25/08/2025
Our chronic pain: How do we understand and deal with it?
Medicine who specializes in chronic pain rehabilitation, emphasizes that pain is merely a passenger in our vehicle, not the driver. We must control it, not let it dictate our lives. To help people manage their chronic pain, he has written a book and launched a website—painrehabsource.com—that provides a step-by-step guide to deepening our understanding of pain; learning how to calm the central nervous system—the brain and spinal cord—to reduce its sensitivity to information and reduce pain perception; and increasing the emotional resilience that enables us to move forward in the presence of pain.
To effectively manage chronic pain and return to a desirable life, Dr. Parks recommends understanding the bigger picture through which a pain sufferer identifies the causes of their intense, persistent pain. It's important to first understand that the origin of pain lies in the peripheral nervous system—the parts of the nervous system outside the brain and spinal cord, including the nerves that connect the limbs and organs to the central nervous system. It provides information about a change, and the central nervous system, responsible for receiving information from all parts of the body, determines the type of response. If the evidence indicates danger, pain is emitted as a form of warning. However, the problem lies within our brains, which can misinterpret this information due to their hypersensitivity to the point of considering normal movements, or even light touches, as a threat, and overreact to protect us. Another problem is an overactive immune system response, caused by stress, which causes serious damage to the body, such as inflammation of the joints, tendons, blood vessels, muscles, tissues, and bones. By understanding the mind-body connection, we can see how our thinking, emotions, behavior, life experiences, and prior learning can transform a relatively minor injury into chronic pain.
Dr. Parks says, "There is acute pain, like when someone hits their finger with a hammer, which sends signals indicating nerve or tissue damage, inflammation, or a fracture. After a few weeks, the pain heals and resolves. There is pain due to neuropathy, perhaps resulting from complications, such as those that occur in diabetics. Because the nerves are not functioning properly and are not sending any information, the brain perceives this failure to receive information as a threat. Chronic pain occurs when the brain and spinal cord continue to view information from the peripheral nervous system as potential problems that warrant continued pain as a stimulus. If someone experiences psychological stress that results in a pulled muscle in the lower back, for example, the brain perceives it as an injury and sends out its alerts, even though tests do not reveal any actual injury."
Often, chronic stress and chronic psychological pressure turn into chronic pain, which may force the sufferer to limit movement. This can contribute to the spread of the pain, or the occurrence of other injuries, creating a vicious cycle of pain. Most of us suffer from pain as a result of the damage to cells, tissues, and organs with age. Some ignore it until a diagnosis is made, which then changes the perception of the condition, and the sense of danger begins.
Calming Strategies:
Dr. Parks points out some strategies that help turn off the stress alarm system that is triggered by pain. When we feel pain, our bodies tense up, our breathing and heart rate quicken, and blood pressure rises. Fortunately, the stress response can be curbed with a useful skill like belly breathing, which involves slowly inhaling through the nose and then exhaling through the mouth, focusing attention on the movement of the abdomen with each breath. Strategies that stimulate the release of calming hormones like endorphins include mindfulness, which involves monitoring feelings and thoughts. This involves tracking sensations from the toes to the head and noticing extraneous thoughts.
To overcome the difficulty of life when pain is all there is to see, one can practice focusing attention and noticing what is happening, learning to relegate the pain to the background. The key to noticing is to intentionally direct attention toward a goal—anything—and suspend judgment. This part of noticing can be practiced at any time by looking around the room, suspending judgment or evaluation of what has been observed, and accepting the situation without trying or wishing to change it. Relaxation and discussing troubling life issues with loved ones can also help relieve the psychological pressures that amplify pain.
To explain the buildup of tension and muscle strain, Dr. Parks invites us to imagine ourselves behind the wheel of a car, driving from a quiet rural area toward a bustling major city. From slow, two-lane rural roads to massive highways, amidst the din of speeding cars and trucks that obscure our vision, then pitch darkness and heavy rain descend upon us. We feel exhausted, our shoulders and backs tense, and blood flow to them decreases. However, our attempts to relax can gradually return our muscles to normal.
Fear of Movement
: Fear of movement is a barrier for those with chronic pain. If they walk, stand, stretch, bend, or take a step, they feel pain. The fear of movement is understandable; pain is the brain's attempt to protect us, urging us to stop moving and preventing us from doing things that might worsen our poor posture. Therefore, our fear of movement is a protective response from the brain, but if we listened to our brains' advice, we wouldn't get out of bed in the morning. Staying in bed, on the couch, or in a wheelchair for days at a time turns a healthy person into a patient with chronic pain.
A study showed that patients with lower back pain who committed to bed rest for only four days were more likely to develop chronic pain and required more medication to treat their pain than those who moved. If we protect ourselves and restrict our activity by stopping exercise or walking, we lose our physical fitness, our muscles weaken, and we feel more pain.
To overcome our misconception that movement is harmful, we must build a new body of information that links healing to movement, exercise to improved mood and the release of feel-good hormones, and make an effort to change our unhealthy habits. Healing requires breaking the rules our brains set to protect us in the short term. Emotions are also a key component of the brain's analysis of how to protect us, interpret what's happening to us, and amplify things.
When the brain asks troubling questions, our emotions intensify those questions and add feelings like anxiety, fear, or sadness. Because of our emotions, we take what our brains tell us seriously. When our safety is threatened, we fear; we worry, we feel sad, we get angry, we feel depressed, we feel frustrated and helpless, and we may even be ashamed of our situation. Chronic pain affects every aspect of life, preventing us from enjoying work, hobbies, and moving freely. It makes us isolate ourselves and prevents us from seeing a future worth living.
To maintain balance while living with chronic pain, it requires adjusting our pace and knowing our limits; this is done by learning to be aware of our body and what happens during any activity. If someone works from home, they need to learn to pay attention to their energy levels and listen to their body when they start to feel uncomfortable and tired. Regulating activity involves movement and rest, and it's okay to stay in the discomfort zone for short periods. The goal is to avoid overdoing it or pushing the discomfort zone beyond the threshold of pain. Going beyond that threshold means the brain associates activity with pain, while what's required is to relearn the brain to accept that movement and activity are not associated with pain. Knowing limits and self-control also helps avoid wasting time and energy.
Moving Forward in Life:
Most chronic pain sufferers describe their suffering as constant misery. Because of this pain, they isolate themselves and refrain from participating in events and activities. They long to control their pain, accepting medications and surgery. Because of the fantasy of a happy life without pain and negative feelings, attempts to control and avoid chronic pain lead to even greater suffering. Therefore, accepting what we cannot change is one of the most important steps in dealing with chronic pain and the negative thoughts and feelings that accompany it. To move from struggling with pain to moving forward in life, we must learn to let go of the past, stay in the present, and focus on what matters to us.
To understand what is happening in life, work to improve it, and increase our resilience, Dr. Parks invites us in his book to imagine two lines crossing in the middle, one vertical and one horizontal. The horizontal line has arrowheads, one pointing left and the other right. Then, we imagine a circle drawn at the intersection of the two lines in the middle. Each person should imagine what they observe in their outer world, in the area above the horizontal line, where they can see, hear, smell, touch, taste, and interact with others. Their inner world, below the line, is where attention can be diverted to observe thoughts, feelings, sensations, memories, self-concepts, values, desires, and needs. Throughout this world, they can observe the feelings of contentment, pleasure, and goodness of engaging in meaningful activities or doing what is important. They can also observe what spoils enjoyment, how to react when painful memories, negative thoughts, and difficult feelings arise, and the desire to be free of all this distress. All of this happens out of sight.
The circle in the middle represents the ability to focus on different aspects of life experience. When a person focuses their attention on where they are sitting, they can use their five senses to see their surroundings, smell the air in the room, hear sounds near and far, and feel the taste in their mouth and the texture of their skin. Outward attention is very different from inward attention, focusing on thoughts, feelings of hunger, memories of yesterday, feelings about family and their news, and tasks to be accomplished. There are negative things: anxious thoughts, self-judgments, blame, dark expectations about what will happen, memories of past losses, painful bodily sensations, predictions of future disappointment—a complex mix of realistic, distorted, dark, and frustrating inner thoughts and experiences.
The arrowheads on the horizontal line point "toward" what matters to us and those who matter to us on the right and "away" from what matters to us and those who matter to us on the left. When we turn "toward," we notice feelings of contentment, meaning, and purpose. We are happy when we live in accordance with our values, not because everything is perfect, but because we live in accordance with what we believe is important. The direction “away” means there is a disability or difficulty, such as the pain we feel constantly, and the tension, anxiety, sadness, disappointment, fear, and weakness it can cause.
What happens is that we want to go right, but when we encounter difficulties, we withdraw and move left. This may temporarily relieve the pain, but at the same time, it robs us of feelings of satisfaction and pleasure. Believing that if we recover, we will work on what is important to us only means we remain stuck waiting for it to happen. Avoidance, or trying to control pain by smoking, sleeping, eating excessively, or using sedatives or implanted devices prescribed by doctors, only creates new problems.
The bottom line is that effective pain management is the key to long-term recovery. This means that the person is responsible for making the necessary changes in their life to move toward health and away from illness. It is okay to expect some setbacks and failures, then take responsibility by learning from the past without blaming themselves, circumstances, or others, and by anticipating and imagining continuous improvement.
https://alarabi.nccal.gov.kw/Home/Article/27403
