Think You'll Never Get Out Of Pain? Unless You Reconsider, You're Probably Right

Think You'll Never Get Out Of Pain? Unless You Reconsider, You're Probably Right

Sometimes pain is controlled by your state of mind

"Whether you believe you can do a thing or not, you're right." - Henry Ford

That's quite a profound quote when you pick it apart. It's short and sweet but it carries tons in weight when you really analyze the crux of the point. If it's a contest, a race, a project, or a goal of some sort, if you think you can't do it, there's a solid chance that you are absolutely correct. 

Such is life. In business, sports, or any other endeavor you can imagine. Your frame of mind sets the stage for your sucess or your failure and more time than not, it's 100% up to you. 

Before we dive in here, let's be clear; no pain is not typically ALL IN YOUR HEAD. That is not what I'm saying at all. 

More has been learned about pain in the past 10-20 years than in the 1,000 years prior. Research is showing more and more recently that your state of mind also has effect and some control on your pain. Not only on how bad a patient hurts but whether they will be able to get out of pain or will be doomed to a lifetime of misery. That is why over the last several years, at our Creek Stone Integrated Medical clinic here in Amarillo, TX, our patients are hearing more and more about chronic pain, education about chronic pain, and education about 'changing their minds' so they can change their pain experience. 

Pain can no longer be defined by the old BIOMEDICAL definition. Meaning, providers can no longer simply look at an x-ray or MRI, find some sort of issue, then treat that issue specifically, and expect pain to vanish never to be seen again. We have learned in more recent years that pain is much more complicated than that and that old, archaic description is lacking and no longer adequate. 

You can get a pain trigger but before you actually feel the pain, it is run through a 'filter' of sorts in your brain. A filter than can decide whether that feeling of pain will be normal and appropriate, or whether it will be amplified or even dampened. Much of this can depend on your brain believe it or not. 

Instead of describing pain as a BIOMEDICAL issue, it is now understood to be broader than that and is defined as a BIOPSYCHOSOCIAL complication. Let me explain that briefly:

1. Bio-medical - Tissue issue to be treated
2. Psycho - Yellow flags (description below)
3. Social - Beliefs, ability to afford care, how labor-intensive one's job is, support of one's family, etc. 

In the old days, when a patient only received biomedical attention or care, they only received 1/3 of the treatment they could have or should have gotten toward resolving their pain. Now, it is clear that ALL three much be addressed. Not only must all 3 be addressed, but we have less than 3 months to resolve it before pain begins slipping into chronic, long-lasting, and hard-to-get-rid-of pain. In fact, somewhere around the 4-12 week mark, it become CRITICAL to get all hands on deck to boot pain out of the house as soon as possible. 

Getting back to patients' state of mind and Yellow Flags, what exactly is a Yellow Flag in the healthcare world? Yellow Flags, when present in a patient, are warning flags for a poor outcome, potential chronic pain, potential disability, and an uphill climb for the patient and the provider if neither understands them or are doing their part to mitigate them.

Yellow Flags

Here are some Yellow Flags. There is good agreement that the following factors are important and consistently predict poor outcomes(1):

• A belief that back pain is harmful or potentially severely disabling
• Fear-avoidance behavior (avoiding a movement or activity because you're afraid it will hurt) and reduced activity levels
• Tendency to low mood and withdrawal from social interaction
• An expectation that passive treatments like only going to the chiropractor or massage therapist, rather than active participation (like exercise) will help them get out of pain

Harmful and unhelpful attitudes and beliefs about back pain

• Belief that pain is harmful or disabling resulting in fear-avoidance behavior, for example, the development of guarding and fear of movement
• Belief that all pain must be abolished before attempting to return to work or normal activity. If long-term pain sufferers wait until they're out of pain to get moving, they're in trouble
• Expectation of increased pain with activity or work, lack of ability to predict capability
• Catastrophizing or thinking the worst. Stinkin thinkin'. "If I hurt like this when I'm 40, what will I feel like when I'm 65? This is hopeless."
• The belief that pain is uncontrollable
• A passive attitude to rehabilitation - meaning the patient won't get moving

Some common unhelpful behaviors that will keep a person in pain

• Reduced activity level with significant withdrawal from activities of daily living
• Not getting proper exercise - It may hurt but as long as it doesn't feel harmful, it's typically a good idea to move. Nudge the pain. It's almost always OK 
• Avoiding normal activity and moving further away from being active
• Excessive reliance on use of braces, canes, and things of that nature
• Poor sleep
• Smoking and substance abuse, including cannabis and alcohol
• Fear of increased pain with activity or work
• Depression (especially long-term low mood), loss of sense of enjoyment
• More irritable than usual
• Anxiety
• Stressed out

You may have been astute enough to find some common themes in the Yellow Flags. But just in case, let me sum it up like this; recent evidence is clear, a sedentary lifestyle (whether due to pain or not) leads to depression, anxiety, sleep issues, mood issues, general unwellness, the maintenance of long-standing pain, and the deepening of the severity of the chronic pain. 

However, understanding that Hurt almost never means 'Harm', getting moving (even though it hurts), and getting active can do a whole bunch for a patient that has spent a signficant amount of time in pain. Not only are there the traditional benefits of exercise on a patient's health, but depression can be improved, anxiety is lessened, confidence in your abilities and your future abilities starts to rise, patients begin getting better sleep, their mood begins to improve overall, and pain begins to reduce. 

Movement is healing. Motion is the lotion for our joints. Just going for a walk every day can solve so many issues. Not only health-related issues but going for a walk also gives patients the opportunity to slow down and think, problem-solve, and work things out in their heads for problems that have been brewing in their work lives and in their personal lives. 

So, while your state of mind doesn't necessarily make up your entire pain experience, it can absolutely be a HUGE puzzle piece when you are trying to piece together the solution to long-standing pain and it is well worth your attention and efforts if you ever plan to get rid of it. 

Here at Creek Stone Integrated Medical, we have medical care, chiropractic care, exercise/rehab, acupuncture, and massage under one roof with providers that are experts at pain and getting patients out of it. If we can help you, call us at 806-355-3000 and let's get you on the schedule. 

(1) Kendall NA, Linton SJ, Main CJ. Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain: Risk Factors for Long-Term Disability and Work Loss. Wellington, New Zealand: Accident Rehabilitation and Compensation Insurance Corporation of New Zealand and the National Health Committee; 1997.

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