- We are overly confident about why we experience pain and how long it will last.
- We believe certain events trigger pain and that there is little we can do to avoid it.
- By planting seeds of doubt, we can disrupt the process in which pain is produced.
The business meeting was over, and nothing was resolved. You knew it was not going to go well.
On the drive home, you’re exhausted, your shoulders and neck hurt, and the old familiar headache is starting to ramp up. You can tell this headache is going to be a bad one. Or is it?
People who struggle with chronic pain feel confident they know themselves and their bodies. Their knee hurts when it rains, and that big grocery shopping trip will flare their pain up for the next 24 hours.
What if our mental predictions of pain and suffering are simply guesses made by our minds? What if the predictions are completely wrong, or worse, have the power to become self-fulling prophecies?
A physician friend who struggled for years with migraines tells this fascinating personal story. He and his wife were on a two-hour drive one Saturday afternoon to attend a wedding. As he was driving, the sun's bright light suddenly flashed in the reflection of the windshield of an oncoming car, blinding him as he drove.
Typically, bright lights triggered his migraines, and this time was no exception. He instantly began to feel the telltale signs of pain that led to a migraine.
But what was he going to do? He was already halfway to the wedding venue but over an hour from home, where he had left his medication.
It was a beautiful day. He and his wife had no other plans, so he said to his wife, “I am just going to keep driving and see if I can make it. I don’t want to turn back now.”
As he recounted the story, he “knew” this migraine would be bad. He knew that eventually, he would throw up from the pain, hours of blurred vision, ice packs, and lay down as he waited for the migraine to subside.
The closer he got to the wedding, he decided he would at least try to attend the ceremony in the church but sit near the back so he could make a quick exit if needed.
Surprisingly, he made it through the ceremony and now needed to decide what to do about the reception. The migraine was still intensifying, which did not surprise him. He wondered, “Should I stay, or should I go?”
What he decided to do next changed his life with chronic pain. He put it like this: “I knew it would be a beautiful reception, with great food and wonderful friends. I just didn’t want to miss it. I decided that if the food tasted half as good coming back up my throat as it did when I ate it, it would be worth it!”
As he attended the reception, the migraine began to subside within a short period. He never threw up. Nor did he experience any of the other typical symptoms accompanying his migraines.
His experience that day with his migraine puzzled him. As a physician, he knew the biological mechanisms that account for migraines. He also understood how the medications he took worked to reduce his suffering. He regularly treated patients with migraines who struggled for years without any real relief. But what happened to him at the wedding?
The Unhelpful Mind
He began to wonder if his mind’s explanation of pain and its predictions were true, valid, and important. He questioned whether it was worth listening to his mind.
This all occurred years before the understanding we have today of the noisy mind we are so familiar with in mindfulness-based practices like acceptance and commitment therapy. Through his own experience, he realized that his mind’s predictions of pain were, in fact, a problem. He now believed that what his mind was saying was not helpful.
From that point on, every time the early symptoms of his migraine showed up, he would ask himself this question, “Okay, brain, how do you know this is going to get worse? What if you’re wrong? What if you’re just guessing or making this up?” And with that, he would decide to keep moving forward regardless of his discomfort.
With this new mindset in place, the migraines never controlled his life again. He learned to let go of the struggle with his thoughts, show up and be fully engaged in the present moment, and keep moving toward what was important to him. The pain went from the foreground to the background of his life.
A Seed of Doubt
As I talk with patients, my explanation of how the nervous system produces pain plants a seed of doubt in patients’ minds. We are generally confident that we understand why we have pain and when it will show up. But what if we are wrong?
I want my patients to ask these questions of their minds as they sense something is going to trigger a headache, migraine, or other types of pain, “Listen, mind, how do you know this going to be bad? How do you know my pain will worsen and last 12 hours, or I will be out of commission all weekend? Why don’t you ever predict I will have only two minutes of pain?”
Here is a simple principle about the mind—our body prepares for what the mind anticipates. Be careful what you listen to when your mind predicts the worst; your body gets ready for what the mind is saying will happen next.
There are two mindfulness-based skills you can learn that will help the next time some event triggers you and your mind is predicting pain. First, learn to observe your thoughts. You are not your thoughts—your thoughts are not necessarily true, valid, and important. They are just thoughts.
Secondly, learn to let go of your tendency to wrestle with your thoughts. You don’t need to think positive thoughts to counter your negative thoughts, convince yourself you are okay or try to make yourself feel good. Just thank your mind and say, “Thank you, mind, for telling me how bad things will be. I know you are only trying to help.”
Let go of the struggle, show up and be fully engaged in the present moment, and keep moving toward what is important to you. Let your experience using these principles tell you if they are helpful or not.