Almost every message that I get from the visitors of this website has some reference to fear or anxiety. No surprise, people who are suffering from severe chronic pain are likely to experience fear of pain, or anxiety or depression over the pain triggers, or all the above. Their mental health issue is often seen as an inevitable consequence of their suffering, but only the mind-body approach views pre-existing mental health issues as a likely contributor or even a cause of chronic pain.
But how does it affect the patient’s recovery? If chronic mental health issues are a contributor or a cause, by addressing them as such, you are essentially removing a contributing factor or even a cause of the problem. This is why we need to talk about fear. Being held back by fear is a very typical scenario in life. It is as common as any life situation we experience daily. As many of those who succeeded in defeating their chronic pain report, being held back by fear was the biggest obstacle to their recovery from chronic pain. Of course, chronic pain is a unique life situation, but fighting the barrier of fear is not unique.
Athletes are great role models!
As I was fighting my fear of symptoms, I studied the methods developed by the mountain climbers to fight the fear of heights. The most helpful was the visualization technique. You preview the upcoming challenge of climbing the mountain, visualize the route, and make sure you understand possible dangers and how to handle them, and then you go, armed with knowledge and careful planning. When you worry about symptoms preventing you from doing something, preview your experience, be prepared, but still go. While in the midst of the real challenge, visualize yourself in a safe place, just as you were when previewing it.
Another technique used frequently is to incrementally increase activities, while still keeping pain at a tolerable level.
A close friend of mine had a knee replacement surgery 6 months ago. An ultramarathoner, he was hoping to get back into running and long-distance hiking. Unfortunately, knee pain continued, even after the 3-month recovery and rehabilitation period and despite his doctor declaring his knee to be in perfect shape. It was always there, and it was not getting any better. As an ultramarathoner, my friend is very familiar with pain. Pain is part of running. But this time around, he first became worried, then fearful of the pain that seemed to have become chronic. He invested 6 months of his life in preparation for the surgery and rehabilitation after the surgery, and a lot of money, too. Still, his knee was more painful than before the surgery.
Being a dedicated athlete, he kept training. Walking first a mile, then 2 miles, then 5 miles. Pain was there, and so was his fear that he would never run again. Luckily, he is a stubborn guy, and he kept pushing the envelope of pain and fear every day, a bit by bit. Then, one day, pain disappeared for a few minutes. It happened as he was hiking his 5-mile course. He soon realized that while he was hiking, his mind would drift away from his obsession with his knee pain, and the pain would go away. He doubled down on more hiking and added weight to his backpack. First, 7 lbs, then 10 lbs. The pain-free periods became longer and longer. His pain was often there, but his confidence slowly grew. Once he got the weight to 20 lbs, a strange thing happened.
The less he worried about his knee, the better it was. After about 2 months of fighting his fear, he broke through the barrier and is now almost entirely pain-free. He hikes 8-9 miles with a 20-lbs backpack and without pain. He is planning a week-long backpacking trip in the mountains this summer. His fear lost the fight.
As Dr. Sarno said, we are much stronger than we think!
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