Chronic Pain

– by Lee Smith, Ph.D.

In many cases chronic pain is another example of how brains and bodies change through the repeated interplay of several systems. If you do something over and over, you’ll get better at it. Chronic pain can be the neuroplastic outcome of a brain and body that has learned to be in pain and to suffer.

The question might arise of whether chronic pain has a legitimate physical basis or whether it’s a psychological issue, and the answer is, yes. Many ingredients are needed to bake a cake, and a lot is baked in to chronic pain as well. The experience of acute physical pain is a result of injury to or illness in some tissue(s) of the body. Pain sensations also activate stress responses, emotions and thoughts.

Acute pain is a good thing because it tells us when something is doing us harm. It’s a protective signal that says, “Look out! Something is harming me”!! Because harm is also a threat, pain signals bring in our old friend, the stress system. Pain and stress are the dynamic duo of survival. Stress activates the immune and inflammatory systems, and it gets us energized, tense, edgy and on the look out.

A lasting, painful injury can recruit a cast of players. They rehearse their lines together, polishing their act, playing off of one another. And wouldn’t you know it; chronic stress can sensitize our nervous systems to pain signals.

In some cases chronic pain can become a case of ‘brain’s gone wild’. The mind-brain can become unintentionally ‘talented’ at being in pain as the cast of players become interlinked, ‘texting’ each other like teenagers.

When we have a pain-evoking and ongoing injury, we are exposed to ongoing and repeated pain messages about the injury. Our nervous systems can become increasingly on guard, watching for pain, and increased sensitization to pain can develop. Neurochemical changes can lead to nonharmful stimulation producing intense pain. An overprotectiveness develops from these private lessons, and the body-brain learns to react with the same stress and threat, emotion and thought, from a mere nudge or light touch.

As this learning settles in, any one of the players can set the others to howling. A new financial or social surprise can produce stress and pain. The persisting pain and stress can cultivate mood changes. Chronic pain may take centre stage, but there is a strong cast of players also at work.

Stress plays a critical role in the development and maintenance of chronic pain. People who are chronically stressed from childhood maltreatment, trauma, loss or difficult circumstances are understandably more vulnerable to developing chronic pain conditions.

Research shows that when we are more accepting of the presence and existence of pain, we’re much less catastrophic and feel more control of our life.

It’s not a matter of just saying to yourself, “Just stop feeling the pain”. That’s about as helpful as telling a novice to just play piano. And being hard on yourself just adds to the stress.

Chronic pain following an injury is very real. Damage to tissue is real and may not be subject to complete resolution. Learning to live with chronic pain equates to finding ways to accept it’s presence in your life and working with your pain to reduce it’s interference. Living with chronic pain involves learning about your stress reactions and facing all of the facets of the experience of pain. Through this exploration, through unwinding the chronic pain learning with new adaptive learning about what’s going on, through learning how to regulate your stress, the mind-body can be retrained. Yoga, mindfulness training, relaxation skills, and cognitive therapy are all helpful routes to better living through neuroplasticity.


– by Lee Smith, Ph.D.

We read and hear in the media about all sorts of things that we’re doing ‘wrong’, that we should do more of, less of, and on and on. Do we crave some sort of disembodied scolding, the wagging finger expression of some quasi-parental concern for us? Maybe. Or might we be drawn to ideas that may help us to sort things out and to become a little more content and safe in our lives? To this loud chorus I’m going to add my little voice today.

I want to survey for you a body of recent research that has really delighted me. This research would seem to be revealing that marked improvements in our well-being can result from something that we can do even just once a week for only a few moments – just a few moments! Continuing to do this for a couple of months seems to bring about some striking and lasting changes. That the research shows that people have less depression and more contentedness from completing this brief mental activity, which requires less than five minutes a week, is amazing to me.

What could we possibly do with our brain in such a short period of time that would act like a kind of inoculation or correction against all of the other troubling stuff that goes on in our mind? Further, what little act of attention would produce a strong tendency to be less confrontational, more cooperative, kinder and gentler?

And there are no costs, no nasty side-effects or contraindications, does not cause drowsiness or constipation, you can operate heavy equipment and you won’t be kicked off a plane for doing it.

Our colleague, Dr. Seuss, prescribed just this balm for the spirit long ago: “It’s a troublesome world. All the people who’re in it are troubled with troubles almost every minute. You ought to be thankful, a whole heaping lot, for the places and people you’re lucky you’re not.”

Gratitude is a sense of thankfulness and joy for someone or for something you experience, whether a gift, a kindness or a moment of awareness of some natural beauty. Gratitude might be a passing state, but it’s also something of a trainable trait, a “life orientation toward noticing and appreciating the positive in life.”

Researchers asked people to write one sentence for each of five things for which they feel grateful and to do this once a week for two months. After these two months of keeping a gratitude journal, as compared to control groups, people felt more optimistic, had fewer physical complaints and were exercising more. The changes weren’t just subjective because spouses also noticed positive shifts. In other research, people suffering neuromuscular diseases felt happier, slept better and felt more refreshed.

Across ages gratitude increases well-being regardless of personality type. Youth who are more grateful have a higher grade point average, greater life satisfaction and more social involvement. They also have less depression and less envy than their less grateful and more materialistic counterparts; materialism is associated with more envy and a lower GPA.

The positive emotion evoked by being grateful on purpose increases our resilience, it firmly disposes us to be in relation to others with more warmth and it becomes reciprocal very quickly. Expressing your gratitude to your partner encourages mutual positive ‘maintenance work’ on your relationship.

Gratitude inspires a sense of life being well-lived. Among the elderly, gratitude is associated with a decrease in death anxiety.

Touch in to gratitude regularly. If you’re feeling irritated, if you’re feeling like your head might explode over some tension or misdeed, a moment of grateful reflection may be the most radiant gift that you can either give or receive.