Why focussing on your pain feels right (but is exactly the wrong thing to do)

If you suffer from chronic musculoskeletal pain you probably think about it a lot. When you’re frequently in pain it can have a serious effect on your quality of life, your relationships, and your equanimity about the future, so this is perfectly understandable. Perhaps you experiment with different ways of holding or ‘guarding’ yourself to avoid or ease the pain, or flit from treatment to treatment, constantly monitoring your pain level to see if what you’re trying is ‘working’.

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However, no matter how understandable this response to being in pain is, there are a couple of reasons why it’s a really bad idea. The first is to do with a phenomenon known as ‘central sensitisation’. Often, when someone has been in pain for a while, the nervous system can get over stimulated and settle in a persistent state of high reactivity*. This lowers your pain threshold, meaning that your pain can be much more acute than the underlying physical cause would be on its own, and it can even result in pain continuing after the initial injury has healed. Interestingly, one of the contributing factors to central sensitivity has been shown to be stress and in particular, worry about the pain itself. Constantly obsessing about the pain, checking it out, and monitoring it can play a significant part in sensitising the nervous system and can actually exacerbate and sustain the pain you’re trying to get rid of.

The second reason why focussing on the pain is a bad idea, is that your moment-to-moment pain level is actually a very poor register of whether or not you’re on the right track to getting better. As we’ve seen, chronic pain is often related to emotional factors such as stress, and these in turn are affected by all sorts of factors in our lives which have nothing directly to do with the pain. Tiredness, work, and family-related events — even the weather — can have a big, though transient impact on how badly we experience our pain, which means that your pain level doesn’t give you a reliable indicator of whether what you are doing to improve matters is working.

The original, physical source of a great deal of chronic, non-specific musculoskeletal pain, is inflammation and aggravation caused by excess muscular tension putting structures in the body under pressure. Even pain that was originally related to an obvious injury is often intensified and prevented from resolving by a combination of poor body use and central sensitisation. So in order to be free of our pain we need to reduce pain related stress and learn to live and move with freedom and ease so that the physical inflammation and aggravation has the chance to die down and any underlying injury is given the space to heal. Continually focussing on and worrying about your pain sensations makes the pain worse, while taking attention and energy away from the sort of positive steps which actually will make a lasting difference.

As an Alexander Teacher my heart always sinks a little when a pupil comes to a lesson and, when I ask them how they have been in the week, immediately launches into a detailed day-by-day description of how their pain levels have been. It’s understandable, but it’s a sign that the penny hasn’t quite dropped yet! On the other hand when someone responds by talking about the progress they have made in terms of how they’ve found a new level of freedom and lack of effort in their activities, how they’re finding a new level of support from their postural system, and how they feel calmer, less worried, and more present in the moment, I smile to myself — knowing that they’re already happier in themselves, and it’s now usually only a matter of time before the pain quietly resolves on its own….

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