People with chronic pain know that they tend to have a pain flare when they are under stress. They are, however, sometimes sensitive to acknowledge it aloud for fear that others might think that their pain is all in the head. Nonetheless, the fact that stress makes pain worse is entirely normal and common. It is a natural product of how we are made.

Attempts to challenge the stigma of chronic pain often fail. Despite arguments from providers and patients alike, stigma remains a persistent problem. 

All or nothing thinking is one of the most common, problematic ways of coping with pain. It’s right up there with catastrophizing, fear-avoidance, and refusing to accept the chronicity of pain. All of these problems prevent people from coping with pain well and being able to live a full life despite having chronic pain. Since we have reviewed the other problematic ways of coping with pain in previous posts, let’s discuss all or nothing thinking today.

Those of you who are connected to one of our social media sites know that we tend to post daily on the latest news and research in the field of chronic pain management. We recently came across a description of cognitive behavioral therapy for chronic pain on the web, which we initially thought we’d send out on one of our daily posts. After finding myself reading it for a second time, however, I thought that it was too good to simply send out on social media without more comment than the usual line or two of introduction that we tend to provide.

No, this post isn't about telepathy. It’s about a common problem faced by people with chronic pain and how to overcome it.

Mind reading defined

The phrase “mind reading” is a piece of technical jargon used in cognitive behavioral therapy and chronic pain rehabilitation programs. It refers to a particular type of thinking in which a person thinks that other people are judging him or her even though the other people might not ever say anything.

A study published this month in Pain produced what is likely some of the most important research findings this year for the field of chronic pain rehabilitation. The study demonstrated that basic CBT interventions can reduce central sensitization (Salomons, et al., 2014). Countless studies in the past have shown that CBT and CBT-based chronic pain rehabilitation programs are effective in reducing self-reported pain in chronic pain patients.

When engaging in long-term opioid management for chronic pain, should healthcare providers discuss with their patients the fact that the medications won’t typically remain effective for the rest of their life? That is to say, should healthcare providers fully review the implications of opioid tolerance prior to beginning long-term opioid management for patients who have chronic pain, but who are neither elderly nor sick with a terminal illness?

We tend to stigmatize pain because we misunderstand its nature. Specifically, we fail to acknowledge the role that the nervous system plays in producing the experience of pain. If we more fully appreciated this role, we would understand that chronic pain is similar to other health conditions that we don’t stigmatize much, such as high hypertension (i.e., high blood pressure) or type II diabetes.

As an educational and public policy think tank, the Institute for Chronic Pain (ICP) brings together thought leaders from around the world to provide information about chronic pain and its treatments. We make every effort to provide academic quality information in ways that are also approachable to patients and their families. We also aim to bring this information to healthcare providers, third-party payers, and public policy analysts.

This year's educational conference by the International Spine & Pain Institute focuses on the nature of pain and evidence-based treatments for pain, including chronic pain. The target audience for the conference is physical therapists and physical therapist assistants. I have no doubt, however, it would be beneficial for most any clinician working in the field of chronic pain management. It will be held in Minneapolis, MN, USA, from June 20-22, 2014.

Author: Murray J. McAllister, PsyD

Date of Last Modification: 5-23-2014