Myths About Chronic Pain

SBM: myths-about-chronic-pain

Ana-Maria Vranceanu, PhD; Director, Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Associate Professor of Psychology, Harvard Medical School

We all have misconceptions about pain that we have learned from TV commercials, family, friends, or even doctors. Learning how to bust these myths can help put you better manage your pain and experience better quality of your life. Here are some of the most common myths about pain that we have identified while working with patients with chronic pain.

Myth #1: Hurt always means harm.

Fact: We can feel hurt (pain) even when there is no harm (damage to the body).

What is going on?

We all have a “pain alarm” that is set to protect us from danger. If you put your hand on a hot stove, you automatically remove it the moment you feel the heat. This even happens to babies that do not know fire is dangerous. This happens because the pain alarm is innate and automatic.

Some pain alarms are useful because they signal a problem. This is what we call a TRUE PAIN ALARM

  • True pain alarms happen when pain means danger.
  • You pull your hand away from a hot stove because the stove is dangerous.
  • True pain alarms are like smoke alarms – we want them to go off when we are in danger.
  • Other examples of a true pain alarm are:
    •  Broken bones
    •  Burns
    •  Inflamed appendix

However, the pain alarm is not always useful.

Situations when the pain alarm is not useful trigger a FALSE PAIN ALARM.

The false pain alarm means the pain alarm is going off when there isn’t danger. The false pain alarm is like a smoke detector that goes off when you boil water. It’s a false alarm because there is no real danger.

False pain alarms still cause REAL PAIN. This means that it’s up to us to learn to tell the difference between pain that is signaling danger (a true pain alarm) from pain that is setting off a false alarm (no danger).

Muscle soreness after physical activity – like jogging or lifting weights – is a perfect example of the false pain alarm. The pain is real, but the alarm doesn’t signal danger – in fact, it signals just the opposite as our bodies are getting stronger!

Folks with chronic pain are often surprised to hear that chronic pain is usually a false pain alarm! This is because the pain sensations in chronic pain are no longer signaling danger. Instead, chronic pain is thought to be caused by pain signals that fire out of control, even when there isn’t real danger. In chronic pain, pain means HURT but not HARM.

Unfortunately, sometimes our brains do not differentiate a true pain alarm (danger) from a false pain alarm (not danger). The pain alarm also makes us anxious and worried. We tend to think too much about the pain at the expense of the rest of our lives.

What can we do about the false pain alarm?

Now that you have this information, you can start by labeling your chronic pain as “false pain alarm.” By giving your brain the message of safety, over time, you can learn to decrease the pain alarm, and regain your full life. Dealing with chronic pain is frequently about resetting the pain alarm system to function normally again.

Myth #2: When medical tests are clear and no biological damage exists, pain must be imaginary or “in your head.”

Fact: Pain is a real sensation. It is never “in your head,” but it is always “in your brain."

Pain can occur even when all medical tests are normal (think headache, back ache, and stomachache). Some patients with chronic pain have normal X-rays and MRIs, or have tests that show abnormalities that may have been there even before the pain. This is why most surgeries for chronic pain do not work.

In chronic pain focusing on the sources of pain (e.g., back, leg) is most often not helpful. However, because pain sensations are processed in our brains, strategies that teach us how to think differently about pain and how to turn down the pain alarm can have an enormous positive impact on both the level of pain and how much pain impacts our functioning and quality of life. There are many scientifically proven treatments for chronic pain that including cognitive behavioral therapy, mindfulness based programs and physical activity.

Myth #3: Chronic pain treatment require pain medications.

Fact: There are no perfect medications for chronic pain.

We live in a culture where we are bombarded by advertisements encouraging us to take a pill for everything. Over the years, we have over-medicated chronic pain. Recent research has shown that they pain medications are not doing a great job alleviating pain, and some come with many side effects not to mention risks of addiction. The elusive pain medication, or “magic pill” does not exist. We need to take an active role in managing our pain and turning down our pain alarm.

Myth #4: Pain always means you need to stop.

Fact: Exercise can help.

In the acute pain phase, particularly in the case of an injury, the pain alarm is right in telling us to stop and rest. However, in chronic pain, stopping any time you feel pain can lead to loss of muscle mass, isolation, depression, and poor quality of life. We call this “the disability spiral”. If you have chronic pain, you are probably already experiencing this. Some people think that rest will make them feel better. However, resting too much makes people feel worse, while moving can release feel good chemicals in the brain that help with both pain and mood.

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