Chronic pain · Fibromyalgia

“It’s all in your head”…. How chronic pain actually works


Yoga helps me to manage my pain

One of the worst things you can say to a person with chronic pain is “It’s all in your head”.  Unfortunately, this statement is heard so often by those with chronic pain the world over.  The first problem with the statement is that it implies the pain is not real.  It’s imaginary and if you just stopped focusing on it, it would go away.  Oh how nice that would be!  Why then do we hear this statement so often?  Because the public and, unfortunately, many in the medical profession, do not understand how chronic pain works.  Acute pain and chronic pain are two very different beasts and must be treated as such.

“It’s all in your head”.

The second problem with this statement is that it is, in fact, correct.  Okay, stay with me, let me explain.  The statement is correct, the implication is not.  Pain does in fact come from the brain.  Without our brain telling us our arm is sore we would not know that we have torn a muscle.  It’s not the muscle that causes us to feel pain, it’s the messages our brain sends out in response to the tear.

So, if I tear a muscle in my arm messages travel from my arm (up the spinal cord) into the brain, the brain then analyses the (incoming) message and sends back a (outgoing) message that determines the level of pain that will be felt in the arm.  If a gate (in my spinal cord) is closed when the (incoming) message travels up from the arm, the message is blocked and no pain (outgoing) message can be sent back in response.

This my friends is my very poor explanation of The Gate Control Theory.  The theory that the pain pathway is a 2-way highway with incoming messages, outgoing messages and a gate which controls the flow of those messages.  The Gate Control Theory was first discussed in 1965.  1965!!  That’s 17 years before I was born.  27 years before my journey with chronic pain started.  27 years!!  Yet it was not until 21 years into my pain journey that a doctor first explained this to me.

For 21 years I treated my chronic pain the same way you would acute pain.  When I was sore, I would rest.  The sorer I was, the more rest my body received.  If I had a particularly bad week I would rest all weekend.  Mum (my ever-suffering nurse) would wait on me making sure I took my meds on time, my heat pads stayed hot and I was sufficiently watered and feed without the need for me to move off the bed/couch.  We had no idea that resting to this extent was one of the worst things I could have done.  When you have an injury, you are told to rest.  “Get the weight off that leg, let the injury heal”.  What we didn’t realise was that my injury had healed as best as it was going to.  My pain was no longer due to an injury that need to heal, my pain was now due to a complex range of biological, psychological and social factors could, in part, be managed by me.

Learning about The Gate Control Theory and The Bio-psycho-social Model were absolute light bulb moments for me.  Not only did I learn that I had been treating my chronic pain incorrectly, I learnt how precisely chronic pain works, what factors can make it worse and what factors can make it more management.  There were so many things that I had previously failed to tell my doctors, like the fact that my pain was worse when I was stressed or upset, for fear of them saying “See, it is all in your head!”  My pain was now, more than ever, validated.  What I had experienced during those past two decades was exactly what you would expect a chronic pain patient to experience.

So yes, the pain is all in my head.  Knowing this is not a death sentence to pain control.  Knowing this means that I now have some control over my pain.  Knowing how pain messages travel up and down my spine means that I can take measures to close the gate and block their travel.  What a wonderful thing to know!


Practising mindfulness is another great self management tool

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