Pain is an Attitude

Manage or be managed by pain.

Being told that pain is tantamount to an attitude can appear patronizing. Extreme or chronic pain quashes quality of life and makes even the most mundane daily chores into excruciating events that heighten the misery. However, there is a huge body of evidence that proves that how we approach pain contributes to how much pain rules our lives — or not. The key is to have an open mind and to understand that the relationship between the brain, our emotions and our physical wellbeing is not only critically important, but inescapable.

When our brain wants to create a distraction from strong emotions or feelings (be they negative or positive) it has a tendency to mildly deoxygenate itself, as noted by Kopf et al. (2013). This occurs rather easily due to neural connections between the emotional and autonomic centers in our brain. These emotions cannot surface or erupt at all times, so they remain mostly repressed. You can call it your brain’s coping mechanism. Personality traits such being a perfectionist, competitiveness, one’s level of gregariousness and other traits can also be internal sources of pressure for the brain, as reported by Scientific American and others.

Dr. John Sarno, a retired professor of physical medicine and rehabilitation at New York University (NYU) School of Medicine and the author of The Divided Mind, believed that real physical pain that is severe and disabling can arise from mild deoxygenating of the muscles, nerves and/or tendons in a person’s joints. Whilst the process can be considered medically benign (i.e. not life-threatening) it can nevertheless still result in significant pain and even disability. Dr. Sarno referred to this process as Tension Myoneural Syndrome (TMS). He was of the belief that this mildly decreased oxygen occurs through the autonomic nervous system, which is a part of the central nervous system that works automatically without our conscious will. It’s the system that regulates the internal organs of our body. Enter the brain and all those emotions bottled up inside you.

Dr Rashbaum continued Dr Sarno’s pioneering work on the brain-pain relationship. He believes, like his mentor and colleague Dr Sarno does, that one does well to assess what external and internal pressure sources are causing the brain to deoxygenate and therefore create TMS. Fortunately, Dr. Rashbaum has found that most patients are able to sort through their psychological or emotional issues on their own as a counterpoint to TMS. If that cannot occur then the person may need to consider a psychologist, a social worker, or a licensed behavioral health provider who understands how TMS can arise and who can then assist in the person’s recovery. Interestingly, it is believed that If TMS is the source of pain then all structural-based treatments such as physical therapy or chiropractic care must be discontinued until the TMS has been treated. If not, the brain may get mixed messages that the pain is coming from both structural changes in the body and from TMS and this may deem any treatment to failure.

This unique approach to TMS is but one example of the huge and exciting strides being done in the study of the brain, a person’s mind-set and the ability to deal with pain. A 2015 study by the University of Colorado at Boulder (UCB) found that the ability to use one’s thoughts to modulate perceptions of pain in fact uses a completely separate brain pathway than the pathway used to send the physical pain signal to the brain. To describe that discovery as a breakthrough is an understatement! That explains beautifully how endurance athletes are able to manage extreme physical pain during competition and training due to a technique those athletes and psychologists call ‘cognitive self-regulation’. This cognitive self-regulation can also be used by those dealing with chronic pain as a coping mechanism to manage pain. The UCB study provides invaluable clues on how all people can better manage and cope with pain.

So, yes, ultimately, the way one copes and manages one’s pain boils down to attitude. Although TMS may be a factor or the need to undertake cognitive self-regulation may be required, the bottom line is that our mind-set (i.e. attitude) to the challenge that is pain is highly instructive. In fact, it could very well be the difference between pain that is manageable and can even be conquered by a person as opposed to pain that is instead unmanageable and conquers that person.