and around the globe.
 
What to look for in a program
A pain rehabilitation program should focus on you as a person, not just your pain.  

Interdisciplinary pain rehabilitation programs that take place in the same facility with health care providers working together with open communication and shared objectives are the gold standard of comprehensive care outperforming medical pain services and less coordinated multidisciplinary programs.
 
A comprehensive pain rehabilitation program typically includes:

• Medication management – To find the right combination of medicines and taper/stop any unnecessary medications along with better monitoring of patients who are prescribed opioids.
• Pain education – To help patients better understand the purpose of pain and how best to respond to it – reducing any fears that pain is a symptom of a serious health issue, and that activity will cause more damage.
• Lifestyle changes – To improve diet and sleep.
• Psychosocial intervention – To change self-limiting thoughts and provide coping skills using acceptance commitment therapy and cognitive behavioral therapy.
• Physical therapy/exercise – To build strength and endurance while reducing fear of exercise and activity.
• Occupational therapy – To modify and moderate daily life activities.
• Relaxation training – To reduce stress on the mind and body – easing the pain experience.
• Family therapy – To teach loved ones how to help/not help those in pain – encouraging self-efficacy and reducing pain behavior.

 
Learn more about pain rehabilitation

• Not all pain management facilities are the same (my blog post)
• Patient Perspective: We Have a Chronic Pain Problem (my article)
• What is a Chronic Pain Rehabilitation Program?
• On Can't and Able
• Interdisciplinary Rehabilitation Programs in Chronic Pain Management
• Interdisciplinary Chronic Pain Management: Past, Present, and Future
• Focused Review of Interdisciplinary Pain Rehabilitation Programs for Chronic Pain Management
• Interdisciplinary Chronic Pain Management: International Perspectives
• Interdisciplinary Chronic Pain Management: Overview and Lessons from the Public Sector
• Economic Analysis of a Comprehensive Pain Rehabilitation Program: A Collaboration Between Florida Blue and Mayo Clinic Florida
• Chronic pain affects the whole person – a phenomenological study
• IASP Pain Management Center – a series of chapters
• The Resurrection of Interdisciplinary Pain Rehabilitation: Outcomes Across a Veterans Affairs Collaborative
• A Call for Saving Interdisciplinary Pain Management
• Evaluation of an interdisciplinary chronic pain program and predictors of readiness for change
• Predicting Readiness to Attend an Interdisciplinary Pain Management Program: What’s better for Clinical Decision-Making? Clinical Judgment or a Patient Self- Report Questionnaire?
• Has your doctor referred you to pain management but you’re unsure where to go and what to expect?
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Learn more about the Mayo Clinic Pain Rehabilitation Center (PRC)

• Program information
• My experience at the PRC
• Dr. Christopher Sletten explains pain, central sensitization syndrome, and what they do at the PRC (22:19)
• Dr. Jeannie Sperry explains how the PRC can help those suffering with chronic pain (9:44)

Pro golfers use visualization when they play. They picture the precise shot they want to hit before taking the club back – the trajectory, shape, roll and finish. This puts a positive image in the mind; the body then makes the motions needed to turn the image into reality.

We can do the same with our pain.

We can visualize a different way to view our pain and respond to it. We can visualize living well despite the pain. And we can visualize the pain leaving our bodies or the pain taking a smaller role in our lives.

Try these exercises

• Audio Meditation - Visualize your Pain​ (9:54)
• Guided Imagery for Pain Relief (9:55)
• Guided Imagery Practice For Pain (9:43)

Find links to these and other self-management tools.

I was recently honored to be a guest on the Compass Opioid Stewardship Program podcast hosted by Dr. Rachael Duncan, PharmD. and Dr. Don Stader.

I'm so grateful for the opportunity and blessed to be able to share my story with clinicians. I'm also thankful for the generosity of Dr. Stader. You'll find out what he offered me at the end of the podcast. It brought me to tears.

You can listen to the podcast episode on Apple, Spotify, and Libsyn via the links below:

• Apple
• Spotify
• Libsyn

Check out the entire podcast series. 

Learn more about the Compass Opioid Stewardship Program.
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