Escaping the Cycle of Chronic Pain

Do you suffer from chronic or recurrent pain for which there seems to be no solution or perhaps even no obvious explanation? If so you will be only too aware of the discomfort, annoyance and worry that this can cause. Ongoing pain can have a very negative effect on your quality of life, and cause a great deal of fear about how it will effect your work, leisure activities and relationships.

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Sometimes chronic pain is caused by tangible damage to structures in the body (for example when there has been accident or we have health conditions such as rheumatoid arthritis). But very often it is not caused by anything being physically ‘broken’, but happens because nerves are becoming inflamed and irritated by being put under pressure because we are carrying unnecessary muscular tension in our bodies. Human beings are very adaptable and clever creatures but, with our precarious upright posture and our ability to choose, we are also rather vulnerable. A cat or dog is essentially ‘pre-programmed’ with a limited range of behaviours which are appropriate for it. We, on the other hand, have a vastly wider choice of possibilities open to us, and this means that we can easily get into the habit of moving, reacting and holding ourselves in ways which are unbalanced, and which result in muscular bracing and tension throughout the body which can put it under great stress. 

Here are some indications that your pain may be at least partly caused in this way:

  • It happens only when you are doing a particular activity, or it seems to be severely exacerbated by something specific that your do  (e.g. work, sport hobbies etc).
  • It gets worse when you are experiencing unusual stress or stressful situations in your life.
  • It is intermittent — sometimes you feel fine, and then seemingly out of nowhere you are caught in pain again.

The good news is that these kinds of pain are usually pretty straightforward to deal with once we understand what is going on. However there is often a little complication, which is it that we can get caught in a vicious circle caused by misunderstanding what the root of the problem is. It works like this: 

  1. Poor habits of posture and movement result in us holding excess muscular tension and misalignment in our body.
  2. This tension starts to irritate and inflame nerves, leading to discomfort or pain.
  3. When the pain doesn’t go away we start to worry about it (will it get worse? will the rest of my life be like this? how will it effect earning a living etc?). 
  4. This worry causes more stress (and hence muscular tension) which both exacerbates the pain and makes it harder to let of the original tension which is causing it.  
  5. At the same time, consciously or unconsciously we start to ‘guard ourselves’ by holding ourselves to try and reduce or control the feeling of pain. Our range of movement decreases and our posture becomes even more set and 'held'.
  6. We start to obsess about the problem. We think about it a lot. Our attention is constantly drawn to the painful place and to our worries about it. We may start to continuously monitor the pain (is it better? is it worse?). Unfortunately, focussing so much attention on the pain in itself makes it feel worse, due to a (partly psycho-somatic) phenomenon called 'central sensitivity'. Again this apparent increase in pain makes us worry even more (surely there must be something really wrong with us to feel this way?) and this worry leads to even more muscular tension.

In short our response to the pain creates more stress, which ‘locks’ the problem further into our system. The more we think and worry about the pain the more we tense up and the worse it gets — because fundamentally it is caused by tension in the first place. The pattern starts to become more and more entrenched, like the groove in a record, until it takes very little to tip us into the pain-worry cycle.

Here it is as a diagram:

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Once we are in such a wound-up state it becomes much more difficult to change the underlying pattern of coordination and ‘misuse’ of ourselves which caused the initial inflammation and discomfort. So long as we are stressed and worried, and our nervous system is over-stimulated, it’s almost impossible to be present, quiet and relaxed enough to learn more beneficial ways of moving and being that would stop us getting triggered into the cycle in the first place.

Beyond the Cycle of Chronic Pain

So what is the answer? There are two strands to consider here. The first and by far the most important one is simply to get off the pain-worry cycle. We need to break the vicious circle that is sustaining and exaggerating the pain so that our system has a chance to quieten down and the excess muscular tension that is causing it has a chance to subside. This largely involves a shift of attitude and understanding:

  1. Realise that there is no ‘instant fix’. Your system is caught in a pattern of worry and over-stimulation which has become a habit, like a well worn groove in a record. With the best will in the world once you have got caught in such a cycle of over-stimulation it will take a little while for your system to settle down and return to balance, and for a while it will be easy to fall back into the familiar pattern. So, in the short term, the pain will continue to crop up in your life, and this is to be expected. Trying to make it go is part of what keeps it coming!
  2. Take time to really understand your own particular cycle of pain and stress. Start to become aware of all the ways in which you respond to the fear and worry which the pain causes. Ask yourself if your responses actually help matters.
  3. Practice ‘floating’. Accept the reality that, though the pain is distressing, in the short term there is nothing you can do to instantly be free of the problem. Learn to ‘Float’ with the pain, accept the reality that right now it hurts, and allow it to be there.
  4. Rather than focussing on the pain start to focus gently on the cycle of stress and worry that is keeping you in it, and on allowing your system to quieten down. Very gently bring your focus away from the stimulating pain and towards things which will encourage your system to gradually settle. Make a practice of noticing your breathing, your physical sensations and the world around you. When you feel yourself being reactive and rushing around take a moment to breathe, to feel the ground, to stop, and to quieten down. 

Once your system has settled (over a few days or weeks) it's then much more possible to look at finding ways to move and find support which are free and relaxed, and which don’t put your body under unnecessary tension so that the pain is not getting triggered in the first place. Both these two strands (letting go of the pain-worry cycle and changing the underlying pattern of movement and posture) are necessary to help the pain resolve. But stepping out of the vicious circle is the first and most important step. Once you have done that and your system has quietened down it will be easy to learn how to take better care of yourself in your activities.

For what it’s worth, Alexander Technique lessons are the best way I know to accomplish both these aims. In addition to gently showing you how you can do things in a way which put less strain on your body, the teacher can gently coach you into calming down and getting out of the vicious circle of pain and worry. Having an experienced guide makes this quicker and easier and can help you avoid certain pitfalls in the process. Taken together these two approaches offer a powerful and empowering way to escape from chronic pain.

Marcus James Sly