Pain Recovery. Robert Hunter

anyone believes you, but it is extremely important for you to acknowledge that all pain is real. Your nervous system is made up of electrical circuits modified by chemical neurotransmitters, and the sum total of how these billions of cells interact is your essence—your joy, fear, sight, smell, and all sensations, and your experience of pain.

       Pain Is a Subjective, Personal Experience

      For some people chronic pain can be disabling, while for others it is merely annoying. Just as pain is entirely subjective, your responses to pain and the responses of your family may vary widely. Some of you stay in bed when you hurt; some of you go about your business. Your unique experience of pain is based on many personal factors, including:

      

Age.

      

Ethnicity.

      

Religion.

      

Circumstances (context).

      

Stereotypes.

      

Prior experience with pain.

      

Gender.

      

Culture.

      

Environment.

      

Attitudes.

      

Social influences.

      

Hormone levels.

      There are countless examples of how these factors can influence your perception of pain. For instance, studies have identified a number of gender differences regarding pain perception. Women are likely to experience pain more often and with greater intensity, while men are less likely to seek help for and express their pain. Attitudes toward and expressions of pain also vary among different cultures. For example, Western cultures tend to have a much lower threshold for pain than some Asian cultures where pain is viewed as having spiritual meaning. If you have had a prior painful experience, you might expect this occurrence to go similarly, and that will affect your actions and, in turn, your pain.

      { exercise 1.2 }

       Pain Is Subjective____________________________

      Describe how your experience of pain has been affected by the personal factors previously listed or list other factors you believe affected your pain.

      ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

       Secondary Gain: A Hidden Barrier to Recovery

      Secondary gain refers to any perceived benefit you receive from having pain. If not identified, secondary gain gives you unconscious reasons for holding onto your pain. This does not mean you are pretending to hurt for the benefits you get, just that the perceived benefits make the pain rewarding in some ways and thus more complicated to treat.

      Some examples of secondary gain that might result from having chronic pain include:

      

Receiving more attention.

      

Not having to work.

      

Being excused from responsibilities.

      

Being on disability—essentially, being paid to be in pain.

      

Getting out of activities.

      

Having an excuse to take medication.

      You may view secondary gain as deserved compensation for the pain you experience. These thought processes may be conscious or totally unconscious. Either way, if these beliefs remain unexamined, they may interfere with your ability to improve your condition. Taking inventory of secondary gain you may be experiencing and examining your attitudes about this is an important step in moving toward balance.

      In the preface of A Day without Pain, Mel Pohl, MD, recounts the role of secondary gain in his personal story of chronic pain:

       Much as I hate to admit it, in some odd way, the pain I was experiencing and the consequences of having that pain served a function in my life. Actually, the pain had some surprising advantages for me. I didn’t realize it at the time, but because of my pain I didn’t have to exercise. I had a great excuse to sit around and watch TV, and, of course I had to eat while I was watching TV, which gave me an acceptable excuse for gaining weight. After all, I was in pain. In most of my conversations with friends and family, the opening line usually was “How’s your back?” A well-timed groan or moan, more often than not, elicited the sought-after sympathetic “poor Melly…”

       Now at the time, if you told me that any of this served me, I would have slugged you. After all, I was hurting, frustrated, furious, and miserable a good part of the time. I felt helpless, powerless, and hopeless. How could anyone suggest I was benefiting from my pain? Thankfully, not a soul dared to make such a suggestion. Without question this would have been a good reason to bite some heads off. I needed an excuse to yell and scream. As long as I stayed angry, my muscles stayed tight. The harder I tried to be powerful and overcome the pain, the more powerless and in pain I was. The more I resisted, the worse I hurt.

       Today my pain is still there, but it is much less. What changed? My attitude. I experience my pain in an entirely different way. I got tired of the pain, of complaining, and of being miserable. I realized that my identity was my back pain, and I had become locked in the cycle of the futile search for freedom from suffering. By my resisting, paradoxically, the hurt got worse. I learned to stop fighting and judging the pain. And, lo and behold, it disappeared—often for days at a time.

       One of the insights I gained was that I was experiencing something known as secondary gain. In other words, I was gaining something (attention, sympathy, support, an excuse for my inactivity) from my negative or maladaptive behaviors. Furthermore, as I gave up my resistance, I found freedom.

      { exercise 1.3 }

       Secondary