The pain game: The connection between chronic pain and psychological illness

By Nancy Gahles

I’ve watched athletes begin their game with the sign of the cross to bless themselves and ask for God’s protection on their game. I do that, too. I boot up the computer of my mind, body, and spirit with sound bytes, whispered prayers from all the wisdom traditions, invoking protection, abundance, and freedom. Freedom from the pain.

Then comes the cascade of thought forms—mental formations, the Buddhists call them, all the negative thoughts associated with the pain. “I can’t move”, “I won’t be able to go to work”, “How will I manage the shopping?” Let the mind games begin.

Ratcheting the feelings up a notch, the breathing changes. Stuck in the chest, panic, anxiety, shortness of breath. Catastrophizing, the psychologists call it.  “I will never be able to show my face again, everyone will know I am crippled”, “I will never get better”, “My life is over”. The sympathetic nervous system is in high gear, the feeling tone of the body is fueling the thoughts and you are stuck in a state of fright, flight, freeze, or faint.  Time out. Take a step back.  Breathe deeply and observe.  What just happened here?

Back pain can conjure feelings of being unsupported in life, literally being unable to support oneself both physically and financially, leading to thoughts of sadness, melancholy, despair of recovery, depression, and even psychosis. The journal General Hospital Psychiatry, published the largest study to date investigating the connections between back pain and psychological illness. The study compared people without back pain to those who did experience back pain and found those with back pain were more than twice as likely to experience anxiety, depression, psychosis, and sleep deprivation.

In my chiropractic practice of 37 years, I can attest to the fact that neuromusculoskeletal pain triggers shock, panic, and alarm at first incident.  If the pain becomes chronic or  intermittent, the mental status degrades to fear, anxiety, panic attacks, insomnia, brain fog, confusion, attention-deficit/hyperactivity disorder, and a host of concomitant physical disorders, such as irritable bowel syndrome.

The truth is that pain is debilitating. Pain limits mobility and function. Independence and self-sufficiency are inextricably tied to the ability to move freely and to take care of your own needs as well as those of your family or others. Self-worth deteriorates when you are unable to be vital, functional, or engage in a meaningful existence.

Chronic back pain limits brain power as well, according to researchers at Northwestern University. They found that chronic back pain, defined as lasting six months or longer, can cause significant and long-lasting damage to the brain, aging it up to 20 times faster than normal. This study is consistent with other research on chronic pain and cognitive ability. Scientists at the University of Alberta have confirmed that chronic pain can impair your memory and concentration. One prevalent theory on why there is such a large decrease in gray matter is that chronic pain forces nerve cells to work overtime. The sense of fatigue, presenting as chronic fatigue in a spectrum of symptoms, is real.

The good news is that we have strategies to change the brain. We can reboot, rewire, and revive our whole selves. Harvard neuroscientist researchers demonstrated through an MRI study that meditation rebuilds gray matter in eight weeks.  Barbara Fredrickson, Ph.D., demonstrated the  effects on diminishing post-traumatic stress disorder emanating from a Loving Kindness meditation practice using the Metta Sutta from Buddhist practice.

The effects of compassion and loving kindness meditation in this study reassure us that we have the ability to change the game. We can take the ball and run with it. We can create a mindfulness practice, we can practice daily, we can become facile with regulating our central nervous system through breath work. We can engage the vagus nerve, initiate and maintain grace under pressure with the relaxation response it evokes. In neurologic terms, we call this evoked potential. I call it a “Positive Potential Practice” which has become a mainstay in my treatment protocol The Triumvirate Technique.

Once we have gained a measure of control over our breath, our mind begins to settle. It is in this moment that we can calmly and objectively observe the feeling tones in our bodies and watch the mental formations attached to them. As we breathe and observe, the body scan practice becomes possible. We can now accomplish this without catastrophizing. Calmly, with regulated breathing, it is possible to go through the body and attenuate the pain, remove the obstacles, the resistance in tissue, thought, and emotions. The Buddhist concept of impermanence presents itself here. As you breathe the character, quality and location of the pain changes. Nothing stays exactly the same from breath to breath, not even the stars in the firmament. Once you realize this, you are back in control.

Now you plan for the end game. How to maintain this state of consciousness?  I learned from playing chess that you must know the last move before you begin. The last move in the pain game is to be in it to win it. Be actively engaged in your life, moment by moment, breath by breath. Be aware that you are directing yourself to play the game.

My top three strategies are:

1. Tend to the body. Broken, crippled, tired, and aching though it may be, it still needs to be fed and nurtured. Body therapies such as chiropractic, massage, acupuncture, whole body vibration, infrared, ultrasound, muscle stimulation, yoga, Tai Chi, QiGong, walking, and resistance training are some strategies that I  find effective to awaken the innate vitality of the body and change the feeling tone conversation.

1. Take care of the mind. Care of the mind strategies include my primary favorite, mindfulness meditation. I have found this practice to be of ultimate value in pain management and, in some cases, elimination of pain. The abundance of research that has recently been done shows the benefits of this practice. Essential to the self-regulation that must be engaged to harmonize mind/body approaches is the selection of an individualized homeopathic remedy. The exact thoughts, the emotions you feel, and the location of pain in the body will provide the proverbial three legged stool upon which to prescribe. For the Triumvirate Technique to be fully effective, mind, body, and emotions must all be considered.

1. Embrace positivity. Emotions are the substrata that lead us to fail. Negative emotions put us into freeze mode and disable us from getting off the bench and into the game. If you don’t want to be a bench warmer, practicing engendering and maintaining positive emotions is a must do.

Dr. Lorraine Gahles-Kildow, Ph.D., noted cognitive behavioral expert in Positive Emotion Psychology, coined the term POP! Pockets of Positivity. Gahles-Kildow tells us that three things are true:

• Peace is a pocket of space

• Present in each moment

• Living inside each breath

Winning the pain game implies that you have attained peace in each moment. These are winning strategies from centuries old traditions:

• Peace of mind can be attained by being mindful. Being mindful is simply defined as a process of bringing your attention, in an intentional way, to the present moment with an attitude of openness and acceptance. Mindfulness is an opportunity to slow down, embrace the moment, and to develop self-compassion.

  The most profound satisfactions, the deepest feelings of joy and completeness lie as close at hand as our next aware breath and the smile we can form right now.

• Peace in the body can be induced by Breath Awareness. Inviting the breath to drop into your body, you experience the exquisite awareness of the subtle flow and vibrations and movements that follow the breath in and out of your body.Breathing in, I know that I am breathing in.

  Breathing out, I know that I am breathing out.

  Sharon Salzberg famously says: If you can breath, you can meditate. It’s that simple.Jon-Kabat Zinn says if you are breathing, there is more right with you than wrong with you. Breath awareness calms the body. The out breath stimulates the vagus nerve.  Slow exhalation puts the brakes on the overactive sympathetic nervous system.  The breath slows, the mind calms, the body relaxes. Grace under pressure. The Nobility of the Vagus Nerve.Thich Nhat Hahn relaxes the body mind with a smile. He says, “You know a smile can relax hundreds of muscles in your face. Wearing a smile on your face is a sign that you are a Master of yourself.

  Breathing in, I calm my body.

  Breathing out, I smile.

  Dwelling in the present moment,

  I know this is a wonderful moment.

  Simply breathing and smiling induces positivity in the pocket of the moment.

  Simply breathing and smiling can make us very happy because when we breathe consciously and mindfully, we recover ourselves completely and allow ourselves to encounter life in the Present Moment.

  I breath in, I’m alive.

  I breathe out, I smile.

Beginning to implement these strategies on your own and with a team of professionals in the specialties you require is the first step to building an integrative pain management team . Not all of the professionals you select for your team will be covered by insurance. Neither were all those years of tennis, soccer and golf lessons, and the endless tutors for each subject that required a bit more coaching.

Medical interventions, pharmacologic and surgical, do not generally fit into this game plan. The opioid crisis is one example of how allopathic medicine fails in the pain game. There is awareness, however. The Joint Commission on Pain Management issued this statement to demonstrate their understanding of the nature of the issue:

“In fact, throughout our history we have advocated for an individualized patient-centric approach that does not require zero pain. The introduction to the “Care of Patients Functional Chapter” in 2001 started by saying that the goal of care is “to provide individualized care in settings responsive to specific patient needs.”

My suggestion is to follow the strategies that work for you. There may be some practices that are covered but don’t wait for insurance reimbursement in order to begin living your best life. Engage those professionals for your team that are specific to your needs. Winning the pain game is a moment by moment endeavor. Peace in every moment begets joy.  Happiness is your birthright.