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In this section:
Pain and Suffering Flow Chart


  • Depression, suffering, loss of hope and low self esteem.

  • Exhibiting pain behavior (moaning, limping) and use of unnecessary devices such as braces and canes to get sympathy, that perpetuate the deep belief in disability.

  • Significant lifestyle alterations and losses, including loss of gainful employment and financial stresses.

  • Drug misuse & dependency. The patient is so focused on the pain that all he can do is keep looking at the clock to see when it is time for the next pill. Medication use could gradually escalate and medications become less and less effective.

  • Many treatments and procedures have been tried and failed. 

  • Inactivity and a sedentary lifestyle lead to deconditioning and low energy levels.

  • Patients may spend too much time ruminating on the pain and continue to “seek a cure”. They believe that there is a “fix” out there, instead of looking within to find resources to manage pain.

Negative Thoughts Flow Chart
Downward Spiral
Depression, Insomnia
Characteristics of Chronic Pain

This is how chronic pain leads to suffering!


Pain makes life difficult enough, but psychological issues create significant additional suffering. We may not have much control over pain, but we have control over suffering. We don’t have to suffer!


Chronic pain cannot be separated from the person suffering from chronic pain. The whole person needs to be understood and treated. This is the most compassionate and humane approach!



Chronic pain is not a stand-alone symptom. It is associated with and caught in a downward spiral leading to and including:

  • Depression & anxiety

  • Lack of sleep

  • Financial issues

  • Anger

  • Litigation

  • Loss of friends and relationships

  • Body and self image issues, low self esteem

  • Physical deconditioning

  • Loss of gainful employment

  • Sexual dysfunction


These are the consequences and complications of chronic pain and they add to the suffering. They need to be acknowledged and addressed.



Stress aggravates chronic pain. Chronic pain causes stress and aggravates stress.


Stress can come from many sources. Pain itself can cause stress, but also job situation, financial difficulties, family dynamics or just worrying about the future are stressful. Stress can weaken the immune system, thus it is not only making the pain worse but also hindering body’s ability to heal itself.


Pain and stress go hand in hand, they cannot be separated. You cannot treat chronic pain without treating stress.

World-renowned Harvard psychiatrist Dr. Dan Siegel says, “Neurons that fire together get wired together.”


He is talking about the intricately inter-woven neural connections that develop in our brain between our pain, our thoughts, our emotions and our actions.


Let me give you an example:

You have pain when you wake up in the morning —> you think, "oh oh, if I am hurting at rest, I cannot possibly move" —> so you feel sad or hopeless —> you take your pills and climb back into bed. —> you worry. —> the pain gets worse —> "my doctors don’t know what is going on" —> "I better find a new doctor who can finally cure me" —> disappointment  —> additional  stress!


After being repeated many times, this pattern then gets set in the brain, so that as soon as there is a hint of pain, associated feelings of depression, hopelessness, stress and pessimism arise at the same time and you crawl into bed.


This is called learned behavior!




When you are under the heavy blanket of chronic pain, negative thoughts lead you to take negative actions that may be counter productive. Instead of healing, they could make your pain worse. In this example, the patient would have definitely benefitted from exercise rather than rest. Unconsciously, the patient has perpetuated this cycle of chronic pain. It is a chain reaction that can make chronic pain progressively worse.



The triad of depression, chronic pain and insomnia go together hand in hand. They set up a vicious circle and one condition makes the other worse.  You cannot treat chronic pain fully without treating depression and insomnia. In fact, your pain will improve with just treatment of insomnia and depression.


Sleep is essential for healing, because that is the time when the body is replenishing its resources. That is when muscles, ligaments and joints can actually rest and relax fully so that they are charged and ready for action the next day. Without a good night’s sleep, you are perpetually tired and dragging! That makes you further susceptible for more injury!


Depression leads to diminished production of certain neurochemicals (e.g. endorphins) that make us feel good, feel happy and relieve pain.

Negative Thoughts
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