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Chronic Pain

When the Doctor Won’t Listen: Cognitive Tips for Chronic Pain Management

Written by Regina Tosca, LICSW

Home » Empower Your Journey With The Viva Blog » When the Doctor Won’t Listen: Cognitive Tips for Chronic Pain Management

The Impact of Chronic Pain

Chronic pain, AKA pain that lasts over several months, affects more than 100 million Americans each year. It’s the number one cause of long-term disability in the United States, impacting more people than diabetes, heart disease, and cancer combined (Baller and Ross, 2017).

Despite its prevalence, those who suffer from chronic pain often face judgment and inadequate treatment. Even when they do receive treatment, like nerve blocks and surgery, it’s not always enough.

That’s why more people are turning to a tool that’s been long underused. It’s available to all of us, costs nothing, and has no side effects: the human mind. 

Sound too cheesy to be true? Keep reading.

Pain: A Gift and a Curse

Despite being inherently unpleasant, pain exists for a reason. “Pain processing is one of the most vital functions of our body and is biologically required for survival,” explains Baller and Ross (2017). 

The sensation of pain enables us to recognize and respond to an injury. For example, if we accidentally grab a burning pan or step on a rusty nail, our pain responses tell us we need to act quickly to prevent further damage. As a result, the inability to feel pain, a rare condition that affects a few hundred people in the world, can actually lead to shorter life expectancy. 

At the same time, persistent pain can impact our mental health. Those with chronic pain are at higher risk of depression, insomnia, and substance abuse. It can limit our work options and earning potential, and place a strain on relationships (all of which may impact our emotional wellbeing).

Stigma and Discrimination in Treatment

The opioid crisis has further complicated pain management, fueling suspicion and judgment in healthcare settings. Many people who rely on medication to get through their daily lives report feeling “disrespected and suspected of drug-seeking” when they ask for medication refills, and “of having pain complaints treated as trivial…difficulty securing medications for pain, and…limited pain treatment options.” 

Race and gender bias in health care place additional burdens on women and people of color. A 2016 study found startling misconceptions about pain and race among white, first-year medical students, 40% of whom believed Black individuals are more immune to pain because they have “thicker skin.” Studies have also found that women are much more likely to be prescribed sedatives than painkillers, and experience longer wait times when receiving pain medication for abdominal pain in the ER.

When faced with discrimination and judgment in the doctor’s office, many people turn to holistic practices for relief. Luckily, since pain affects both our mind and our body, our minds hold the potential to soothe some of our symptoms.

Training Our Brains to Experience Pain

Through a process known as neuroplasticity, we’re able to teach our brains new ways of operating, including how to perceive and experience pain. This can be done through meditation, breath work, and pain management strategies that rewire our neurological reactions.

Pain resulting from injury is spontaneous. Chronic pain, on the other hand, is partially learned. We have an experience of pain, which leaves us with a memory of it. The memory of pain leads to worry about feeling it again. This worry in turn exacerbates our pain. The more we feel pain, the more we worry. Thus begins an endless loop of discomfort.

Research suggests that we can “unlearn” our experience of pain through self-management approaches. What’s more, self-management strategies can help counter the feelings of helplessness and loss of control we often experience with chronic pain. 

There are many self-management strategies for pain. Below are a few that I’ve found effective for my clients. 

Mindfulness Meditation

Mindfulness meditation encourages us to pay attention to our thoughts, sensations, and emotions without making judgments. The idea is that the way we judge our pain exacerbates our distress, so working to decrease our judgment can relieve certain symptoms.

Many of us have a natural aversion to pain: we don’t want to focus on it. However, mindfulness meditation encourages us to notice the pain, how we react to it, and the thoughts we associate with it so that we can begin to shift our reactions.

For example, I might notice that my pain makes me think “I can’t take it anymore.” This thought may increase my anxiety. But what if I separate this thought from my reaction by telling myself it’s just a thought and I don’t have to be anxious about it? I can just notice it’s there and let it come and go. Over time, that thought will lose its charge, and it may even be replaced with a more neutral thought.

Tapping/Emotional Freedom Technique

The Emotional Freedom Technique, commonly referred to as tapping, uses acupressure points on the body to calm the nervous system and reduce the emotional distress associated with pain. 

In tapping, light pressure is applied to pressure points in a sequence. At the same time, a statement of safety, e.g. “I’m okay…” is paired with a statement of fear or worry, e.g. “…even though I’m scared I’ll always be in pain.” 

Tapping helps us experience relief from pain while confronting our biggest fears. Over time, it decreases the ability of these thoughts to influence our experiences.

Creative Visualization

Creative visualization uses the imagination to reshape how we envision pain. In creative visualization, we turn our attention to the pain and begin to identify the characteristics we associate with it. Do we see it as a certain color? Does it hold a certain shape? Is it cold or hot? 

We then imagine changing those characteristics to ones that we perceive as more soothing. For example, if I see the pain as as throbbing, jagged, red, and hot, I focus my mind on slowly changing the image of the pain to a cooling color, such as green. I might also imagine the jagged edges becoming soft or disintegrating into dust. 

As a medical social worker, I used creative visualization with a hospitalized patient who was experiencing radiating pain in her abdomen and lower back. We went through the exercise together, and after ten minutes I noticed her blood pressure had fallen 20 points on her bedside monitor. This observation was comforting to the patient, lowering her distress despite the presence of pain. 

Pain Does Not Equal Powerlessness

Our bodies and brains are unique and individual, and what works for one person may not work in the same way for another. It may take some time and testing to find a specific strategy that works best for you. 

Chronic pain can quickly and easily feel like the loudest and most persistent voice in the room.  By harnessing the power of the mind, we can help quiet it down so that other voices – ease, hope, calm, even joy – have space to express themselves too.

Regina Tosca, therapist

About Regina Tosca, LICSW

Former therapist at the Viva Center in Washington, DC. She works with people experiencing grief and loss, including from their work in animal welfare.


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