The first step to reprogramming a sensitive pain alarm is understanding how it works, and why we have pain in the first place.
Pain is your body's alert system, it's a protect-o-meter if you will, to try and keep you safe. It is supposed to tell you about danger and more specifically about injury. Some of us with chronic pain just have bodies that are a little better at protecting us than everyone elses'. While this is a great thing if you are in a war zone where heightened senses can help keep you alive, it can be very inconvenient in civilian life.
Once we determine that the pain we are feeling is a "hurt pain", not a "harm pain", we can begin to set about reprograming the alarm. If you aren't sure what hurt and harm pains are, see Hurt vs Harm & Car Alarms: Interpreting Chronic Pain to understand why pain signals are more complicated than just the generic term "pain".
In order to reprogram the pain alarm, we are going to take advantage of the fact that pain is processed in our brains. This is a huge advantage for us because the brain has the ability to adapt and change based on what we use it for.
Our brains work on a "use it or lose it" basis. There are plenty of things that you might have learned in high school, that you don't (or won't) remember in your 30s. For example, if you take a foreign language in school, but don't regularly use it after you graduate, you are not likely to remember very much of that language a couple of years later.
For people with persistent pain, you are using your brain to process pain frequently, if not constantly. Not only is that exhausting, and prevents your brain from accomplishing other tasks, but it also reinforces the problem. If we use our brains to process pain all the time, they get really good at processing pain. In fact, research shows that our brains will start to use spaces that are meant to perform other functions to help us process pain instead. (1)
This is why for many people with persistent pain, things like remembering names, directions, or where they parked their car become very difficult. What used to be simple tasks like finding the right word to say or calculating a tip on a receipt can become challenging. Even emotional processing can be impacted because the brain is using that space to process pain. A person with chronic pain may find they get easily frustrated and snap at their family because their brains are overwhelmed by the added stress of processing pain with the usual noise of the TV, the kids asking questions, and trying to cook dinner at the same time.
So how can we start to take those spaces back? By only letting our brains process and focus on pain when they should be. If a pain is harming you, it's important to listen to your body and not continue doing an activity that is damaging. You cannot think your way out of having pain entirely. The pain is not just "all in your head". If you put your hand on a hot stove, leaving it there is not going to make it hurt less. On the contrary, the longer you leave it there, the more it will hurt and the worse the burn will get. The phrase "no pain no gain" is not always true. Some people with chronic pain who believe in just pushing through the pain become "over-doers" and it can actually make their condition worse. (See Harm Pains: Why Respecting Them Matters)
Hurt pains, on the other hand are very real. You feel them, but they aren't actually telling you about tissue damage or injury to the body. As explained in the car alarm analogy, they are a "false alarm" or a software problem rather than a hardware problem.
In this instance, it's important not to focus on the pain. When we focus on pain, and pay attention to it, we are essentially telling our bodies that we agree this is worthy of our attention. That reinforces the neural connections in our brains. The brain therefore believes that it is processing things correctly.
In reality, we want to use these pains as an opportunity to teach our brain that it is not processing the signals correctly. We want to teach our brains new patterns by recognizing, reframing, and redirecting in hopes of rewiring our brains.
To do that, we have to first recognize and acknowledge the signal we are receiving to make sure we don't miss a "harm" pain. We have to interact with that signal and take time to interpret if it is indicative of a pain that is "hurting" or "harming" us. We can't make good decisions about what to do until we can identify hurt vs. harm pains.
Second, once we determine the pain is hurting us and not harming us, we need to reframe the pain for our brains and focus on the facts. This means thinking to ourselves or perhaps even verbalizing out loud that this is a "hurt pain" and we are not in any real danger. We don't need medical attention for an injury. No new tissue damage or injury has occurred. In this phase, we reassure our brains that it's safe to trust us and our interpretation of the events.
Engaging the logical portion of our brains here can be helpful. Pain instantly triggers some degree of emotional reaction. That can be as simple as "I don't like it", which is a normal and healthy emotional response to pain. However, it is also normal that pain can trigger fear and anxiety regarding the severity of the danger, or feelings of helplessness in our ability to resolve the problem. These stronger emotions can make it difficult for us to reframe the pain signal as a "hurt" rather than a "harm" pain. They can shake our confidence that we are processing things correctly. Our brain believes that surely, there must be something seriously wrong, because that is what pain is supposed to mean.
Working through a decision tree and establishing a process for deciding if something is hurting you or harming you can help manage this reaction by engaging other more logical parts of your brain. (Coming Soon, see Hurt vs. Harm: How Do I Know The Difference?). If this process is still challenging for you, work with a physical therapist who can help screen for and rule out any possible orthopedic causes for your pain to give you more peace of mind.
Third, we redirect our brains to something else. This not only helps break the neural connections that we don't want, it helps form new ones. To help redirect us, we engage in what's called distraction techniques. Every parent of small children knows this well. When your toddler asks for candy, just saying "no you can't have that" may result in a meltdown. Instead, giving your child choices of alternatives has a better likelihood of a favorable outcome. Perhaps you offer your child that they can have a piece of fruit or some crackers instead. Maybe other food isn't the best choice and you engage with them by picking up a toy to play with, or suggesting they play hide and seek.
While this looks different for children and adults, the principle is the same. Distraction techniques take many forms. For some suggestions on how to get distracted, see Making Distraction Work For You.
It's important to recognize that this process of reprogramming the pain alarm won't cure your chronic pain overnight. Our bodies have been learning how to process pain since we were small children. Some of us learned good things, and some not so good things. We all experience a variety of people (parents, teachers, coaches, etc.) teaching us how to process pain a variety of ways. The anxious helicopter parent who hovers over every ache and pain, teaches you to do the same. On the opposite end of the spectrum, some people experience being told they are fine when they really are injured. Still others experience abuse at the hands of a person they are supposed to be able to trust, or neglect where there is no attention given to them at all when they are trying to learn to process pain.
While you can use this strategy of recognize, reframe, and redirect to rewire/reprogram your brain at any age, you should be aware that the neural pathways are more well worn into the current patterns the longer you've been experiencing chronic pain. That being said, it can still make a difference over time. It also should make us recognize the importance of recognizing and treating chronic pain in children so that they can grow up to be healthier adults with less pain. (See Helping Kids With Chronic Pain Grow Into Successful Adults)
As always, this article is intended for educational purposes and is not a replacement for individualized medical advice from a licensed healthcare provider. If you are interested in seeking personalized recommendations for managing your chronic pain or other conditions with physical therapy, call or Book Online to schedule your consultation.
References:
(1) Chronic Pain: Structural and Functional Changes in Brain Structures Associated with Negative Affective States by Seoyon Yang, and Min Cheol Chang.
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