Feeling your pain
Congress has declared this the Decade of Pain Control and Research, and with good reason. More than 50 million Americans have chronic pain. Headache and lower back pain are the most common forms of pain. Back pain is the leading cause of disability in Americans 45 and younger. Costs associated with pain are estimated at $100 billion each year, including medical expenses and 50 million lost days of work.
Because pain is so common, it has already been widely researched. The results are clear: pain is a mental problem. Studies show that job dissatisfaction and stress, not physical strains, predict who will get back pain from work.
Then there is the fact that being in pain can provide benefits--this is called "secondary gains." For example, cases of repetitive stress injury (RSI) skyrocketed in Australia after labor unions won a new health-care provision that allowed anyone with RSI to go on paid leave until they recovered. And it is interesting that in countries where whiplash is not recognized as a symptom meriting financial compensation, car accident victims don’t have disabling neck pain. And everyone knows that "not tonight, dear, I have a headache/backache," is a way of saying "no" without actually saying "no."
Stress and pain
Although the mind-body approach to health regards pain as the outcome of ignoring mental problems rather than the product physical ones, this in no way means that pain is not "real." When you feel pain, you’re really feeling it, but tension rather than physical damage is the culprit. Unresolved mental and emotional distress can produce many painful physical responses—like tension, cramps, spasms, and inflammation.
The unconscious process of turning mental stress into bodily discomfort is called somatization. Instead of recognizing the source of your distress or conflict and doing something to relax, you shove aside your distress, which then finds its way to expression through physical symptoms. Everyone does this. For example, you have a tough day at work and end up with a headache, or a neck ache, or a backache. Usually these pains are gone by morning, and they can serve as a reminder that we need to find ways to relax.
However, when the tension caused by your habitual responses to stress creates ongoing physical pain, and your focus on that pain leads to more tension, which in turn generates more pain, you can end up experiencing chronic or disabling pain. Studies show that disabling or chronic pain—pain that interferes with your life in any way—is a signal you are ignoring the need for making changes in the way you think about and deal with problems in your life.
Treating pain
The way conventional medicine deals with with pain isn’t working for most patients or medical institutions. In his book, Timeless Healing: The Power and Biology of Belief, Dr. Herbert Benson notes, "Patients with concerns and symptoms related to societal, interpersonal and work difficulties do not tend to receive appropriate and responsive care within general health care systems. A perfunctory and unsympathetic response is most typical...If the patient, however, unconsciously translates this distress into low back pain, the patient is immediately "rewarded" by the physician in the form of X-rays, laboratory tests, medications, and return visits."
This means that one barrier to treating pain as a mental problem rather than a physical one can be overcome by HMOs making mental health services widely available. In a study done for Kaiser Permanente, one of the nation’s largest HMOs, it was found that using the services of mental health professionals benefited 85 percent of patients with pain.
Healing your pain
But you, the person in pain, are the other barrier to treating pain as the mental problem it is. A revealing study done by Robert Gatchel, Ph.D., of the University of Texas Southwestern Medical Center at Dallas, showed that it was possible to predict who would develop chronic pain by testing individuals for psychosocial factors (the ways you deal with life mentally and emotionally), not by analyzing their physical diagnosis. Factors chronic pain patients have in common are denial of emotional and relationship difficulties, a worried over-focus on bodily sensations, and not feeling in control of their lives. Gatchel found that in order to successfully treat these patients, cognitive therapy needed to be added to educating them about their pain and teaching them stress management techniques.
"But not me," you may be thinking. "I have real physical problems that are causing my pain. It’s not all in my head!"
But denial, as they say, is not just a river in Egypt. Your protests that this way of looking at pain could not apply to you are in keeping with the link studies have found between chronic pain patients and denial. Therefore, if you have chronic pain, it is most likely that you are in denial about your emotional and interpersonal problems and the fact that how you cope with them is causing you stress.
Pain can serve as a distraction from your problems, protection from life’s demands, an innocent excuse for avoiding things you don’t want to deal with, a way of saying ‘no’ without being responsible for your choices, and a covert means of exercising power over others. It’s hard to imagine giving up all those advantages. It’s also hard to admit to them.
Cognitive therapy—education in changing your mind
The most important thing to remember about pain is that it is always a message that something needs to change. Chronic pain means you need to change your mind about what's bothering you so that you can relax. Chronic pain tells you that the way you react to problematic situations and people doesn’t work. Your pain sends you this message as long as you continue to deny it.
Cognitive therapy (also know as rational emotive behavior therapy) teaches you new ways of thinking about and reacting to situations you don’t like. Having a mental health professional help you with cognitive therapy is useful, since recognizing your areas of denial can be challenging. Besides it usually works better to have support when making changes in habits of mind. Often part of changing the way you think is learning to get help when you feel you need it.
Using cognitive therapy, you learn not to knot up with worry when things don’t go as planned or when life is uncertain or difficult. You learn not to dwell on how terrible you feel if people don’t approve of you. You learn to feel okay when you do feel in complete control of situations or when you make mistakes. You learn not to blame things and people around you for your unhappiness and problems. You learn to take action to change situations you don’t like. You learn to deal with your problems instead of denying them.
Developing a more constructive thinking style is like being reborn. You will not only leave your physical pain behind, you’ll also become more fully yourself as you abandon false assumptions about what is possible in life. Let go of that pain-producing, limiting denial. Start changing your mind now.
Resources
Recommended reading
Healing Back Pain Naturally : The Mind-Body Program Proven to Work, Arthur M. Brownstein, M.D.
Caveat: The point of view and exercises are useful. The nutrition information can be ignored.
Mind over Back Pain : A Radically New Approach to the Diagnosis and Treatment of Back Pain, John E. Sarno, M.D.
The Mindbody Prescription : Healing the Body, Healing the Pain, John E. Sarno, M.D.
Caveat: There is much useful information in Sarno’s books, but be advised that he makes liberal use of the Freudian theory that our emotional problems stem from childhood traumas. This is a belief that can be limiting. You do not have to delve into your childhood to uncover the source of your dysfunctional reactions to life. You could simply deal with them as they come up in every day life, since your so-called dysfunctional responses are readily accessible in the present. My advice: Read Sarno's books for the liberating information about the reality behind your pain and skip over the Freudian stuff.
How to Stubbornly Refuse to Make Yourself Miserable About Anything--Yes, Anything, Albert Ellis, Ph.D. (The father of rational emotive behavior therapy.)
For more information on cognitive therapy, search google.com for "cognitive therapy" and "rational emotive therapy."