How Mindset Can Influence Pain and Function

By Dr. Ro Mahajan, MD

After treating over 40,000 patients with different kinds of pain problems, I have come to understand that pain is really a subjective experience. Meaning that two people with the exact same injury or structural issue — like a herniated disc or torn rotator cuff — can have vastly different manifestations of pain.

Why is this?

There are a few factors that determine how we experience pain, including:

• Genetics

• Early childhood experience

• Prior exposure to chronic pain

• Hormonal differences

• Stress levels

• Sleep habits

• And substance use/abuse.

All of these factors can play a role in how an individual experiences pain.

But I’ve found that a person’s mindset — how they perceive and choose to deal with challenging situations — plays a major role in how they experience pain.

This isn’t just my opinion.

A recent study of more than 1,200 adults looked at the link between chronic pain and mindset. It concluded that chronic pain patients had worse well-being and more negative stress mindsets than people without chronic pain.¹

This is not intended to blame the victim.

Rather, my goal in writing this article is to empower any patient to understand that, regardless of their circumstance, no matter how badly they are hurting, and even in the face of severe physical trauma, they have some level of control in the situation.

There is some hope that they do not need to suffer to the extent that they are.

In this article, I'm going to reveal three crucial tips that can help change the way you think about pain. But first, let me give you a real-life example of this concept at work.

Mary's Story

Mary is a 75-year-old patient of mine. She has struggled with severe mid-back pain and flank pain for the last seven years.

When she originally contacted me, she was tearful, depressed, and hopeless. She had tried everything — injections, physical therapy, chiropractic care, opioids, and other medications. But nothing was helping her get from a severe level of pain (10 out of 10) to a more moderate level (6 out of 10).

She was stuck.

Mary was working with another pain doctor in town who offered to implant a peripheral nerve stimulator. She was just about to move forward with this when she found our clinic online and decided to reach out in a last-ditch effort to see if there was something — anything — else out there she could do to help improve her situation.

I examined Mary and acknowledged that, yes, she had a physical deformity in her spine. Over the years, her back had become more hunched over. She had also developed a rotation in her spine called scoliosis. She had tenderness just from me touching her skin. It felt like her skin was on fire.

I felt terrible for Mary because she was so miserable. And, worse yet, she thought there was no hope.

I told her I would help her, but only if she went out on a limb with me.

She had to put in some work to better understand how our brain processes pain. I wanted her to try to see her situation from a different perspective.

So, I gave her a copy of The Pain Reprocessing Therapy Workbook and told her to start reading it. I told her that if she would commit to doing the exercises in the book, I would commit to finding any tool I could possibly use to help her.

She started reading the workbook, and we kept in touch.

We talked about how chronic pain eventually becomes a “brain wiring” issue, which is maladaptive, and that there are things we can do to reframe the pain in our brain.

Despite seven years of suffering, she was never informed about this. She began to understand that she had some control and that she wasn’t just a victim to her body. Something clicked.

Since Mary did her part, I did mine.

I told her I thought she would be a good candidate for shockwave therapy because she had a lot of tender muscles on examination, and it would be a safe, easy way to bring her pain level down.

We completed the first shockwave session, and in the days following, her pain dramatically improved. When she felt this improvement, I reminded her that we hadn’t changed the deformity in her spine — yet her pain improved.

I helped her understand why and how the pain was improving, and I coached her to remind herself to work on how she processes the pain in her brain by talking to herself about it.

You see, when our brain is constantly exposed to pain, it begins to expect it.

I often tell patients that when they are experiencing pain after an injury, or after years of arthritis, it’s common for the voice inside their head to say things like, “Why is this happening to me?” “Will I ever get better?” “How am I going to live like this?” “I won’t be able to work anymore.”

Essentially, we bombard ourselves with negative thoughts related to the pain.

I then point out that when they have moments where they are not having pain, there is no voice to point that out in the same way.

In other words, we are bombarded by negative thoughts related to pain, but not with positive thoughts when the pain is gone.

This is just one example that shows how pain affects someone’s mindset, and, conversely, how it is possible for someone’s mindset to affect their pain. By actively working on our thoughts about pain and our ability to function, we can modulate the intensity of the pain we experience.

It’s not easy, but it can make a dramatic improvement.

After Mary completed three shockwave sessions and the workbook I gave her, she reported a 50% reduction in her pain.

People started to notice that she wasn’t consumed with the pain anymore. She started to be more active again. And as she improved, she became eager to see if we could accomplish even more relief.

So, we decided to try a session of prolotherapy using dextrose and platelets. It might be difficult to believe, but after just three months, she says that her pain is now at a 2 out of 10.

She is no longer pulling at her clothing because it is aggravating her pain. She is playing with her grandkids. She is smiling again.

Her daughter told her she could see that Mary was in less pain just by how her eyes looked.

3 Tips for Changing How You Think About Pain

In many ways, Mary’s story is unique. Yet the situation itself — someone struggling with pain and feeling hopeless because of it — is far too common.

Perhaps you, or someone you care about, are having a similar experience with pain that is negatively impacting your quality of life.

I hope that’s not the case. But if it is, I’d like to share three simple, actionable tips for changing the way you think about pain — so that you can take the first steps toward meaningful healing.

Take a deep breath. No, really. Right now, as you’re reading this, take a deep breath. Inhale through your nose for two seconds and then exhale through your mouth for four seconds. Do this for 3-5 minutes.

When you exhale longer than you inhale in this way, you naturally reduce your heart rate and calm your nervous system. I want you to see that it’s possible to change how you feel, even though you haven’t changed anything — structurally or otherwise — about the part of your body that’s hurting.

Learn more about pain. Pain was engineered to give us a survival advantage. This works great for sudden and acute pain triggers, like accidentally touching a hot stove. But chronic pain is a different story. With chronic pain, our brains eventually start sending out danger signals even when danger isn’t present. This often creates an emotional strain that adds unnecessary baggage to the real pain we already carry.

Here are some of the best books to read if you want to gain a deeper understanding of pain:

• The Pain Reprocessing Therapy Workbook: Using the Brain's Neuroplasticity to Break the Cycle of Chronic Pain by Vanessa Blackstone and Olivia Sinalko

  
  

• Unlearn Your Pain by Howard Schubiner, MD

  
  

• The Way Out: The Revolutionary, Scientifically Based Protocol to Stop Chronic Pain by Alan Gordon

  
  

• Built From Broken: A Science-Based Guide to Healing Painful Joints, Preventing Injuries, and Rebuilding Your Body by Scott Hogan, CPT, COES

Focus on function — not on pain — when working with professionals. When you live with pain, it’s often very easy to focus on how much it hurts rather than what you’re still able to do. Find professionals who can help maximize your function, such as a physical therapist, behavioral therapist, chiropractor, personal trainer, or physician.

Here’s an important tip: If you feel like the person you’re working with doesn’t “get” you, they probably don’t.

But don’t give up hope. Instead, seek someone else out who might be a better fit for you.

Putting It All Together

I know that not everyone will have a story like Mary’s.

But I hope that everyone living with chronic pain makes an honest effort to understand the relationship between our brain, body, and our subjective perception of pain.

You can start with the three tips I mentioned above.

Take a deep breath. Even something as simple as the way you breathe can affect how you experience pain.

Learn more about pain. The better you understand pain, the better-equipped you’ll be to overcome it.

Focus on function. Work with a professional who understands your needs and can help maximize function.

These are the first (and perhaps most important) steps to realizing that we can overcome our pain — and even improve how our bodies function — simply by changing the way we look at the situation.