I know what you may be thinking: why would I go to a mental health practitioner to work on my chronic pain? I felt the same way. I went to two doctors, three physical therapists, a handful of massage therapists, a chiropractor, a few acupuncturists, a traditional Chinese medicine practitioner, and anyone who would listen to me describe the symptoms that I did not understand. My therapist was not on the list of people to talk to because this was a physical issue and one to which I assumed she would have no answer. When I went to therapy, my counselor asked me to look within and find what was true, which did not seem like it could apply to the pain I was experiencing in my body. For that, I wanted a straightforward approach to stop the distress.
The mindset that considered this issue is of particular interest to me now, several years later. An experience about this process that really stuck out to me was how outwardly facing this search was. On the path to understand and eliminate my pain, I wanted an external expert to give me a diagnosis, tell me the story of why I was having the pain, and then hand me the solution that would make it stop. I wanted someone else to fix it for me yet at every turn, I was met with a different conceptualization of what was going on. So many different theories were presented to me along with countless recommendations and through it all, I still had the persistent pain.
Maybe this resonates with you. Many individuals can tell a similar story of an exhaustive, expensive, and potentially hopeless search for an answer. A jarring revelation from this process may be the understanding that the “experts” do not always have the answers. As a therapist in training, I prefer this reframe instead: we are the experts of our own bodies and experiences. This in turn means that we can champion the process of navigating our pain by building more understanding around experiences we are having.
To be clear, I would thoroughly recommend seeing medical professionals to anyone dealing with chronic pain, as a physical assessment is an important aspect of this process. Some types of chronic pain may indeed have straightforward answers, and your doctor or physical therapist might be able to point you toward rapid improvement. But instead of placing the focus entirely on physical health practitioners, I strongly recommend you talk with your therapist as well about what you’re experiencing. To understand why, it’s important to dig into how we experience the many dimensions of pain.
Of course, we have all had encounters with physical pain, whether it’s a scraped knee as a child playing outdoors or accidentally banging our elbow on a piece of furniture. Pain is an incredibly essential part of our system, sending messages about our surroundings and our physical safety. But pain is never just one thing; it never lives solely in the body at the point of injury. It is not only a communication between your brain and the bodily system that is experiencing distress. Instead, like many things in life, we have a multilayered relationship with pain that goes beyond the biological process.
Modeled for us from a young age, we intuit messages about how we should respond to pain; whether it is alright for us to cry and be comforted; if there’s a certain time limit to how long we are allowed to express the hurt; if we are supposed to shut down the response and prove to others we are strong, etc. These experiences have delineated certain responses to any pain our bodies encounter and cast us in roles, dictating what we are and are not allowed to do. Sometimes, these messages are so deeply engrained that our reactions to bodily hurt become rote and are enacted outside of our awareness.
Further, physical pain carries with it a dimension of emotional experiences that can sometimes be difficult to intellectually separate. Perhaps accidentally pinching our fingers when closing the lid of a jar brings up a feeling of frustration about carelessness in the moment. Maybe ongoing pain in our knee comes with fear about what mobility may look like for us in a year, five years, or ten. Even when we describe pain to ourselves or others, our language can include descriptors that bleed into the emotional realm such as overwhelming, frustrating, confusing, frightening, etc.
While pain that comes and goes can be distressing, chronic pain, which is pain that persists for more than three months, can carry large amounts of emotional and psychological burdens. The pain on its own might be heavy enough to carry, but these other elements added in contribute significantly to this complex relationship. It’s not just that your shoulder has been hurting for months and has limited your range of motion. It’s also the weight of irritation that you don’t seem to know what caused the pain to start or how to make it stop. It’s also the concern for the future and if the pain is going to make itself an unwelcome companion to your life, limiting your ability to do the things you’d like to be able to do. It’s also the fact that at some point in your childhood, you may have internalized the message that talking about your pain was shameful, made you appear weak, or was selfish.
Perhaps there is a round of rigorous physical therapy exercises that can help reduce or completely resolve the chronic pain you have experienced. Maybe massage and acupuncture can alleviate the inflammation or your doctor has an excellent treatment plan that will return you to a painless experience. There are certainly many approaches to take in order to care for the physical presence of ongoing pain. But while you work through those options, the emotional and psychological burdens are summoned to the surface and can feel overwhelming as you tend to the physical distress. And perhaps while you navigate these different options and attend these varied appointments, you could use some support for the toll that this process can take on your mental health. That’s where therapy comes in.
Chronic pain often isolates the individual it effects. It can happen to anyone at any stage in their life, even if they are doing all the “right” things and have never had pain like this in the past. Confounding the process, although the umbrella of chronic pain can relate to a wide array of different presentations (headaches, back pain, muscular inflammation, arthritis, etc), they are often linked by the uncertainty of why the pain began and what causes it to persist. As a result, it feels important to name here that many individuals navigating chronic pain may experience an array of emotions including:
-Hopelessness
-Fear
-Anger
-Overwhelm
-Anxiety
-Depression
If any of those feelings resonate with you for your experience, I want to affirm that you are seen in the complexity of this experience. Whether you know it or not, you have a community in the shape of a large network of other people also experiencing chronic pain.
You may have heard the sayings “move it or lose it” or “motion is lotion” in regards to physical health and aging. A physical therapist or doctor might tell you to be gentle but urge you to keep utilizing that part of your body as an aspect of your recovery. The same is true for working with the emotional and psychological aspects of pain. When we shut down and stop sharing about our experiences, our isolation with our pain can make the experience more pronounced. Pain can cause our world to grow smaller and grab at our focus until it occupies an intimidatingly large part of our day. Instead, sharing with a therapist and joining a pain support group are linked to significant improvements in quality of life and sometimes, noticeable pain reduction. This is a common experience shared by many who navigate chronic pain. After an evening with friends or a particularly supportive conversation, many folks later realize that they forgot about their pain while experiencing that connection with others. This experience holds significance in pain research, as nothing physical intervened to reduce the pain and yet, it was absent for a period of time.
I would love to tell you that there was a therapeutic process that is guaranteed to eliminate your chronic pain. I wish that in the same way that I wished my physical therapist would resolve my pain by the third appointment and I could go on with my life and forget about the process. Instead, I’ll tell you that exploring this in therapy could completely change your relationship with pain by helping you tune in deeper to yourself. Exploring what feelings dominate your experience of pain and cultivating a sense of hope and community in the process can cultivate resiliency in the face of discomfort. And whether your experience with chronic pain lasts several months, years, or a lifetime, resiliency and hope are coping companions that can soften the process and center your recovery.