Skip to main content

Verified by Psychology Today


Fierce Pain, Explained

Most chronic pain is caused by your body being in flight-or-fight physiology.

Key points

  • Being with your pain instead of fighting it is a major factor in healing; fighting reinforces it.
  • It is challenging to be with your pain, in light of severe nerve pain.
  • It is definitely doable, but mind over matter can't and won't work.
  • There are a number of tools to help in processing the effects of inflammatory physiology.

An intense description of suffering arrived in a mailing from an expressive arts gallery:

My arms reach upward as the mind and hair are disintegrating, reaching through burning into the light. Grounded in the earth, I dance. My heart lifts up, surrendering into light, moving with the energy, letting go of resistance, opening to the possibility of a new layer of growth, channeling wild fury and mad aliveness. I am here to be bold and to show the real, raw intensity of what my past two months have been like. I have had a rash on my skin from an unknown cause that erupts as red welts on my arms. Ouch. I am in process of getting tested to discover the underlying root cause, but in the meantime, enduring outrageous jumping-out-of-my-skin irritation *%?#*! Yikes! I am using this intense experience to build endurance and stamina… to practice staying grounded and present in the midst of such reactivity, this is for real. Just as in nature, there are wild storms as well as peaceful meadows, I see this energy may be an aspect of shadow anger that has been suppressed that is now erupting, in my body as well as in the collective….what if I can welcome even this and thus become more whole.

This description reflects several important concepts about pain, a type and pattern of which is uniquely difficult to endure.

First, there is a clear cause for the painful skin rashes. When body physiology (how it functions) is in flight-or-fight mode—precipitated by the perception of some threat— mast cells are activated. Each mast cell has many granules of inflammatory chemicals that are released, creating intense reactions. They include:

  • Allergic reactions—migratory skin rashes with burning/anaphylactic reactions
  • Irritable bowel syndrome—stomach pain, diarrhea, constipation
  • Burning, itching, hot, cold sensations throughout the body
  • Irritable bladder (interstitial nephritis)
Source: Dr_Microbe/AdobeStock


Tests can be done to discover the cause, but most of medicine is looking in the wrong places for causes to problems. As a result, the diagnosis may be rendered as MUS (medically unexplained symptoms). It is commonly applied when causes go undiscovered—but such a diagnosis could not be more wrong.

When the body is in sustained flight-or-fight mode, much goes wrong. Every cell in the body is bathed in and affected by the chemistry of stress—the reason why a person might experience so many different symptoms. Yet the underlying state of physiologic activation goes undetected. The correct term should be MES (medically explained symptoms).

The sufferer has identified the eruption as the shadow side of anger. Anger is also a sensation generated by threat physiology. The anger and the pain are the same entity. Perhaps a better term for anger is “hyperactivated threat physiology.” It is not a psychological problem but the body’s response to feeling unsafe.

The key to treating the anger and the physiologic disarray is to learn methods for lowering your stress reactivity. It requires a multipronged self-directed approach that is not difficult but requires commitment to develop the expertise to regulate your physiology.

Connecting to the pain

What is unusual about this story is the degree to which the symptoms are embraced and used as a source of learning. Most of us want to fight or run from the disquieting sensations of threat-activated physiology, which, unfortunately, reinforce and amplify pain signals. Learning to be with your pain, mental or physical, is a major aspect of healing. As the saying goes, “what you resist will persist.” It is like trying to escape from a finger trap. The harder you pull, the tighter the trap becomes; the key is letting it loosen first and gently removing it.

The story describes quite severe pain, and with intense pain, unless there are additional approaches being used while you are healing, you’ll eventually wear out. White-knuckling alone can’t and won’t work. Connecting with your pain is a powerful foundational step. But it is not the final solution—just the beginning of a “C” quence of healing.

Anger—the tipping point

The tipping point in healing is learning to process anger. This is especially challenging in the face of chronic pain, because the pain itself provides a legitimate reason to be extremely angry. As a physician, I have always been in favor of doing whatever is needed to provide symptomatic relief. Options include medication, biofeedback, heat, ice, TENS units, massage, acupuncture, medical hypnosis, vagal stimulation, and possibly spinal cord stimulation. None are definitive solutions, but in the context of a healing journey, they can be very helpful.

Source: koldunova/AdobeStock

Ants under the skin

A close friend of mine developed sensations of ants crawling under his skin throughout his whole body; understandably, he was more than miserable. I talked him through the concepts behind solving the symptoms.

One way of countering inflammation is to stimulate the vagus nerve. It is the 10th cranial nerve; it originates in the middle part of the brain and connects to every internal organ and the immune system. It is highly anti-inflammatory. My friend engaged in expressive writing, active meditation, and used various breath techniques that stimulate the vagus nerve. Within a couple of weeks, the sensations resolved, and they have now been gone for more than six months. There are still other things he can do to keep moving forward, but his focus on one set of techniques to jump-start the healing process was remarkable. Another factor was his decision to take charge of his situation.

My story

My personal experience is relevant. For over 20 years, I experienced severe burning sensations that enveloped both of my feet. During the worst period of my ordeal, I felt like they were in toaster ovens, especially at night. I took off my shoes whenever possible. I underwent many tests to find the cause; nothing was found.

The symptoms have now been gone for over 19 years, with just occasional tingling. I also had skin rashes that randomly appeared on my arms, wrists, and legs. Their eruption was preceded by severe burning for 10-15 minutes, they would last for several hours, and then they would disappear. Those have also resolved—unless I quit using the tools I teach everyone else. If I stop doing expressive writing for a few weeks, the first symptoms to show up are skin rashes on the backs of my wrists.


These cases illustrate the major paradox in treating chronic pain. You have to process the anger that’s inflaming your physiology—but first you have to deal with the legitimate anger about suffering so intensely from pain. For me and for hundreds of other patients that I have witnessed breaking free, the common theme is persistence in using the tools and layering others on. Jumping around for a solution is counterproductive.

If you allow it, your body knows how to heal.

More from David Hanscom MD
More from Psychology Today