On a scale of one to 10, with 10 being the strongest, how would you describe the pain you’re feeling?

All pain is real and all pain is subjective. You may feel excruciating pain and yet be told that tests reveal no structural damage in your body. The inference being that the pain is all in your mind. Which doesn’t make it any less painful, right?

Even when pain is related to an injury or another medical condition, there often isn’t a one-to-one relationship. The pain you feel may be more or less than expected based on your degree of tissue damage or other physiological measures.

Pain relief

Persistent pain is confusing and frustrating. Even when no disease or damage is apparent, the pain you feel is very real and reflects changes to your nervous system.

It’s important to explore the management of any medical condition with your doctor. It’s also important to speak with your doctor to rule out potential causes of the pain that might require medical attention.

Yet pain often persists even after treating any underlying medical conditions or when no such conditions are identified. Pain can be a real fucking pain.

Currently there’s no cure for persistent pain. Pain medications or interventions often have only a modest benefit. Pain relief is highly individual. What works for someone might not work for you. Might even make matters worse.

Opioid analgesics can open another world of pain with drowsiness, constipation, addiction, and potentially fatal overdose. Side effects from anticonvulsant medications used to treat nerve pain include dizziness and weight gain.

Psychological treatment

Other approaches include psychological treatments such as cognitive behavioral therapy (CBT).

Making mental space for the pain, and thoughts and feelings about the pain, to be present can help.

By reducing the struggle to control pain, you can learn to live with persistent pain. Perhaps even thrive.

CBT isn’t a cure for pain nor does it focus on reducing pain. Instead, it focuses on reducing your thoughts and feelings around pain.

It’s about noticing and stepping back from those painful thoughts and feelings. Stepping away from the maelstrom of negative thinking that swirls around the pain, making it more persistent and ever-present. Making it even more excruciating.

How can you avoid drowning in the turmoil of despairing thoughts and rising waters of anxious emotions?

Removing thoughts

Close your eyes. Let your mind wander. Imagine an open sky with white, fluffy clouds. Imagine putting each thought that pops into your mind onto a cloud and watching each cloud float away.

Don’t rush the clouds along. Simply notice each cloud stacked with your thoughts drift by at its own pace.

Your mind will wander and you’ll get distracted. That’s what our minds do. When you notice this happening, gently refocus your attention on your thoughts and place each one on a cloud.

Unpleasant feelings? Nagging emotions. Take them out of your mind and place them onto the passing clouds.

If clouds feel a bit dippy or trippy, imagine balloons in the sky or leaves on a stream or cars on a road.

Get creative. Bring awareness to your painful thoughts, especially negative thoughts, and let them go.

Let them all go.

References

“How to live well with persistent pain” Psyche (2022)

“A primary care-based cognitive behavioral therapy intervention for long-term opioid users with chronic pain: a randomized pragmatic trial” Annals of Internal Medicine (2022)