Kara Araujo 12/3/24 Kara Araujo 12/3/24

How Can Therapy Help Me Heal from Chronic Pain?

Particularly in the case of chronic pain, over time, we learn that lots of things are dangerous, like sitting for too long or doing specific movements. In most cases, this leads to intense preoccupation and focus on the pain (reinforcing it as dangerous) and chronic hypervigilance, or the feeling of being constantly alert to anything that might trigger the pain. We also become tremendously (and understandably) frustrated with our pain–we want it gone, now.

The more pressure and urgency we place on our recovery, the more our experience of pain intensifies. Over time, our central nervous system becomes hyper-sensitive and the neural pathways in our brain actually change to more quickly associate any threat–external or internal–with pain. This becomes a vicious cycle. But there is good news. Just as the brain can learn pain, it can unlearn it.

By Jess Freedman, LMSW

Chronic (of a problem): long-lasting and difficult to eradicate.

In this country, our medical system utilizes the “biomedical model” when treating pain and illness. This means that when there is a problem in the body, we look to the body. (When your foot hurts, you go to a podiatrist or if you’re experiencing migraines, you go to a neurologist, for example). However, up-to-date research in pain science indicates very clearly that pain is what’s called a “bio-psycho-social” phenomenon. This means that three factors dictate our experience of pain:

Biological factors: Think: the body. Genetics, tissue health, neurochemistry, age, etc.
Psychological factors: Our thoughts or opinions about our pain, our feelings about our pain, our overall mood, our stress level, personality types and tendencies, etc.
Social factors: Our jobs, our families, our friends, our support systems, our communities, our access (or lack of access) to certain resources, etc.

Most people come to claim their pain as chronic once traditional Western medicine has given up on them. (I use the word “pain” interchangeably with any chronic symptom that does not respond to medical interventions over a long period). They’ve been told: I don’t know what else we can do for you or this is how you will feel for the rest of your life. Most people feel like a medical anomaly, a complex riddle of symptoms with no answer. The problem is that you've been treated in a one-dimensional manner for a problem that is three-dimensional.

The idea that the mind and body are connected in this way goes against everything we’ve been taught about how pain works. Going against the grain and trusted medical professionals feels foolish, uncertain, and unorthodox–and therefore uncomfortable. But just like in all forms of therapy, we move through discomfort by gaining awareness and understanding.

“Healing is not guaranteed, but it is available.” - Dr. Gabor Maté

The key to understanding what pain actually is and why it can become chronic is understanding the brain. Before we continue, I think it is important to emphasize that what you’re feeling right now is real. Most people who experience chronic pain have had to defend their pain again and again. They’ve been challenged, invalidated, and even dismissed many times along the road to getting help. If you’ve ever been sitting in a doctor’s office, desperate for answers, and told it’s “just stress,” you’d probably want to throw that little swivel chair across the room. (I know I would). This explanation lacks context, nuance, and any practical information about what you can do to feel better. So if pain is not “just stress,” then what is it?

Pain is a danger signal. We are evolutionarily wired to feel it to survive. When we put our hand on a hot stove, the nerve fibers in our hand travel through our central nervous system at a speed beyond our comprehension to communicate with our brain that we are in danger. The brain responds by sending pain, a warning, back down to our hands and we quickly yank our hand away. But what if the brain were to make a mistake?

A widely recounted 1995 case study in the British Medical Journal reported an instance of a construction worker who stepped on a nail while he was on the job. The nail pierced right through his boot and was sticking out the top. He was taken to the emergency room in agony. He was in so much pain that he had to be sedated. But when the doctors carefully removed the boot, they saw that the nail had gone right between his toes, it had missed his skin entirely. Pain that is “real” vs. pain that is “all in your head” is a false distinction. All of the pain that we feel is generated by the brain, whether it’s an accurate reflection of danger or not.

The more pressure and urgency we place on our recovery, the more our experience of pain intensifies. Over time, our central nervous system becomes hyper-sensitive and the neural pathways in our brain change to more quickly associate any threat–external or internal–with pain. This becomes a vicious cycle. But there is good news. Just as the brain can learn pain, it can unlearn it.

Studies that examine the difference between acute (short-term) and chronic (long-term) pain show that acute pain lights up regions of the brain that are more typically associated with pain, while chronic pain lights up parts of the brain that are associated with learning and memory. This type of learned pain is called “neuroplastic” pain. More and more research indicates that almost all cases of chronic pain are neuroplastic, or at least have a big neuroplastic component, even if there is a structural explanation.

You haven’t healed as you’d hoped, not because there’s something wrong with you, but because the treatments you’ve tried haven’t targeted the root cause of your chronic pain. Therapy can help you get to the source, offering a path to understanding and rewiring the neural pathways that keep pain in place.

“Each of us is a dynamic system with a constant potential for change in which self-healing is the norm, rather than the miraculous.” - Candace B. Pert, Ph.D.

A lot of people say that they just want to get back to who they were before the pain started. I invite you to look ahead, to a recovery through pain reprocessing therapy. It won’t be like it was before. In learning to change how you relate to your pain, you inevitably learn to change how you relate to yourself. You will have greater capacity and access to resilience, self-compassion, and an overall sense of ease, both in your life and in your body. Together, we will discover how to place the wellness of your mind-body system back into your own hands. The resources you've been searching for have always been within you.

A note to those currently suffering:

Chances are, if you are seeking therapy to help you cope with chronic pain, chronic illness, chronic mental health challenges, or chronic anything, this is not the first thing you’ve tried. More likely, therapy feels like a last resort.

I know that whatever it is that you are struggling with has also been long-lasting and difficult to eradicate. Difficult not just because it’s painful to feel physical pain, but it’s also psychologically painful to feel the emotional hurt that comes with efforting so hard to explain yourself in an attempt to be understood, only to be misunderstood.

When this happens to us enough times we become rightfully distrustful, frustrated, and skeptical. I also understand how much courage and strength it takes to seek help again after so many false starts. I know you’ve told your story more times than you can count and have endured the hope/disappointment cycle again and again.

Welcome. You are in the right place. You don’t have to keep going through this alone. Therapy offers a different kind of treatment course—one that isn’t just about managing or coping with pain, but about experiencing true healing and meaningful relief. I know how much it takes to arrive at this point. I know because I’ve been where you are. Let’s take the next step together.