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Catastrophic thoughts or “assuming the worst case scenario” have the most negative influence on pain. They lead to increased pain, distress, and inability to utilize coping techniques. Sometimes you want to just crawl into bed and do nothing. Worst is going to happen anyway, so why bother!


Thoughts such as “my pain will never stop” or “nothing can be done to improve my pain,” actually interfere with other treatment.

Good news is that the research has shown that these thoughts can be turned around with a focused approach and that has a most powerful positive impact on recovery from your chronic pain. 



Focusing on finding the solution “out there” can interfere with effectiveness of treatment by taking attention away from you and what you can do about your pain. You can spend hours researching online and dollars on physicians and consultants and tests. But every time you “fail” to find a “cure,” that sets off another cycle of pain and depression.


Chronic pain does not respond to acute treatment measures, and failing to respond to these has a detrimental effect on the psyche, and thus on the chronic pain.



You may have a persistent belief that you are stuck in this situation for various reasons that are not your fault and so you can never get out of it.  Either the insurance company is not authorizing the right treatment you need, or the employer did not take care of the claim in a timely fashion or it could be that the doctors have not been able to correctly diagnose the condition. Whatever your belief, you feel victimized and at the mercy of the system.


Unfortunately, this belief can have a negative impact on your recovery and your ability to respond to correct treatment modalities.



Flare ups are part of chronic pain. We are worried about re-injury, so we limit our life style to avoid flare ups. This inactive life style makes your chronic pain worse.


You guard against the pain by limping or bracing yourself. But this develops unhealthy habits, and behaviors contribute to the belief in continuing “disability.”


Though flare ups will happen, they do not indicate re-injury. It is important to learn how to manage a flare up, and continue daily activities rather than climbing into bed.

In this section:
Life's Negative and Positive Balance

There may be negative things in your life that weigh you down, such as injuries, pain, aging, financial difficulties, but we have to remember and be grateful for things that are working too, your children are happy, you have a good marriage, you have family support, you are healthy and educated etc. In fact, you can make a list of your positive achievements and other positive things in your life and keep it in your pocket as a reminder. 


And it is also in your hands to add more on the positive side of the scale with exercise, positive attitude, good coping skills, laughter, gratitude, good relationships with friends and family etc.


Life is only 10% about what happens to you and 90% about how you deal with it.


with serenity to accept the things you cannot change;

courage to change the things you can;

and wisdom to know the difference.

Psychological Issues
Coping Tools
Who You Are Pyramid

Psycho-neuro-immunology tells us that there is an intimate link between our thoughts/attitudes/beliefs and our body, our health, our immune system. You are the mountain, standing on the foundation of your thoughts/attitudes/beliefs. Pain is just the tip of this mountain.


In fact, think of thoughts/attitudes/beliefs as the glue that holds us together.


Thus, treatment aimed at pain, muscles, bones, nerves is helpful, but treatment that integrates your psyche into it has the deepest and long lasting healing impact.


Our thoughts/ beliefs/attitudes can thus impact us either positively or negatively. We also see that it is possible to “feel better” by just changing our belief system.


Remember that your psychological patterns have taken decades to develop, so please allow time for these therapeutic techniques to sink in and create a positive shift. They are not quick fix techniques, so please be patient; don’t throw them out after trying them just once or twice.


So let us look at specific issues and see how a positive shift is possible!




This is the way to work with catastrophic thinking, fear of re-injury, victimization and similar thoughts.

In general, as pain gets worse, thoughts become more negative. Research shows that negative thoughts actually increase pain. Negative thoughts also get in the way of doing the things that we know help alleviate pain. Unhealthy thoughts lead to unhealthy choices.


Everyone has negative thoughts! Often these thoughts are automatic. For example, you may have thought, “My pain is never going to get better,” or “I can’t do anything with this pain.” Believing these thoughts may lead to avoiding activities and people, making you less likely to use your pain management skills.

This chain reaction of negative, unhealthy thinking, feeling upset, avoiding others, and not using active coping skills is the cycle that we are trying to break!



  • Is this thought 100% true?

  • Is there a different way to look at this issue?

  • What would I tell a close friend if they had this thought?

  • Is this thought helpful to me?

  • Is there evidence that I am not taking into account?


Your truthful answers give you a more balanced and realistic view of the situation. Replacing unhealthy thoughts with more accurate ones will help you cope better and allow you to practice pain management skills.

The more you practice, you will become skilled at becoming aware of negative thoughts and also turning them around quickly. It is that easy to stop the drain on your energy level, change your mood and attitude and manage your pain.



Short term goals and long term goals both provide motivation to get better. Your goals should be: specific; achievable; measurable; relevant to your life. Examples: increase exercise; cut down on TV or medications; increase time spent looking for a job or with children.


Seting simple achievable short term goals allows you to see improvement in short increments. Example: increasing walking time by 10 minutes every week. Long term goals should be realistic. Examples: returning to work, going fishing again.


Long term goals are important part of recovery. It indicates you are taking charge of the situation and that you are realistic about what is possible. They could be about education or future job or living a healthy life style. Pick goals that are meaningful to you and will bring you deep satisfaction when you achieve them.  



Some people are prone to “pushing through” pain to accomplish a task. They will not stop until it is complete. Others, preoccupied with fears about harming themselves, may avoid activity. When people with chronic pain are feeling better they use a “good pain day” to try to complete a task that has fallen by the wayside. They clean the garage or mow the grass – but wake up the next day feeling like they cannot move. They need bedrest for a week. This cycle of overactivity, increased pain, and increased rest can happen repeatedly and can lead to negative consequences such as increased stress and anxiety, decreased efficiency, lowered self-esteem, and avoidance of all activity.


Pacing allows you to increase your activities at a slow, comfortable, measurable rate to successfully increase strength, tolerance, and function, while managing pain levels. When pacing, you break an activity into active and rest periods. Rest is as essential as the activity. Rest periods are taken before significant increases in pain level occur. It provides structure to the overall activity level, guiding you to build an optimum schedule, minimize pain, and maximize productivity.


If you can only tolerate walking for 10 minutes at a time, you can rest for 5-10 minutes; and then walk again for another 10 minutes. If you can tolerate washing dishes for only 5 minutes at a time, then don’t push yourself beyond that. Wash for 5 minutes, sit down and fold laundry for 5 minutes, then return to washing dishes for another 5 minutes.



Flare-ups, the seemingly uncontrolled, overwhelming symptoms of chronic pain can feel unmanageable. It leads to muscle guarding, holding the breath, fear, anxiety, worry, anger and feeling overwhelmed. These reactions further aggravate the pain.

With chronic pain, flare ups are to be expected. They do not indicate a threat of re-injury or worsening of the condition, but they do need to be managed.


Recognize that the pain is worse and remind yourself that you are OK – this is just a flare up and not a new injury. Calm yourself, check that you have not been overdoing it, and then plan a day of paced activities rather than spending the day in bed.


Learning to recognize that flare up is just a flare up and not indicating additional harm allows you to gradually move past it. Tools that you use to help acute pain such as ice, heat, massage and rest are passive tools and not as effective for managing a flare up of chronic pain. Active tools being mentioned here are much more effective and they give you a sense of independence and control as well.



Kinesiophobia, the fear of movement and re-injury is a common barrier to the patient’s return to work, a normal home life and leisure activities after an injury has occurred. This typically becomes an important issue 6-12 months after the injury. Typically, you might find yourself pushing to be more active and more social, but as soon as pain increases, your fear about some as-yet undiagnosed illness takes over. This fear can lead to inactivity, disengagement from life and withdrawal from social life.

You need to learn to gradually re-engage in activities that you have been avoiding since the injury.

Once you recognize this pattern developing, you have to pace yourself and try to gradually engage in activities you have been avoiding for a while.



  • Activities that make you happy actually release the “feel good opioids” in the brain and they help pain.

  • Begin to cultivate family and social relationships again.

  • Laughter

  • Engage in pleasurable activities every day: gardening, being out in the nature, music, play, dance, volunteer, social activities etc.

  • Touch and hugs are not only pleasurable, they are healing.

  • Prayer is healing.



Patients with chronic pain tend to avoid engaging in many enjoyable activities such as gardening, golf, hiking and fishing because they believe they are no longer able to do them. Not only may this avoidance contribute to physical deconditioning, but it can also lead to lowered self-esteem and increased depressed mood.


The benefits of pleasurable activities include healthy distraction, increasing socialization, improving concentration, and developing a sense of purposeful direction.


It will help to identifying pleasurable activities that you want to engage in and gradually increase your participation in them. If indeed you used to enjoy activities that you cannot do any more, then take this as an opportunity to find and pursue new pleasurable activities.


You have to live and enjoy life fully, even if you have chronic pain!



  • Strengthens the immune system

  • Helps promote muscle relaxation

  • Reduces stress hormones

  • Increases pain tolerance

  • Decreasing inflammation

  • Increases “good” cholesterol level



Relaxation is a skill that can help people better manage stress and muscle tension that can increase pain. There are many relaxation skills that are easy to use, and we want to find some that work for you. It’s important to make them part of your daily routine, and they can help when you have a pain flare-up.


The goal of relaxation is to reduce the effects of stress on your health. Chronic pain taxes your body and creates increased muscle tension so even if you don’t feel “stressed” emotionally, it is likely that your body is impacted. While we can’t avoid all stressors or pain, we can change how we respond. Relaxation is more than resting or enjoying a hobby. It involves taking a break and reducing tension in your body and mind.


  • Deep breathing technique: Take off your shoes, wear lose clothes. Sit in a comfortable chair and close your eyes.  We are going to focus on deep breathing which means bringing air into the belly. Put one hand on the belly and one on the chest so that you can see which is moving with breathing. Inhale slowly through the nose and allow the belly to expand for 3-5 seconds. Then exhale slowly through the mouth over 3-5 seconds. Do the exercise for 3-5 minutes.

    You can do this several times a day. This will not only help the brain but also refreshes the mind. It can be done anywhere, any time.


  • Progressive muscle relaxation: This exercise is focused on systematically tensing and relaxing specific muscle groups. By deliberately tensing the muscles and then relaxing them, you can learn to observe the difference between these two sensations; the body can then learn to notice tension in muscles and to release that tension. Progressively go through tensing and relaxing the whole body, starting with lower leg, upper leg, lower arm, upper arm, abdomen, chest, neck and upper back, mouth, jaw and forehead. Hold tension for 5-10 seconds and then relax for 10-20 seconds.

    This allows the muscles to actively relax from their deeply held chronic contractions and thus helps pain.


All these self-management tools will not only help in short term to manage your pain, anxiety and depression, but will also help in the long run to improve your overall health and quality of life and prevent serious illnesses.



Flow, a book written by psychologist Dr. Dr. Mihaly Csikszentmihalyi, is a study about what makes people ultimately happy. He discovered that it is not about having specific possessions or being educated, but simply setting goals, for having passion about these goals, and achieving them. Thus you reach a state of “optimal flow.” It is the flow that makes for happiness and contentment.

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