Pain Relief and the Issue of Control

We have been discussing the case of Bill, who recently injured his back, and then suffered from excruciating back pain and sciatica. Bill soon learned that his attempts to control the pain by escaping, fighting, or struggling with it just worsened his misery. These attempts create muscle tension, blood vessel changes, and hormonal changes that intensify the pain and prevent healing. After Bill realized this, he learned to identify when he was trying to control the pain, and he noticed how his condition improved when he gave up the attempt. He did some relaxation training, and learned to turn his attention to the sensation of pain, and to the body sensations of his attempts to struggle with the pain. He experienced first-hand how his suffering lessened when he stopped his futile attempts at control.  

The opposite of trying to control is letting go, allowing, or "letting be".  Bill understood that this did not mean that he was giving up on healing himself.  He saw that "letting go" was in fact THE way to exit from the spiral of agony, where pain leads to struggle, which leads to increased pain, and so on, in an ever increasing maelstrom of panic, anger, frustration, despair, and suffering.  Bill also learned that "letting go" requires practice - it is not automatic.  The natural, automatic reaction to pain is the fight or flight defensive reflex.  Learning to let go and simply be there with the pain takes some time practicing with techniques like relaxation training or meditation.

It took Bill about four weeks to learn how to let go of his attempts to control the pain. Meanwhile, he did some easy physical exercise, as much as he could tolerate without stressing his back.  After about six weeks, Bill's condition improved considerably. Eventually he was able to live a normal, pain-free life.  In fact, he was able to enjoy many of the activities he felt he was forced to give up, such as golf, tennis, and roughhousing with his children and pets.

Futile attempts at control increase suffering universally. For example, if you are prone to motion sickness you might have noticed that attempting to control it makes it worse.  Try an experiment - the next time you start feeling queasy, don't resist it. Don't tense up and try to "hang on". Keep your head up and look at something steady in the distance, just above the horizon. Take a deep breath and relax. Relax the muscles in your forehead.  Relax the muscles in your face, jaw, and neck.  Feel the sensations in your body without trying to change them.  See what a difference this makes.

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The Role of Emotions in Pain Relief

What is pain?  If you ask different people, you may get different answers.  For some, pain is a physical sensation, such as occurs with a physical injury.  Other people think of pain as an emotion, such as the pain of losing something important - a loved one, a job, or a favored material possession.

It is significant that we use the same word for the apparently different experiences of physical pain and emotional pain. The experiences of physical and emotional pain are related.  We have seen that the experience of physical pain involves the emotional pain of fear, anger, or despair - we are in physical pain and we can't make it go away. In addition, the experience of emotional pain involves sensations. For fear and anger, there are the sensations associated with excitement, such as a pounding heart.  For despair, there may be the sensations of dullness and heaviness.

With both physical and emotional pain, we are in a situation that is not what we want, and we are unable to change it. We are not in control. We have a headache, or a loved one dies. We want our pain to go away, we want our loved one back.  We want things to be different. Lack of control is a key similarity between physical and emotional pain. We experience emotional pain when things are not the way we want them to be, and our attempts to control the situation are unsuccessful. Some emotions are always a sign of an unsuccessful attempt to control.  Anger occurs when we cannot control the present, but we continue trying. Fear and anxiety occur when we cannot control the future.  Guilt occurs when we cannot control the past. Anger, fear, anxiety, and guilt are very significant emotions, because if we pay attention to them, they tell us when we are trying to exert control.

Why is this important?  We have seen that the attempt to control pain creates a defensive reflex in the body. This defensive reflex includes muscle tension, hormonal changes, and blood vessel changes that increase pain and prevent healing. The most important thing is that the defensive reflex occurs when we attempt to control ANYTHING.  Regardless of what causes it, the defensive reflex will increase our suffering and prevent our body from healing. For example, many people report that their own pain symptoms, whether they are headaches, backaches, TMJ, or whatever, are made much worse by stress. Why is this?  Let us first ask what is stress.   We say we are stressed when we are attempting to control a situation, but we are unable to. For example, we are late for an important appointment, and congested traffic is making things worse. A deadline is approaching, and there are too many things to do.  We are working furiously to prepare for the holidays, and a family member becomes ill and requires attention. 

It is vitally important to understand the nature of stress and the issue of control.  Stress can cause physical pain all by itself, it can make existing pain much worse, and it can prevent our body from healing. Many people are chronically stressed and are not aware of it.  Their bodies are suffering the ravages of the defensive reflex, and they do not know it, so there is nothing they can do about it. Some of the physical symptoms of chronic stress are headache, backache, muscle aches, chest pains, upset stomach, constipation or diarrhea, chronic tiredness, and insomnia. If you have any of these, you might want to check on your stress level. When you are done with this lesson, click on the following link if you would like to take a stress test:

 http://www.kaiserpermanente.org/locations/california/mod34/mod34- index.html  

How do we deal with stress and the issue of control? The first thing is that we must be aware when we are stressed, and we must understand that stress is physically harmful. Sometimes the goal we are seeking may be worth the stress, but often it is not. You are the judge of that. We need to be aware so we can choose wisely when to be stressed, and when to give up or modify the goal, rather than pay the price in physical and emotional pain and suffering.

A good technique for identifying stress is to look at your emotions, particularly anger, anxiety, fear, and guilt.  Whenever these emotions arise, be aware that you are trying to exert control, and that this can cause pain. When you are experiencing physical pain, muscle tension, digestive disturbances, or any physical discomfort, ask yourself if you are feeling anger, anxiety, fear, or guilt. Really look into it with an open mind. Search for these emotions. Looking with an open mind helps to counteract control. Think of your emotions as a useful signal. This is difficult for many people because they consider negative emotions as bad, and they don't want to think of themselves as angry or anxious.  The truly bad thing is how people usually react to these emotions - the emotions themselves are natural signals that come and go, and you can learn to use them to deal with situations more effectively. 

In the next lesson, we will discuss how to deal effectively with painful or negative emotions, how to use them for relief of physical pain, and how to free yourself from them.

Copyright 2004 by Dr. Ken Pfeiffer