Changing the Definition of “Pain”
Settle in for some science nerdery with this one folks!
This one’s about something I see with nearly all of my clients on the road to chronic pain recovery. I'll start with a story.
Several years back I worked with a client experiencing significant low back pain. They were in a tough spot, describing consistent, daily pain at a 7 or 8 out of 10 level. That's hard, and as you might imagine, it was affecting a lot of their comfort and function every day. Basic things like going up and down the stairs in their home had become a brutal test of focus and grit.
Over the course of several sessions they improved remarkably, pretty quickly arriving at a regular experience of pain at just a 1 or 2 out of 10 intensity. That's a big change! Naturally, they were thrilled.
Until they weren't.
One day they came to our session kind of down-and-out, feeling the disappointment of still experiencing pain, even though it was at a just 1 or 2 now consistently.
What they'd missed, and what our conversation illuminated, was that now their life was radically different. Those stairs? Not a problem. They could go outside and do yard work without thinking about consequences. And, as basic as it may seem, they'd reported that their back no longer hurt getting up or down off the toilet (you always take that one for granted until it hurts!).
Objectively their body was healing and feeling much better than it had for years. That discussion was the lightbulb moment for them that really illuminated how their brain was trying to keep them in the problem loop. And it changed everything about their experience.
What exactly was happening here?
This client was experiencing what's known as "prevalence-induced concept change (PICC)." It's a bit of a mouthful.
What's PICC? When the prevalence of a problem decreases, we don't celebrate. Instead, our brains redefine the criteria for what it classifies as a "problem." We instinctively move the goalposts to include more borderline cases, which can mask that the problem is, in fact, disappearing.
Basically, our standards get harsher or more critical as things improve.
Functionally, it's "cheaper" (it literally takes fewer calories) and more efficient for our brains to keep the model of "I have a problem that needs solving" in place, and to then redefine what we perceive as a problem to reinforce that concept, than it is for our brains to have to expend the effort reassessing and redefining our lives as no longer having a particular problem.
This is the science behind what author Michael Easter calls "your stupid first world problems."
It's behind phenomena like:
Getting a significant pay raise that makes a tangible difference in your life, then quickly returning to feeling like you're still not making enough money.💸
Buying that new thing that you just know will make life better & easier, finding it didn't quite scratch that itch, and moving on to the next purchase that'll surely be the right one.
And, if you're like me, happily giving up the "brutal inconvenience" of walking the aisles at the grocery store for two hours for the ease of online shopping & pickup, then starting to complain about how annoying & inconvenient spending 20 minutes putting that order in becomes.😆
And it works the same way with chronic pain.
As we're recovering, pain that we once may have viewed as a minor nuisance rises to the level of problematic.
Are you starting to see what was happening in my client's brain? That was PICC in-action!
Solving your chronic pain (or other persistent problems for that matter) is an inside job. It pays to know that our brains will make things hard for us perceptually, especially when we've begun to change our definition or thoughts about ourselves to things like, "I'm a person that suffers from daily pain," or "I'll never be able to do that again," or "my body just gets injured or hurt easily." (etc etc)
Part of chronic symptom recovery will be to overcome your brain's definitions of who you are, and the built-in biases we all have that work to keep our perceptions basically the same over time.
Your brain will always lead with "evidence" aimed at keeping your existing beliefs intact -- potential threats or harms attract our attention first (that's the negativity bias); information that aligns with our pre-existing beliefs filters in easily while new or contradictory information gets downplayed or ignored altogether (that one's the confirmation bias).
So, your job, my friends, is to aggressively demonstrate to yourself evidence and information that disconfirms these innate beliefs and biases.
Here's how:
Know what's happening (you're reading this, so check!✅) & normalize it. Remember that our brains naturally make small things stand out and grab our attention. For example, background noise is always louder in a quiet room, and a tiny speck stands out on clean surface.
When you experience pain again after a period of improvement, really break things down rationally, especially if you feel frustrated, disappointed, angry, etc. when it happens. Ask yourself the question, "does this pain experience have the same intensity, impact, or duration as before? (hint: it very often doesn't)
Track objective improvements as you go. Awareness of details like how long pain lasts and changes in what you can do over time (or reductions in what you can't do) are clearer measurements of progress than black & white assessments of "am I in pain or not?" and even our interpretation of sensations as being "pain" or something else. PICC distorts our perception of what things are like on the inside of our bodies ("interoception"), but it doesn't distort function or capability.
Get ahead of the game! Practice tracking "safe," "neutral" and "pleasant" sensations. Tune into your system and practice exploring the positives. This will keep your brain from defining unfamiliar or even neutral sensations as something dangerous (it'll try!).
Appreciate that PICC is one of your brain's many efforts to create and maintain safety. If you catch yourself assessing something as painful, start first by relating to it with compassion, positivity, and dare I say, appreciation. Everything your brain is doing it's doing for you.
Finally, remember the basics of Somatic Tracking -- slow down, tune into your body, reappraise what you're feeling as safe & OK to experience, then turn your attention to something positive.
You can't make PICC go away my friends -- it's a feature of the human system, not a bug. But with these tools, you can bend the game back in your favor. I use these every day with my clients; they work for them, and they can work for you too!