If ‘Pain Is an Opinion,’ There Are Ways to Change Your Mind

All pain is real, but it’s also true that it’s “made by the brain” and that we can exert some control over it.

Comments: 282

  1. I wish this article mentioned the pain of contractions during labor given how many of us will experience it at some point during our lifetimes.

  2. @M The gal who did my childbirth class told us "I'm not going to tell you that if you do this that or the other, you won't have pain. I can tell you that if you are freaking out it will be a lot worse." And most of the techniques she said were worth trying were basically distractors, giving you something to occupy your mind with and give you some sense of time.

  3. @M There are Other pains as well not mentioned.

  4. @M One of my friends meditated and swears she felt no pain, she went into her "zone" of a meditated state.

  5. I had a back operation. I go to the pain center. I work out. But on my left side, it really hurts. I do just as you mentioned. I attempt to separate the pain in my brain. I rarely mention that I had a back operation. Of course most people think there is no problem because I am active. I go to Chinatown and have them work on my back. It is great. I am not going to have pain run my life.

  6. @Bob Washick Love this: “I am not going to have pain run my life.“

  7. @Bob Washick I go to pain management once a month . They check to see that I am not on drugs! I said to the doctor it gets worse in the winter. I really need it a shot in the back. No shot! He changed the drugs. At 80 I will drop pain management from seeing the doctor every month.

  8. I am a retired soldier with a few physical and mental health issues and learning to deal with pain from my chronic back and shoulders make life interesting. I learned to see my pain as part of my life and know that it will pass and I will be okay. I had to change my life and way of thinking about pain, take walks and exercise in moderation, I meditate and when the pain comes I remember that it will pass. I did not and can not do this alone, I have a community and my belief in a higher power to help me out with life. I am going to be in pain but I am not alone.

  9. @Mustapha Rahim my dad was in the military, and struggled with chronic pain, but he'd used to tell us pain is the signal you are alive. That's a good thing. Change, adapt and acceptance is hard to do, especially when hurting. I'm so grateful I didn't jump on the pain pill train, when all my doctors wanted to treat it with narcotics. I hurt. I deal. At least I'm not at the mercy of a pain clinic for my messed up hip and spine.

  10. @Ford313 "pain is the signal you are alive." So what is good about being alive if the ONLY thing you experience is pain (except if/when you're lucky enough to sleep)? We need MAID (medical aid in dying) for all of us who do not have a terminal disease but need help leaving a life of terminal misery. Why does anyone want people to go on suffering with no end in sight? I have never heard an explanation, except from religious zealots and disability rights activists, whose answers are not only rubbish but have nothing to do with the rest of us.

  11. @Jamie It's definitely not a stance held by everyone, Jamie. Of course there are legal (and, I suspect, quite heavy intraprofessional) ramifications guiding how licensed professionals will act and advise within their official clinical roles, but quite a number of them are more open-minded off the records. You can find publications from hospice/palliative providers as well as sympathetic organizations like Exit International on this issue.

  12. I am a psychiatrist and one technique I use with some success is to explain that once the patient has been to the doctor and told that they were not suffering from a serious illness, that is, that the pain was no longer signaling "danger," then they could relax somewhat about the pain. I encourage them to reassure themselves when they felt the pain again that it was a miscue, a learned response to a problem that may have existed but no longer did. I encourage them to get their pain checked out the first time they have it (if it didn't go away in a few days) but after that, they should reassure themselves that it was no longer worth worrying about. Also, I encourage exercise despite the pain; the natural endorphins from exercise can be more effective than any medication. Finally, I encourage them to feel strong that they weathered another crisis, that they were stronger than their pain, at least for a little while. That good feeling can be grown within the patient, and they can induce it in themselves.

  13. @Ellen Tabor Unfortunately, as a pain management doc myself I can tell you that because of doctors, patients often refuse to accept that there is no identifiable disease state or condition that can explain the pain and end up getting many unnecessary tests and often unnecessary surgeries. It's estimated that as many as 80% of the surgeries done for back pain don't need to be.

  14. @Ellen Tabor Your approach tracks with the work of Dr. John Sarno, who helped so many people as a pain specialist. He emphasized that pain is real, not “all in your head,” even as he worked on it as a mind-body phenomenon.

  15. If only her approach worked.

  16. I cannot say for others nor for other forms of pain but I can speak to the Sudeck (first described during the Civi War) or Complex regional pain syndrome (CRPS) I developed after breaking 4 fingers off the joints of one hand as they were pushed backwards in a fall.... The hand and arm became swollen after a few days, turned dark red, was several degrees higher than the other and both hairs and nails grew much faster. The pain was totally incapacitating yet unrelated to the broken fingers that were healing. Symptoms did not match the injury. It took three years of stimulating the nerves between the injury and the brain, anti-inflammatories, lymph massage, work therapy and artificial salmon hormones ... but what changed everything was using the kind of box with a mirror on the side that is used to treat pain in missing limbs. The idea being to train the brain to see a healthy limb in the box (because a mirror image of the healthy hand). The damage to mobility is done (fibrin irrationally sent to joints by the brain locked up the joints) ... but life without that kind of pain is worth living. Complex regional pain syndrome (CRPS) is often undiagnosed so treated with pain relievers and other medications that can leave a person permanently handicapped in a sea of pain for the rest of their lives because treatment must address the cause. I can only thank my doctor for thinking "out of the box".

  17. @Si Seulement Voltaire As a pain doctor, I agree CRPS is often undiagnosed. However, it's worth noting that no one has a single treatment that works on even the majority of patients. In fact, the most common treatment, sympathetic nerve blocks, don't seem to work at all on most patients who undergo them.

  18. @Si Seulement Voltaire That might work well with a damaged limb. But how effective is "mirror and box" treatment for a damaged spine? For pain in both extremities? Cancer?

  19. @Si Seulement Voltaire I had CRPS after breaking my wrist 20 months ago. I had all the symptoms you mention plus two more: my hand would sweat relentlessly, and my hand would go numb all of a sudden. After two sessions of acupuncture, the sweating went away entirely. Biofeedback and deep relaxation also helped raise the temperature of my hand, and cognitive behavioral therapy reduced anxiety contributing to the numbness.

  20. Having experienced excruciating pain of rheumatoid and psoriatic arthritis for 50 years while living my life, I have a personal connection to this article. I also agree that pain can sometimes be managed through thought, but not always. If only it could. I was lucky though; the first time I experienced pain I was 17 and thought I had injured my left shoulder. It was a rather gentle type of pain that periodically returned. While away at school it changed and started moving between shoulders and right hip. Also a gentle pain that allowed me to function with only minor disruption to life. When this moved to the excruciating phase, it was brief, but I was diagnosed with "arthritis" and told it might not hit me fully for another 25 years. The diagnosis was spot on and luckily it allowed me to prepare myself mentally for what lie ahead. I made decisions to reduce life's stresses; no debt but enjoy life and work hard. Ongoing agony began in my mid 40's. It was a 3 year event. A shattered ankle did not hold any semblance to the agony of 10 to 20 inflamed joints when the pain seemed to extend between them. The ankle hurt, but was temporary. Relief only came with the right combination of drugs and then it was immediate and long lasting. Chronic pain is stressful, but hope is a powerful antidote. The correct medications help too.

  21. This article begins with an argument: 'If pain is an opinion, there are ways to change your mind.' It all depends on the first premise, which is doubtfully true. Certainly, if there are things that you enjoy doing, you may distract yourself from your pain for a time. It does not follow either that pain is an opinion or that, in distracting yourself from (or in being distracted), you have changed your mind. The problem with the article is that it assumes the premise, and that, even though he is the director of a supposedly 'evidence-based' research organisation, he provides very little by way of evidence, as opposed to carelessly expressed opinion. Pain is not an opinion, after all, and it is pointless to suppose that it is, even if playing the trumpet can make you feel better.

  22. @Eric MacDonald There are many circumstances in which distraction can help take one away from a problem situation. If one has an addicted spouse, it is possible to go to compelling theatre and not think about your problem spouse for a couple of hours, but that does not mean your problem has gone away or even gotten better during that time. It means you were able to escape it for a bit. I think the author can escape his pain by playing his instrument. But I don't think he cured it, even for that time period.

  23. Excellent article. Pain is real whether it is caused by any number of things real or imagined. The trick is to use the best method(s) to cure it and not listen to quacks, extreme unproven measures or told to buck up and not do anything.

  24. Why do doctors always ask the patient to “rate their pain from 1 to 10”? If pain is not related to severity of injury, it seems a dumb question as well as an annoying one.

  25. @Claire : I think it helps them decide whether and how to treat the pain. Someone telling you that their pain is a 10 likely needs treatment, at least on a short term basis, regardless whether that pain level is objectively provable.

  26. @Claire Medical practitioners in this country were forced to adopt this practice in the early 2000's with the "pain is the 5th vital sign" campaign (brought to you by the opiate industry). "Pain is what the patient says it is" was the cause of the day, treated with narcotics. Its a question most of us hate, but somehow is enforced by the corporate machine as a meaningful assessment.

  27. @C. I believe that the scale is known to be helpful for acute pain not chronic pain. I do not have the research reference on hand but it has been documented for while. Take care.

  28. John Sarno was a master of the mind-body connection and its relationship to pain. Saved me from unnecessary back operations and helped me get through cancer treatment side effect free. So grateful his work found me and made sense to me. You must be willing to address difficult emotions however, which isn’t something everyone is able to do.

  29. Anyone in pain needs to read John Sarno and use his approach as an integral part of dealing with pain. Deep relaxation also instrumental.

  30. @TRCM Part of the difficulty of Sarno is that he makes some of the same points as the author of the article. He acknowledges that certain types of chronic pain are very much "real" pain (and can be absolutely excruciating) but also have psychological roots and can be controlled mentally to a much greater extent than is generally realized. To benefit from Sarno, you have to be able to hold those two contradictory ideas in your head. Otherwise, his work can easily get dismissed as, "He's just saying it's all in your head and blaming people who are already suffering," etc. Besides, if you have scans showing, say, a degenerated disc and the entire medical-industrial complex is supporting the idea that it's the cause of your back pain, who are you going to listen to?

  31. Why no mention of labor contractions? And no mention of how education, breathing and relaxation techniques , and coaching by a partner can help reduce the need for pain medication in childbirth?

  32. @Edie Clark : Possibly because a type of pain that will always end within a relatively short period of time (within 24 to 36 hours, typically) is not directly comparable to chronic unrelenting pain, such as that caused by, for example, inflammatory arthritis. Part of the problem in dealing with the latter sort of pain is that there is never any end in sight, which is a much more formidable psychological hurdle.

  33. True, but with my rheumatoid arthritis I’ve found that gentle yoga and meditation do help. Seems to be some carry over of the breathing & relaxation techniques.

  34. @Edie Clark Why no mention of post-herpetic neuralgia? Why no mention of testicular torsion? Why no mention of tooth pain? This is an article on the general perception of pain using a few examples germane to the discussion. It certainly didn’t- and couldn’t- include every single type of pain experience known to people. Take it for what it is even if it didn’t mention the specific thing you wanted it to.

  35. Pain and depression go together. The article would be improved by an examination into this dynamic whereby the chronic pain causes severe depression and the severe depression amplifies the experience of the pain. It can be a debilitating, stubborn, life destroying cycle that is difficult to break. What do you treat first? What do you treat most? What is the exact connection between the two? How do you break the cycle before the cycle breaks you? Difficult questions for a challenging infliction that can stop a productive life in its tracks.

  36. @RKNJ There have been many studies on the subject. Most say that you need to treat both at the same time in order for either to improve. Unfortunately, the depression is often overlooked because it is considered just secondary to the pain despite studies showing pain is a very common symptom of depression.

  37. @RKNJ I totally agree with your statement. Effexor at 300-375mg per diem helps with the pain and depression.( Effexor is an SNRI) That way you can treat both to some extent.It reduces the need for some opiods. I still will always need the Fentanyl patch to make walking bearable. Both conditions-chronic pain and depression -need treated together. Also additional pain conditions such as fibromyalgia develop from acute injuries. That never leaves either, and becomes an additional chronic pain syndrome if you overdo your new limits. Your life is never as it was prior to chronic pain.You lose a lot of activities and some "friends" who do not understand your condition, due to their ignorance of what it is really like to live this way. Also, say goodbye to 50-60 hours of productivity at work. There is a lot of mourning when you realize that you will never be the same as before which should be talked through with a competent qualified person.

  38. Rumination is dangerous and when we are in pain it makes it hard to focus on much else so mindfulness does help. But I’ve seen people fall into this cycle with both.

  39. Though the article makes it clear, "pain is an opinion" is far from true, and possibly damaging or life-threatening. No one chooses pain.

  40. @Stourley Kracklite - Opinion: a view, judgment, or appraisal formed in the mind about a particular matter. It seems that the author used the word "opinion" in the sense that, as he noted, "In truth, pain is in our brain." Not that we choose to feel the pain, more that the perception of pain is "formed in the mind".

  41. @Stourley Kracklite Pain is subjective- nobody is given a unit of pain. Many expect an outside source to alleviate pain. Some people do chose pain, I have seen it. The whole point if this article is to shed some light on the pain process, truth that was taken away from us by the manufactured opioid epidemic.

  42. @C. Many will be surprised that their pain was somehow other than something presented to them without their express desire. I can't explain what others see when they observe the choosing of pain. Maybe reassurance that bad things only happen when people leave themselves open to it, or don't take care of themselves?

  43. So once again Mother is shown to have been right all along. Kissing the boo-boo really does make it feel better. The human brain is an amazing thing.

  44. Dr. john Sarno already covered this concept in the early 1980s.

  45. @Dr. Sam Rosenblum I know someone that did NYU's Sarno program after cancer surgery created chronic pain. She didn't get much out of it. She felt like a failure, and they agreed with her. She then found (on her own) and received pelvic physical therapy from another facility that targeted the scarring and muscle spasms. She got better. A lot better. Sarno's program won't address real tissue damage that can be treated by skilled providers. But it takes a wider lens than "pain is all in your mind, therefore it isn't in your body".

  46. @Dr. Sam Rosenblum And Ronald Melzack covered it before then.

  47. Traumatic physical illness or injury can leave a nervous system on red alert long after the crisis is abated. It is not always the case that individuals with persistent pain have unresolved difficult emotions or severe depression. Sometimes, against their own will and efforts toward calm (sleep, exercise, mindfulness, etc) pain is perpetually produced by an over-activated nervous system. It is my experience that most people who tell others that pain is produced in the brain and thereby in one’s reach to interrupt, have not experienced the potential debilitation of real chronic pain. Having tried everything under the sun for my chronic pain resulting from infection and injury, I found that the only thing that truly helped was neuromodulation - the implant of nerve stimulating equipment into my body to interrupt the pain signaling. My nervous system needed the medical assist. Thought alone would not budge it.

  48. @Sati Okay,pain isn't produced in the brain but If you pound the foot of someone with a transected spinal cord which would prevent any signals from it reaching the brain, that person won't experience any pain from it. Yet, as the article notes, people often experience phantom limb pain where the pain can't be produced in a limb that is not longer present but can be produced in the brain.

  49. @Steve I do not dispute the fact that pain is produced in the brain. Rather, I dispute the suggestion that because it is produced in the brain it is therefore under our control. It may be for some with internal stressors not given an appropriate outlet. It may not be for others who simply have an over activated nervous system.

  50. @Steve Thanks. I just wrote a comment that made the same point(no signal to the brain, no pain) but you helped me see how to make the point in a new way. Let's do a thought experiment. Some one has invented the most amazing psychological technique. They've also precisely identified two regions of the brain associated with pain: Region A can be trained to reinterpret any pain experienced any place in the body. Region B can be trained to stop nerve messages coming from any place in the body. So let's get back to Steve's foot pounding example, with Sati as my patient (I teach psychological pain management, among other things). I begin by teaching Sati how to access and activate Region A in a way which will enable him to radically reinterpret the nerve messages from his foot as it is being pounded. He fails to active Region A and continues to insist that the only solution will be neuromodulation. I make a clinical assessment and determine that Sati is the kind of patient who particularly values being in control, so I teach the "Activation of Region B" technique. Sati, after much practice, succeeds, through various attention-control techniques, in stopping altogether the nerve messages from ascending his leg as his foot is pounded. He then goes on tour, doing fire walking, and various kinds of foot pounding demonstrations, showing the validity of the Region B technique as he smiles while various methods of food pounding are applied! www.remember-to-breathe.org

  51. I wonder if anyone has researched a connection between pain experience and the so-called "resilience gene," which was much talked about a few years ago? I'm a member of the chronic pain community, as I suffer from a type of inflammatory arthritis, and I am often perplexed by how differently patients I know with almost identical labs and imaging experience pain. My observation is that some people are just programmed to deal with any type of stress, including pain-induced stress, better than other people. For me, the key to managing my pain is routine -- routine bedtime, routine meals, routine exercise, routine schedule all around. Disrupt my routine, and my pain levels and other constitutional symptoms (e.g., fatigue) increase.

  52. I have suffered from chronic debilitating pain for 14+ years caused by a severe arthritic condition in my spine, Thank you for the article and the comments, it is helpful... I have gone down every rabbit hole trying to alleviate my pain. Prescribed and unprescribed drugs, ice, changes in environment, extreme diet modifications (still a work in progress), yoga, breathing exercises, and meditation ... While I prefer and recommend actions that don't leave a residue (drugs ), thank God for all the choices that are available ... I think people often underestimate the horror of what pain can be ... I think suicide and even mass violence are expressions of the horror of pain. I'm looking forward to reading about some of the information that was left in many of the comments (music therapy, John Sarno ...) I wish the article had talked more about (my understanding ) that if you can slow your breathing you calm your nerves. Wishing everyone with pain ... love

  53. Excellent.

  54. @Paul Yes, why no mention of wonderful Dr. Sarno?

  55. @Paul I went on the same hunt as you to try to cure my chronic pain. I had the wonderful opportunity to attend the 3-week Mayo Pain Rehabilitation Center. There I learned to accept pain as my new normal, adjust to it and adapt to it. Part of that program involves relaxation techniques like deep breathing. Check out my Facebook group: Chronic Pain Champions.

  56. If my pain is an opinion. I sure wish it would change its mind. This opinion is kicking my butt.

  57. Austin, this is great info. I’m sure you are aware that John Sarno was a pioneer in this field. He deserves to be mentioned in your article as much of this research was started by him and he faced disbelief and ridicule for years until he had the clinical proof. His books are widely available in libraries and for purchase. Please share the real credit and offer the solid resources that you and your colleagues are building on.

  58. @Lisa Thanks Lisa, I was looking for a reference in the article to Dr. Sarno. He helped so many people and gets so little credit. Why?

  59. Thanks so much for this article and for the links. Very helpful.

  60. Maybe there is nervous tissue that transmits pain. We are discovery something new daily.

  61. Guaranteed Reduction of Pain Within One Month, If Not Sooner: Get a Labrador Retriever Puppy "If there are no dogs in heaven, then when I die I want to go where the dogs go." Will Rogers

  62. @capnbilly And, if you don't care if your animal companion is indifferent to your pain, get a cat. A purring creature nestled in the crook of your arm, giving comfort while indifferent to you, can be both a pain reducing AND a maturing experience. Dogs? For the emotionally needy.

  63. @LGato Cats - the parasite that infects cats also infects then brains of prople with cats. Then they start to like cats and do their bidding.

  64. @Jana This parasite thing is a bizarre little tidbit that seems to be getting a lot of air time lately. I presume you're talking about Toxopasma gondii. It's become a case of whisper down the lane. It does not mean you will "start to like cats and do their bidding" LOL. Good grief.

  65. Pain is relative. Most of my relatives are a pain.

  66. In the same way that pain is all in the head, so is all tactile sensation, from the feel of cool water to that of dry gravel. Our brain interprets all stimuli provided to it. This questionable premise does nothing but trivialize suffering and place blame on the individual who can't just will it away.

  67. @rbyteme I don't understand your point. Let's try something different: The word "nociception" is a technical term referring to the specific sensation associated with the psychological experience of pain. The nociception is real. The pain (the brain interpretation of the nociception) is also "real." There is no blame or trivialization involved here; this is simply a scientific statement of how the brain and body work. Now, how do you lessen the pain? In my experience in psychological pain management, there is only a very small percentage of chronic pain patients who can eliminate the pain associated with nociception by psychological means alone. But a very high pecentage of chronic pain patients can rather substantially reduce the pain (ie train the brain to reinterpret the nociception). And if they can't do that and use only physical methods, there is absolutely no reason to "blame" them. To review. These are simply facts without any judgment: Nociception is the sensation; "pain" is the brain's interpretation of the sensation. A few people can train the brain to change its interpretation sufficiently to eliminate pain. Many people can train the brain to change its interpretation sufficiently to reduce pain. Those are facts. Whatever method people choose, all physical, all "brain training," or a combination, is entirely up to them, no judgment involved. Does that help? www.remember-to-breathe.org

  68. About 15 yrs ago I started to get treatment for chronic back pain. I had a lot wrong with my spine that was easy to see via MRI or x-ray. Here's how it goes. First you are pretty much out in the cold if you don't have Medicaid or Medicare because private insurance is a joke on all of us. So states love those cheap pills as does Uncle Sam and they hate physical therapy because it's hard to corrupt that kind of treatment. So as usual the patient get punished. They are told they are faking it, or my favorite is that somehow every single quack out there says "I've seen worse backs than yours it didn't cause that patient as much trouble" This is the way our rotten doctors blame the patient and discredit him as a drug seeker when it's the doctor and ONLY the doctor who controls the drug and that state denies patients request for PT. We simply do not have a functional health care system because it's become a pipeline for our justice system.

  69. For people interested in pain, check out the NYT article “At 71, She’s Never Felt Pain or Anxiety. Now Scientists Know Why.” Surprised the author doesnt mention her. The iOS NYT app algorithm doesn’t seem to think its relevant enough to show below the end of the article.

  70. Thank you for this article and for especially the excellent links. I’ve been sidelined for several years with the pain and disability of advanced osteoarthritis. As a retired nurse with a critical eye for good science-based information, I am hopeful today to find expanded understanding and a path to getting my life back on track.

  71. @Kathleen Please consider finding excellent physical and occupational therapists that could help you turn things around. This could be covered by Medicare. Also consider home modifications to increase your ease and safety. They don't have to be expensive or disrupt your home.

  72. Cathy, she’s a nurse. She’s probably heard of physical and occupational therapy.

  73. Yes, a good physical therapist, and I also suggest pool exercise classes. I have done zumba and aerobics, but with aging and my arthritis, the pool exercise is far superior.

  74. Our entire lives occur only in the moment. Past is memory, Future is yet to come, Life is Now, always Now. Yes, this moment includes pain, and while pain is not what I'd choose (wouldn't life be boring if we could choose all experience?), nonetheless it is my reality and there are lessons in all aspects of this gift of Life. I try to accept the pain, let it be, and continue with my day. I think of those whose lives are far more challenging than mine and who appear to deal with their challenges with grace and courage - and that gives me strength. The results of Acceptance do vary with the level of pain, of course. Some days it doesn't work so well and I try to remember the Buddha's teaching that, "This too shall change". I also use marijuana in small, regular doses and find that being mildly stoned allows me to step back from the pain, to view it somewhat dispassionately, to be less intimately involved with it.

  75. @Miss Anne Thrope Nice rework of St. Augustine's definition of time: The past is only memory (often very faulty), the future is only hope (that may never be fulfilled). There is only the present.

  76. @Miss Anne Thrope "Our entire lives occur only in the moment. Past is memory, Future is yet to come, Life is Now, always Now." William Faulkner would disagree with you …

  77. @Miss Anne Thrope Please don't forget that there may be Western medical intervention that could cure your pain for good.

  78. I think this is a good article. During an attack of kidney stones at age 20, that caused intense pain for two days, I was surprised to notice that, when my friends paid me a visit, I barely noticed my pain. However, one should be careful about raising patients’ hopes and of making those patients unable to find any relief from mind control techniques guilty (as one should not make cancer patients believe that, with a better attitude, the may never have contracted the disease).

  79. @Claude Vidal This works because of distraction, as it would with something like grief. No one can be distracted all the time.

  80. Tell this to me and my senior friends, who go to exercise classes 3 times a week, and still fall, frequently, because we can't control our pain. Keeping on moving helps, but it does not solve the problem. Pain makes you extremely tired, and it can be a depressive, as well. The fight against pain is a very tough one.

  81. @ChesBay Tai Chi-- a gentle type of exercise that helps with balance-- might work better for older bodies..Worth trying?

  82. @ChesBay I too am an advanced senior, and while I've spent my entire life exercising a LOT and eating the right things, meditating and being active and working at a grueling job because I loved it, the chronic pain I now struggle with in my advancing years is NOT a figment of my mind. I have multiple x-rays and MRI's to demonstrate where it comes from. Now I'm beginning to understand some of the arrogance that younger people display in these issues. Some day you too might get to live a long and active life, and you too will be surprised by the toll it takes on the body.

  83. It's always fascinating to check in to brain developments, but continue to leave thinking: "Better, better, but still not there yet." This article is a good one, showing an important piece of a larger puzzle. It would be nice to do a larger "brain" series, including framing out the various other pieces, and aiming to show their interconnections. For example, this article equates brain and mind. I became aware of the pros and cons of this apparent identity over 40 years ago. When I recently re-checked in, it appeared the "definitely not the same" side had won, but it's still unclear where the non-brain part of the mind resides. Then you have two other parts the Times has actually covered: a fascinating recent one by Brooks on the cognitive: emotional connection. One on brain re-wiring. There's the question of what MRI images of parts of the brain lighting up in certain situations tells you, versus what can be misinterpreted. I've also seen contradictory evidence about whether certain functions (e.g. memory, learning, the auto-pilot things), are strictly connected to dedicated parts of the brain--or not? And the biggie, the most confusing of all, are our brains (or, better, our consciousness) linked to each other and maybe to nature, as many in my network confidently state? And then, can you make a further connection with lowering pain or increasing positive things like empathy or better ways to learn? Lastly, are we so sure other critters don't have these going on as well?

  84. Many people who are able to practice meditation as described by practitioners like Robert Wright in his book, Why Buddhism is True, develop the ability to experience pain with increasing detachment. You experience less of the negative response to pain and simply observe it instead. This is quite different than being distracted from pain. Eventually, the pain dissolves so to speak. I highly recommend mindfulness meditation as a useful exercise for anyone trying to manage aches and pains as well as stress, chronic or acute.

  85. Not too surprising considering that for almost 50 years we've known that the signals that come from the brain are just as important and often more important than what is going on in the periphery with regard to pain. As a pain management doctor, patients often ask if the pain is all in their head. I say yes because even if you have an injury or disease the signals have to reach the brain for you to experience pain. And, by the way, the major world wide organization for pain management professionals, the International Association for the Study of Pain, defines pain as always being a psychological state.

  86. If you have pain, you might find the book "You Are Not Your Pain" by Burch and Penman helpful. It changed my life. The causes and the flares of pain are still with me, but most of the time it's manageable. And often the techniques in the book make the pain just stop.

  87. Every kid knows that as soon as you put a bandaid on a cut the pain decreases,

  88. @JimmyP well said .

  89. @JimmyP My dear Jimmy P, you are mistaken, it ALSO requires a sticker and a kiss! Baby talk and snuggling also helps.

  90. All this mind-over-matter pain control is leading toward taking away our only serious treatment for pain—opioids—which most of us will need at some point in our lives. Nobody lives this fictional stress-free life. Everyone sits in front of a computer eight hours a day or works a physical labor job eight hours a day, and then commutes. All of this takes a toll on the body and will eventually lead to pain for many people. The body was not meant to live like this. It won’t be long before we will be back to a tossing back a shot of whiskey and chewing on a rag after surgery or when we’re dying a painful death. 

  91. @Rose "Nobody lives this fictional stress-free life. Everyone sits in front of a computer eight hours a day or works a physical labor job eight hours a day, and then commutes. " Not true, Rose. There are those, like me, who have life routines that reduce stress. I get eight hours of sleep a night, work at a job (artist, working at home so, no commute) that keeps me moving (but without straining), take a 45 minute nap after lunch, sit and listen to 30 minutes of classical music before dinner and enjoy a bottle of red wine in the evening. No stress and I haven't been ill in decades. I know many others in my situation as well. You just have to set your mind, and goals (read 'money') to a more reasonable level.

  92. @Rose If you think that opioids are the only serious treatment for pain, you're completely wrong. In fact, the most common forms of chronic pain are much better managed with both non-opioiid medications and non-pharmacologic treatments. And if someone needs opioids in order to get through a normal work day, they've got a serious problem.

  93. @Jimmy I hope you never have a kidney stone or a herniated disc. Then, you'll know what pain is.

  94. Several years ago I did a 10-day silent meditation course, 100 hours of sitting in total, 10 hours a day, in one and two-hour sessions. I was no meditation expert at the time, just curious. After 40 hours, I found myself sitting for over four hours straight without a break. The most astonishing thing was that my legs didn't hurt, at all. Somehow the meditating had temporarily turned off the pain/ache I would normally feel when sitting. I now know a bit more about what happened to me for those few hours, it turns out that that withdrawing from the senses has been part of many meditation techniques for thousands of years. I will never tire of reading about and experiencing firsthand how Eastern mysticism continues to inform Western science, philosophy, and medicine.

  95. @David Evans So, if you had leg pain from a "real" cause (say, arthritis), you could eliminate it meditating all the time. Sorry, that doesn't work for most of us. I'm glad it did for you.

  96. Sorry, the whole concept that pain is "an opinion" or something that a sufferer can magically will away is a dangerous view that may well cause additional -- and utterly necessary -- pain and suffering to people who suffer from chronic or acute pain, who may then be told "live with it! It's all in your mind!" Some techniques can certainly help alleviate pain, and pain medication can be -- and is -- abused. But for many pain sufferers, pain medication is essential to living a decent life and being able to function without misery. Legitimizing suffering as an "opinion" or an "option" is a dangerous view -- and frankly an irresponsible one from a medical practitioner.

  97. @NYer I agree, but in spite of the dumb headline, I don't believe that's what the author is saying. Pass by the brain science for a moment and re-read the last paragraph. The author is saying that explanation, reassurance, and distraction (e.g., playing the trumpet, talking with a friend) can temporarily reduce or even relieve pain, which is a good thing. He never says, nor does the research cited say, that pain is only an opinion that can be changed at will.

  98. Is it possible that the areas of the brain active in sensing and communicating pain are also involved in being absorbed in a pleasurable activity such as playing music and therefore too busy to feel sense/transmit pain at those time? Like the thyroid gland which when filled with non radioactive iodine is unable to uptake radioactive iodine, the idea behind thyroid oills in case of a nuclear power plant accident.

  99. In 2016, I had cancer. I survived but not without the help of pain meds that allowed me to withstand radiation and chemo. My excellent and awe inspiring doctors and nurses at Fox Chase made sure that I got enough pain relief but not enough to become reliant upon the drugs. Mind over matter wouldn't have done a darned thing about the pain that I was experiencing.

  100. As you point out very well the perception of pain is related to the degree of control that we have over it. The best example is not one you included: self administer narcotics are generally less than those needed when the patient is not in control. Control is the first element of Antonovsky's sense of coherence that he found as the hallmark of healthy people. The others are a sense of understanding and meaning. We think we ought to build a system based on this coherence rather than one contributing to learned helplessness and the absence of any sense of control. Look for it at "Salutogenesis Revisited".

  101. What a completely damaging and ridiculous idea.

  102. @Rich It's not an "idea" ...

  103. Pain lets us know we’re alive, only the alternative is pain free.

  104. I have come to be a great believer in the adage that "pain is not suffering." Pain is indeed a genuine experience. Suffering is our reaction to that pain. Suffering is under our control and is optional.

  105. @PatC Completely agree. Check out my Facebook group: Chronic Pain Champions- No Whining Allowed.

  106. I also think that understanding what is happening to you can sometimes help reduce the pain. When I had gallstones and was in agony, I know that part of the pain was fear as I had no idea what was wrong -- was I having a heart attack? had my appendix burst? was it cancer? While still very painful, once I found out that I had gallstones and the doctors developed a plan for treatment, the pain was different than when it was mixed with fear.

  107. @TrixieinDixie The more we know about chronic pain and that it always doesn’t mean more harm makes it easier to live with.

  108. The photo at the opening of this article shows art work related to pain. I was disappointed to see that there was no mention beyond that picture of the use of art therapy to address pain. I am a retired art therapist/professional counselor and had success using art therapy for this issue. Also, I found no mention of the use of guided imagery to address pain. Interactive Guided Imagery(sm) as taught by Martin L. Rossman and David Bressler also is a powerful intervention for pain and I saw many clients experience significant pain reduction with its use. Imagination is very subtle and very powerful. With little attention to the imagination pain can easily be exaggerated by expectation and fear. With proper attention and guidance imagination can change one’s relationship to pain, modify the meanings one makes about their pain, reduce the suffering associated with the pain, and reduce the experience of their pain both in the short and long run.

  109. @BobS My surgeon referred me to an alternative medicine specialist after a radical mastectomy. She taught me to visualize. First image of my cancerous breast was of a violently active volcano. Went through a number of images during chemo, and the last image was of white worms working through black dirt which I recognized as my white blood cells. This helped me enormously with pain and anxiety and was actually cheerful and often funny.

  110. @MaryDB Thank you for sharing this. I hope you are well now. Yours is a fine example of the efficacy of the use of imagery in healing. Not only does one’s disposition to the pain/trauma change, but this can also affect the progress of physical healing, according to studies available through the Academy for Guided Imagery. (acadgi.com/about_sitemap/imageryresearch/master_bibliography/)

  111. Pain is real and can be nasty, sharp, biting, mean and cruel. On the other hand, have you noticed that in the throes of pain, a talk with a good friend(or playing the trumpet or anything you love doing) distracts you from it, and you almost forget its there. Your spirit comes up and your pain is no longer your focus. It hasn't gone away, but your mind is no longer dwelling in it. Of course it returns. But I think the author of the article is saying their are ways to control it. When I was a child I used to stand in the shower, and make it progressively hotter and hotter almost until I couldn't take it, but then at the same time disassociate from my body, leaving m bodily sensations. For a moment or minutes I wouldn't feel the heat of the water at all. Mind over pain? I don't know. Disconnecting from your body thru a meditation or mental distraction may not take your pain away, but might help reduce your focus on it. Also, seeing pain as a temporary state helps. For most, it always diminishes over time and hopefully goes away.

  112. What I've found out about pain from having terminal cancer where the pain is almost in my entire bones and abdomen is that it's personal. When my cancer was starting to spread before I knew I had it, I was running 20 miles a week. My schedule was every other day 6-7 miles. I dropped the miles the last 2 years from 34 miles to 20 because I was having a hard time running 34 miles in a week. That 20 miles a week really helped me. The days I didn't run, I was in quite a bit of pain but was too tired to figure out why or even think to make a doctor's appointment to figure out why. Two years later, I'm almost bed ridden and would give anything to be able to run or even walk. So I agree that there are things that can help with pain besides drugs. Do those things for as long as you can. Little did I know I was running 6-7 miles riddled with tumors.

  113. I was also a runner before being diagnosed. Losing my identity as an athlete has been so difficult. I am still able to do some things and go into the outdoors, but I doubt I'll be long for the world once I can't. I wish you all the best and am sorry you have had to experience cancer.

  114. @Nancy, it is really hard to change the perception of who you are. Especially after running for almost 40 years. Good Luck with your diagnosis too.

  115. It's interesting how many articles claiming "Pain is all in your brain" have been published lately. The Washington Post just published an article in which an MD suggesting that pain sufferers learn to live with pain, like Chicago residents must learn to live with the noise and disruption of the city's infamous Elevated train. As someone first diagnosed with degenerative disc disease in 1984, I find these articles vastly entertaining. Interesting that my pain has nothing to do with the nerves compressed by the adjacent vertebra. So exactly how far does this "play or pray the pain away" extend? When my appendix became gangrenous, should I have meditated or played a musical instrument? Is the new protocol for chest pain to exercise? We're doing a lot of things to avoid even the legitimate prescription of opioids. For years the VA has been substituting a less effective gabapentin for my pain; now news reports indicate that gabapentin is related to an increase in suicidal tendencies. Soon pain management will be down to swallowing a placebo with a shot of whiskey and biting a bullet.

  116. Ken Arbogast How true. It is humiliating when you are asked to leave a urine sample and pain management wants to count your pills etc.Until you have the "lovely" experience of chronic pain,no one else understands until their own ox is gored. Then the doubters sing another tune. One is never given enough to make you addicted.The pain specialists' philosophy is that a certain amount of chronic pain is "tolerable". MY question is to whom is it tolerable? Not the pain patient.

  117. Reply to Ken Arbogast, You’re right. I’ve noticed this topic as the new pop psych human interest theme across various media, as well. Put it out there and the zeitgeist will follow, I guess. Now that modern media can literally count eyeballs on stories, we must assume these stories pay. I find the comments on this theme the only useful antidote. That well-intentioned others apply these ‘facts’ to those who suffer (shall I say it), I find insufferable. God bless us, everyone. Although I suspect Tiny Tim may have exaggerated his limp in order to obtain a larger portion of goose and pudding in a competitive family of older siblings.

  118. But what does this tell us? Aren't all physical sensations and physiological events connected to, mediated by, the brain? Is hunger just an opinion, too? Obviously, if you're hungry, or experiencing any unpleasant sensation, you can distract yourself, to a greater or lesser extent, by (for instance) playing the trumpet, or anything that floats your boat. Sometimes distraction will work, but in other situations, and for some people, that is simply freaking ridiculous. It seems to me this "pain is an opinion" is at best a truism. We can push through lots of physical discomfort by distraction, whether hunger, thirst, fatigue, etc., or feeling briefly comforted when a loved one holds our hand, etc. That isn't news. What does it accomplish for us to consider these states an "opinion"? Lately, I am nearly as wary of the continual bombardment we are under regarding "mindfulness" and meditation as the cure-all for everything - well, that and CBD - as we all should have been about the pharma-orchestrated opioid campaign ("Here, take 150 pills with you and call me next week if you need more"). Distraction can be a useful tool, but dressed up in neuro/psycho/spirituality babble, I'm not impressed. Although I am not in chronic pain, I understand the rage of those of you who are.

  119. When I feel strong pain, I have always (as long as I can remember, at least) pictured the old footage of the rocket launch, the part where there's a ring of fire and the debris of the spent rocket falls away, down toward the blue earth.* It's not something I'd thought much about until I was older and discussing pain (drug-free childbirth) with friends. I just assumed other people also pictured something as they dropped their pain away. I in fact visualize/feel that my pain is being pushed down, slightly to my left, when I am trying to carry on. My friends informed me not everyone "drops their pain away" and they didn't know anyone who had a specific concrete routine visual like that. It's always happened, for as long as I can remember, inadvertently. I can concentrate and make it happen for little things and it happens on its own for big things. I did have open heart surgery twice, once as an infant (forgotten) and once more as a young child (remembered). I suppose that formative experience has contributed to my relationship with pain. *See the 3:07-3:14 mark on this video for what I see: https://www.youtube.com/watch?v=vHWDNrrfhnI

  120. Doctors and psychologists need to be careful with this "all in your head" mentality though. Pain, for the vast majority of times, is an indication of an injury. That you don't see or understand the injury doesn't necessarily mean that the pain is phantom; it could only mean that the injury is not understood instead. And I'm afraid some people are too quick to invoke biopsychosocial model or call the pain/disorder functional. NYT article discussing the problem experienced by the US embassy workers in Cuba and China as a likely case of mass hysteria is the case in point. (https://www.nytimes.com/2019/07/23/science/cuba-diplomats-health.html). Later study did confirm the injury in the brain of the affected people.

  121. @TK Sung I suggest you go back and read the article again. The authors of the study clearly state they couldn't say there was any connection between the symptoms and the study results. And by definition chronic pain is considered to be pain that continues to occur after any injury or disease has resolved. Finally, pain is one of the most common presenting symptoms of depression.

  122. One could substitute the word "fatigue" for "pain" throughout the article and comments, and it all would still make sense.

  123. @Richard Kaye How about hunger? Thirst?

  124. @DW Yes, those too, now that you ask. I speak as a competitive runner and (at times) as someone diagnosed with chronic fatigue syndrome. As a runner, when you lose hope of catching the competitor ahead of you, it gets a bunch harder to keep going.

  125. What about when “chronic pain” is due to a physical problem that can and should be corrected? Tricking our brains to ignore or minimize pain could be dangerous, right? I was told for many months that my severe headaches (and tremor, hyperreflexia, syncope etc) were due to migraines and was sent to a psychologist, physical therapist, etc etc. What I actually needed was surgery to remove a brain tumor that was pressing on the brain stemand tectal plate, closing the Aqueduct of Sylvius so the 3rd ventricle couldn’t drain, etc. All the mental tricks to ignore the pain and feeling of head-exploding pressure did little...I just felt dismissed and insulted by most doctors I saw (being informed there’s nothing physically wrong with you and that they suspect you’re just looking for drugs will do that). Eventually it got so bad I did seriously consider going and buying heroin or pills on some street corner for relief, or just killing myself, but I had a young child (and an intense career of 20+years (which I lost), and am a single parent, so I didn’t. On and on, grinding pain. Couldn’t lie down flat (pressure in my head got worse). Anyway, a neurosurgeon (my hero!!) finally identified and removed the tumor, and now I’m fine. FINE. No mental tricks needed. Occasional minor headaches from a chronically over-stimulated cranial nerve, but I can distract myself from that sort of pain. My point is real pain can be a warning, as well as traumatizing, and shouldn’t be ignored, right?

  126. @emily Amen! Having multiple clinicians dismiss your pain might just mean that you’re a woman, a POC or someone with a history of anxiety. In my case, too, it simply meant they didn’t know and were looking for easy outs...or simply acting on their own biases. The right diagnosis isn’t insignificant in treating and managing pain. Pain programs that insist you stop looking for answers are suspect to me.

  127. @SE I wonder if either of you - Emily or SE - could help me. I didn't see anything in Dr. Frakt's article about "dismissing pain. The situation remains that, Emily, if you had not had the tumor removed, and you had the capacity to use attention to radically change the way your brain interpreted the pain, it could have lessened dramatically, yet remained as a mild indicator of a warning that something needed to be done. I don't see anything in the above paragraph that involves "dismissal," and I don't see anything in what either of you wrote that changes the fact that 'pain" (defined both by the American and International Pain Associations as something "psychological" - not meaning it doesn't exist but it is an interpretation of a physical phenomenon) only exists if the brain interprets the sensation in a particular way. I wonder if it might help to speak of "nociception" (which is the technique term for the sensation associated with pain) as the physical component of your experience, and "pain" as the psychological component. The nociception is absolutely real. It is not remotely dismissive to speak of pain as psychological. The nociception is there, it's real, but the intensity of the pain is entirely dependent on the interpretation of the brain. Most people probably can't change that reinterpretation of the brain by psychological means alone. My own research suggested it's about 30% who succeed. But that doesn't change the fact - no brain no pain.

  128. @SE I don't know of any pain program that insists on not looking for the right diagnosis (ie the right answer). If you have tried surgery and all kinds of medications, neuromodulators, etc and no other physical means has helped to reduce the pain, wouldn't you want to at least consider some kind of brain training that could help you reinterpret the sensation (leading to reduced pain) so at least while you're looking for the most accurate diagnosis, you will be in less suffering?

  129. I am currently enrolled in a workshop called “Mindfulness based chronic pain management” as a patient suffering from neuropathic pain. It is based on a book by Jackie Gardner-Nix (The mindfulness solution to pain). The first thing they made clear in the workshop is that pain is NOT in our head, meaning that it is extremely rare for physical pain to be purely psychological. The painful sensations are very real, whether you are suffering from fibromyalgia or a herniated disk or cancer, etc. But as we all know pain is increased by stressful situations, by rumination, by lack of physical activity, etc. There are a lot of things one can do to manage their pain. Personally, since I started the mindfulness approach, my relationship to pain has changed a lot. I am still in pain, but I am a lot less defeated by it. I suffer less. I am more active and calmer. I meditate every day. I am more aware of what triggers pain and less frazzled by flare ups. I also understand how my nervous system is stuck on high alert and how through both body and mind therapy we are trying to reprogram it. There is a lot more to chronic pain management than taking pills even if those are still an important part of any treatment. Psychological approaches are a key component to any chronic pain management program. Again, it absolutely doesn’t mean that we are imagining the pain!

  130. @Sophie I don't think Frakt is saying that you (or anyone else) is imagining the pain. He's just trying to describe the brain's role in interpreting signals from the body. The very fact that you are enrolled in and finding some relief from the mindfulness program underscores the importance of paying attention to factors that affect the brain's response.

  131. I think you absolutely missed the whole point of the post. What is abundantly clear from research now is that "Pain is in your brain". Your brain CONSTRUCTS pain and nociception is just one of the inputs. It is just like vision; the brain constructs the visual image for you. Even the definition of pain says " Pain is an "emotion"... And remember that there is actual physiology behind psychology. Your thoughts are actual nerve impulses that you just don't happen to see. Your thoughts aren't floating around in vacuum. Phantom pain is a classic example of pain with little nociception. Book by Moseley called "Explain Pain" is a great read ( easy read too) if anyone wants to learn more about the new understandings in pain and pain management.

  132. Why is it so easy for people, especially medical professionals and doctors, to think you're making up your own devastating pain? Unless you have had an accident, as I have, and have a dreadful and degenerative back injury, please don't stand in judgment of me or my pain. You can't possibly know what I've been through or how my pain shapes my life. I don't take opioids and I never have. I'm not addicted to anything, and never have been. Instead, I exercise and use my pain expertise to handle the pain. When it gets unbearably bad, I turn to nothing but myself. I refuse to allow anyone to tell me pain isn't real, or is all in my head. Walk a mile in my shoes and you'll understand. It takes guts to face pain head on.

  133. @Pamela L. The article did not say that people are making up their own pain. it is a description about how the brain processes nerve impulses, and how the perception of pain can be modified by multiple things. Pain can be both real or phantom. There are many instances of this, as described in the article. And pain is in fact in the head, because that’s where the brain is! As someone in the medical profession, I’m guessing you probably had some negative experiences during treatment. Based on your description of your case, I can also tell you that you have handled pain better than many.

  134. Chronic pain is chronically complex. Every situation, every person experiencing whatever form is unique. A combination of of factors amplify chronic pain intensity, some cited in the article, others by comments already made. I'm a clinical psychologist who works both with benign chronic pain across the lifespan and malignant pain at end of life. What works for one person is typically never 1 practice, medication, or approach, and what works - a puzzle of sorts of a few (or many) approaches will not be the same person to person. It is vital to note as many comments have cited that pain is real. It is important to note that pain is a mind-body experience; we're whole. Treating the whole person, not in a mechanical (Western medicine) way is a key to improving quality of life. Improving quality of life is the name of the game. So very many people cannot, will not be able to eliminate pain at all; but the point in treating it with a multifaceted approach is to improve quality of life, even if quantity - as in end of life - cannot be extended.

  135. Back pain bootcamp. The trainers take you into the pain via exercises and eventually the minds fear of the pain is reduced. The trainers use the mind muscle connection to push the envelope until the fear and actual sensation are reduced thus allowing one to carry the groceries or what have you with out threat or fear of sudden pain striking.

  136. I’ve had the good fortune to find a Back Bootcamp just outside of Boston. It works! Thank God!

  137. Persistent, unexplained pain should absolutely be investigated before turning to meds (e.g., ibuprofen), distraction, or dismissal. I developed back pain at about 50 years old, and attributed it to getting older (and so started going to yoga in earnest). After a year of dismissing and enduring this pain, an eleventh-hour MRI showed bone metastasis on my spine. Now, I meditate (and still do yoga) to help with the cancer pain; and this helps, somewhat. But context is everything; pain can certainly be a signal that something is wrong.

  138. After three months of increasing and debilitating severe pain and the useless and plain incorrect advice of 12 doctors, sports medicine experts , physiotherapists and radiologists, I was finally fortunate enough to be recommended to a neurosurgeon (by a friend not a doctor!) who performed a simple 40 minute operation called a disc decompression on my L5S5. Guess what? Turns out all these health professionals were plain wrong and the pain definitely wasn't in my head - I had a conjoined nerve which meant the the prolapsed disc everyone said was so minor was causing extreme and unrelievable pain in unexpected places. This despite the fact that cnojoined nerves, although rare enough in the general population, are actually reasonably common in people with intractable back pain. After surgery I was able to sit pain free or the first time in 3 months and I have never looked back. I needed to come off the meds I had been using slowly - none of which controlled or relieved the pain anyway - but I have never experienced a recurrence of my condition apart from a form of ghost pain due to an overstimulated nerve left for way too long by people who were so fixated on the idea that my problem was pain amplification that they never considered the obvious idea of looking for a nerve problem with a simple MRI. Fortunately my condition wasn life-threatening like some other readers, but please, get checked out properly before you accept any pseudo-diagnoses from so-called pain experts.

  139. More mumbo jumbo to justify doctors' ignoring pain and making feeble recommendations for relief. The healthy and the young are always telling the sick and the old that they can and must suffer longer than they may want to or be able to, especially when it comes to mental anguish. Right to die legislation is great, but it doesn't go far enough for those whose pain will never end no matter how hard they try.

  140. @Nancy We've had people here in Canada approved for medical aid in dying solely for pain. A woman in my province was the first with just osteoarthritis. It's the "final" solution to poorly treated pain. We now qualify in early Alzheimer's as well.

  141. Mr. Moseley and Ingram make great points about how neurologically derived pain (which is all pain) is not the same as our "thoughts" and part of quite complex system. Unfortunately, I don't think that FraktI disabused many of that false connection with this superficial and short essay. For example, I wish Frakt did not follow Moseley and Ingram's key points with a somewhat reductive and cursory take away (deep breathing and changing your job, etc.). I would like to hear more from Moseley and Ingram about specific behaviorial modifications and therapies that have shown promise or are currently being (or should be) studied. Sadly, there is more money in pushing pharmaceuticals than in investing in behavioral studies.

  142. This is what happens when scientists skip their required Philosophy of Minds classes: We have no real idea what pain 'is' and anyone who claims that they know what it is has not thought very carefully about it. We can never understand another's pain -like the first one - we have no idea what the mind of another is experiencing. We have no idea how bad our pain is let alone someone else's pain - see the first two points. And lastly to the "All pain is real" - well no - this might be your shorthand for the idea that we should treat and act as if all pain is real

  143. Pain is a sensation. The effect sensations of all types have on us is influenced by how much attention we give to them and what they mean to us. This is the basis of most cognitive and emotional methods of managing pain clinically, and it helps to explain how people naturally differ in how much they suffer from pain. How we behave as a result of that sensory effect can largely determine how the condition turns out. The behavioral expression of that sensation can heavily influence how our environment responds to the pain condition. That response loops back to further influence how much attention we pay to the pain and how we interpret it, as well as how it is treated by the individual and by health professionals. Therefore, the individual's cognitive, emotional, behavioral and social proclivity can do much to determine, over time, the huge differences in how a pain problem can ultimately affect someone, from a manageable nuisance to a crippling tragedy.

  144. If pain is imaginary, why do animals have pain? Or is this just the story we tell ourselves to justify horrific cruelty?

  145. @Cloudy I think you may want to reread the article. It does not say pain is imaginary, just that there are many things that affect how we experience pain.

  146. @pechenan "if pain is an opinion"?

  147. @Linda Ramachandran is one of the world's leading neuroscientists. How would one apply that statement, understood correctly, to animals? We now have strong evidence that "it is like something to be a one celled organism" (to paraphrase the philosopher, Thomas Nagel). before that organism can respond to the environment, even though it doesn't have a brain, there is some kind of "cognitive appraisal" of the surrounding habitat. Its response is determined by this cognitive appraisal. now consider more complex animals with nervous systems. It is essentially the same thing with a cat or dog. Whatever sensation is occurring, it does not become a "pain" experience until nerve messages are interpreted by the brain. The very same thing is true of humans. One commenter said "When I broke my arm I felt pain immediately." Well, no he didn't. There is at least one, most likely several, milliseconds between the arm injury and the complex brain-based interpretation of the neural messages coming from the arm. All the author is saying is it is potentially possible to train anyone's brain to modulate the way the brain interprets those messages. For people saying "well, my kidney stpnes, my cancer pain, my shingles, etc," nobody is disagreeing or lacking compassion for your terrible pain. They're offering you an additional option. if you wish to solely rely on physical means, all the best to you. if you wish to explore further psychological options, that's great too.

  148. Serious pain is pain that is not soothed away by any means. It is perisistent despite all mindful efforts. Sure, it helps to relax, be accepting, disassociate from your body. But can you do that 24 hrs a day when the efficacy of that approach is about 5 percent pain reduction? Opioids are effective drugs. The current anti-opioid, anti-drug mantra and FDA guideline conspiracy is harmful to the person who unfortunately is saddled with serious pain for which there is no other effective treatment. I don't know the answer to how to stop people from getting addicted after taking a few vicodin. We need a village. We need a caring country. We also need compassion for the pain patient. Suffering is not fun. It is potentially as deadly as an opioid overdose.

  149. @serenocormac also, we need to recognize different types of pain. For most people, opioids do little for pain caused by nerve damage and yet there has been very little effort put into learning how to treat such pain more effectively. And sadly, there are no IV medications that are effective for nerve pain so if you are unable to take pills for a while, you have to use the IV opioids for what little relief they provide. (I've been there a few times.) Then there's medical marijuana which does help with pain for many people......

  150. @serenocormac Not sure where you got the 5% pain relief statistic. I personally have had a lot more than 5% relief from using MindBody approaches and have heard from others who have as well.

  151. @Helen No one gets addicted after taking a few Vicodin. I suffer from severe, chronic pain in my leg due to nerve damage. I take an opioid for the pain, and it works. Although I am physically dependent, I am not an addict. In fact, most chronic pain patients are not. I take my medicine exactly as prescribed. I don’t get high. Tried the miracle drug marijuana. Nothing.

  152. Let's talk about intense acute pain (as opposed to chronic pain) for a moment. I've progressed through two kidney stone attacks and two completely unmedicated childbirths. The pain in each of the four events was excruciating. However, with labor and delivery (during which, of course, there are tiny breaks between contractions), I could visualize and breathe my way through to birth. With the kidney stones, no way. When a stone tries to pass through a too-small tube, what can one envision? What help is breath? (I remember hearing the doctor say, "I've given her as much medication as I can -- it's the pain that's keeping her alert.") Some types of pain can be managed; some cannot. And let's keep in mind that every person is an individual, with genetic quirks that can affect how they perceive pain.

  153. @Pdianek It also helps to know during childbirth that it will be limited to maybe a day...having a definite end point to a difficult situation certainly makes a difference!

  154. @Di And you wind up with a baby!

  155. @Pdianek I agree and I wrote a separate comment about my experience with kidney stones. I think it’s highly irresponsible for this author to suggest he used mind over pain with his stone experience. I tried to manage the pain once and I ended up with a kidney infection from a stone- I could have died.

  156. Your personal anecdote about how your pain associated with kidney stones began to diminish when you arrived at the treatment center is interesting but shouldn't be taken too seriously. I normally manage pain reasonably well. However, I've had three kidney stone events and, in every case, the pain simply continued until I received appropriate medication. It isn't clear to me whether or not you meant your column to be informative. If you did, I think you should recognize that your case doesn't belong.

  157. I am glad that the fact that pain is an opinion is getting coverage in the NYT. However I feel this article downplays the positive impacts of MindBody medicine (addressing pain through the brain). I used Curable, an app that teaches MindBody techniques for chronic pain, to address my chronic fatigue and perceived muscle weakness. These were lingering from a well controlled autoimmune disease. When I started Curable, I could only walk 130 yrds, and had to lie down often. Now, I can rollerskate for an hour, walk around the mall for two, sit all day, drive, with no problem. Do the Curable techniques get rid of pain forever? No. Besides, you wouldn’t want to live pain-free. Then you wouldn’t seek help when there is something serious going on. But the techniques in Curable can greatly reduce your pain. There’s a huge difference between experiencing pain sometimes while knowing how to manage it and experiencing chronic pain. The quality of life in the first one is much better than the last. There are many people who have used curable techniques to recover from many different ailments. You can hear their stories on the Curable podcast. As for me, Curable gave me my life back. For the folks in the comments saying this concept is damaging, a year ago I would’ve agreed with you. Curable is in no way saying that pain is anyone’s fault or that it’s not real. It’s saying that with time and practice, you can learn techniques to reduce your pain, and potentially reduce it a lot.

  158. This seems to be the opinions of a writer who is not a NYT staffer. Reading on the web site (to which I subscribe) this is not made clear until the end of the article. I believe the articles should be labeled to make the sources clear.

  159. I have a SERIOUS sciatica problem....opioids barely put a dent in the pain... It's constant and nagging... I'm 62 BUT.... When I'm engaged in physical activities that require my utmost concentration.... I still paint interiors to earn money, when I'm tuning up my bicycle, even in front of a computer scanning important negatives and am deeply engrossed in filing them properly in folders and with the appropriate metadata added by myself or even my hobby of building plastic helicopter models where I have to wear magnifying goggles and am utilizing my fine motor skills... Magically... No pain...None... maybe it's because I'm distracted, I'm no doctor but it works for me.

  160. I walked around or should I say tried and walked for over a year after a knee replacement at 47 years of of age in excruciating debilitating pain. I went through three additional surgeries and several types of physical therapy. I was told it was in my head. Through my own research I discovered that my popliteal tendon was rubbing against calcification that was not removed properly during my knee replacement surgery. Finally, after several months, a Dr. at the Mayo Clinic listened to me and performed surgery. My tendon was so shredded it needed to be removed. PAIN IS REAL!! My mind and body were not playing any tricks on me!

  161. @Veronika, I had a TKR 2 years ago, with an additional surgery on the same knee 6 months ago. I still have pain...I have been rehabbing from many different angles. I am hanging on to hope, but it is difficult & I just am not sure what else I can do.

  162. @Veronika Hello. Do you know how the doctor finally diagnosed your issue? I had a knee replacement 15 years ago, am in constant severe pain, am quite active with a personal trainer and walking as much as I can (and losing 50 pounds over the last year). Short of a revision surgery no one has been able to find a cause for the pain. MRI's, CT's, Xrays, etc. Also, pain meds, injections, PT, alternative medicine, acupuncture, chiropracture. I'd love to know how they found the cause. Everything seems to be a shot in the dark!PM me at [email protected]? Thanks so much.

  163. I think this article would have worked better if the author had not referred to pain as being an “opinion.”. I am not a chronic pain sufferer, but I can see how that could be very offensive. I agree pain is in your head, because everything is in your head! Pain can have a known source or an unknown source. I have nothing but respect for all of you living with and trying to deal with chronic pain. Thank you for your stories.

  164. @Ellen Campbell They are not saying that pain is the opinion of the person. What they mean is that pain is the brain's opinion. As in, it is your brain's opinion that there is a threat present, and that the threat requires your attention in the form of pain. Sometimes when your brain thinks there is a threat, there is an actual threat. But other times - there isn't. For example, some people are afraid of Daddy Longlegs, when in fact, they pose no threats to humans. Lorimer Moseley has a great TedTalk on this called "why things hurt".

  165. “They’re stressed by the pain itself and also by major life challenges and socioeconomic problems that no one could solve with anything less than years of effort and maybe a miracle or two.” Addressing social and income inequality and providing healthcare for all become imperative if this statement is true.

  166. I have osteoarthritis, back issues and fibromyalgia. I take only two doses of acetaminophen a day because I have learned to focus on things other than my pain. Sometimes I use a heating pad, but rarely (once or twice a year) do I need even an NSAID, let alone something stronger. It's all in how we look at pain.

  167. @Barbara No, it's not "all how we look at pain." Tell that to a terminal cancer patient. Or someone who lost a limb in an accident.

  168. @Barbara You are oversimplifying. I have psoriatic arthritis, fibromyalgia, Crohn's disease and post-herpetic neuralgia, courtesy of shingles on the sciatic nerve 6 years ago. I have been in pain every day for 35 years. I am often able to get through the day with just tylenol (I'm not allowed NSAIDs any longer), but must take stronger pain medication at bedtime. During the day I can distract myself some with other activities, but at night when I'm relaxing, it comes surging back. Without a bedtime dose of pain medication, I wake at 4 or 5 am in great pain and have to take something and wait for it to work before I can sleep more. Everyone, including my doctors, comments on my positive attitude and my determination to keep going, but there is no way I can control my pain just by how I look at it.

  169. @Barbara To clarify, I am not saying that pain is not real. My pain is real and sometimes debilitating, making it difficult to walk. I am saying that if we catastrophize pain, we feel worse. I am also speaking of chronic pain, not acute pain, though how we think about any pain--what we tell ourselves about it--makes a difference.

  170. I spent a month at the Mayo Clinic's Pain Rehab Center. I met lots of people on serious dosages of heavy pain meds, who were successfully weaned off using Cognitive Behavioral Therapy and exercise, at least while they were there. I was one of the lucky ones, in the best shape, and my life has improved. Pain continues to be a frequent companion, but in the words of another clinic patient, "the pain just takes up a smaller slice of the day's pie."

  171. @David I also attended the Mayo program. While I still hurt, pain no longer consumes me. Great program! I have started a Facebook support group based on the theory of not focusing on pain: Chronic Pain Champions - No Whining Allowed. Check it out.

  172. "If something in the mind — fear — can make pain worse, can some other thoughts or mood make it better? Yes, to an extent." The "Yes, to an extent," sums up this article. Mind over matter does relieve pain, but it's exhausting.

  173. If, as neuroscientist V. S. Ramachandran says, there are "no nerves dedicated to sensing and transmitting pain", then what does he think the function is of the neurons and tracts associated with the spinothalamic tract? And the trigeminal cranial nerve? Yes, it is accurate that as humans we interpret pain once but the neurophysiology shows that we (as do other animals) have peripheral nerve pathways that transmit pain.

  174. Thank you for mentioning the trigeminal nerve. As someone who has TN and ATN pain, this ‘article’ made me snort. I’m on neuro transmitter inhibitors to quell my pain. I see an acupuncturist, exercise when I can (walking is all I’ve been able to do up until recently; post MVD I can finally get back to swimming), craft, think happy thoughts, etc. When it comes down to it, those who have trigeminal nerve pain suffer some of the absolute *worst* nerve pain there is. Before my surgery I couldn’t handle AIR movement of any kind on my face. Nothing I did (in fact, I had to stop doing many things) alleviated the pain. Post op I’m mindful of my everything for anything could possibly set off an attack, as it is with many those with TN. We are probably some of the most careful people you will ever meet. Prior to this I had abdominal scar neuromas for a few years. They were horrendous. I’d rather deal with those again than deal with TN on a daily basis and this ‘article.’

  175. Yes, all pain is real when you are feeling it. At the same time, it is also true that there are ways to relieve pain that do not require pain medications. I am fascinated by this because I have broken a number of bones in my lifetime and consistently find that I have had little or no pain during these large and smaller bone breaks. The weird part is that I've had sprains that hurt more and migraines and intestinal cramping that has hurt a lot more. So I wonder why these things that are not as serious would create so much mind "pain" when they are so minor. I've played with this in my own mind: I've spent time focusing on specific painful places to see if that works--it does sometimes. I've found relief by focusing on something else--being outside works for me. The more I exercise, the less arthritic pain I feel as long as I don't really overdo it.

  176. Perceptions are everything, if you can change them by talking to yourself, groovy, but general anesthesia stops your perceptions too, and anesthesiologists can put you pretty far away from them; as I’ve concluded that painkillers, the general anesthetics being an extreme case of them, don’t really stop the pain, they just make you not care about it, change your perception, and I agree with the commenters that say it can be very dangerous to mask your perceptions- you should be trying to be as sensitive as possible to them.

  177. This article is timely for me. As I write this I am visiting my husband in Chicago where he is in the chronic pain program at the Shirley Ryan Ability Lab (affiliated with Northwestern Medical Center). He came to the program out of desperation. He had a back injury 43 years ago and has been in varying degrees of pain ever since. He’s tried many treatments but this has been the most systematic and comprehensive. And it works along the lines described in the article, combining standard (but excellent PT and OT and medical care) treatments with thorough instruction on calming the mind and lessening some of the agitated pathways of pain through meditation and exercise. He thought he couldn’t exercise but they are helping him find ways. I think that for certain patients, clinics like this are the right answer. It’s helped him a lot because they really know what they are doing and he has support and guidance here. We think he now has the tools to use in his daily life. This was a big step to take but worth it. I encourage others to look into programs like this. Speak to the intake people and explore whether you qualify and work with them on the coverage and logistics.

  178. Thank you for this article. Last year I had my first panic attack. I had just eaten raw almonds, and within minutes felt that I could not swallow. My heart was pounding and racing. My head was killing and I was out of breath. Tests at the ER showed I wasn’t having a heart attack or an allergic reaction. I was exhausted at this point. I asked the nurse if I was crazy. She looked right at me and said, “Your symptoms are real. Your pain is real.” Thank you for reminding us of the connection between our minds and our bodies. If controlling our thoughts, can help relieve pain symptoms, even a little, it is something worth talking about. 

  179. One of the problems with this sort of article is that it muddies the water for extreme pain sufferers. If the author can get perceive enough relief by "playing the trumpet" or "improving his social life", Than I am here to suggest that his pain levels are mild. Extreme pain is indescribable , savage and relentless. There will be no trumpets played, There will be no new social contacts. When Mr. Big Pain visits, nothing else exists. except , perhaps a fleeting hope that it will subside or can be mitigated. But even that hope is diminished by a society that cannot even differentiate between legitimate prescriptions and street purchases , let alone mild or moderate afflictions being written about as over treated severe pain.

  180. @J J Davies I don't see how it muddies the water. The concept was pretty clear to me. Maybe even clearer than before I read it. Maybe it's a matter of perspective. Maybe you're muddying the waters between "a society that cannot even differentiate between legitimate prescriptions and street purchases" and an article about how our state of mind/emotional state/pre-existing comfort level can affect our perception of pain.

  181. @J J Davies agreed 100 percent. You can’t think about anything other than relief.

  182. @J J Davies I agree that the author seems to have described his pain as milder on the chronic pain spectrum. However, people in severe pain have found relief using mind-body approaches. There are recovery stories from this on the "Curable" podcast. I have used these techniques to address severe fatigue and muscle weakness and have improved a huge amount. Mind-body approaches are about rewiring our nervous system. When you've been in pain for a long time, the nervous system can learn to be in pain. It can send us pain signals or make the pain worse when it's not actually necessary. Using these approaches you could potentially disrupt these patterns and reduce the amount of pain you feel. These methods are backed by scientific research.

  183. Pain is personal. I am a cancer survivor and have nerve damage caused by Chemo. My feet are in constant pain. I choose to ignore it, but it does slow me down and I can no longer wear “cute” shoes. I also take a Chemo drug every day that causes both muscle and joint pain. Many patients stop taking this drug and risk recurrence due to the pain. I keep going. Do I feel less pain? Of course, In general I am a wimp about pain but I see this pain as evidence of my successful battle against cancer. I feel the pain and keep going. I exercise, I walk. The reality is that a pain free life is not possible for most of us, especially as we age. The opioid epidemic stems from an idea that we should never feel any pain. I worry that those who stop taking needed drugs and no longer exercise due to discomfort do so because they think there should be no pain. I accept my pain as evidence that I am alive. I am sure others have pain that is much worse than mine. But I think the idea that we need to be completely pain free is misguided and dangerous. We all need to learn to mange our pain.

  184. @Liza Good points - sorry for your challenges, and congrats on such a good attitude. I think you're right, people expect to not have any distress any more. Many have become intolerant of guilt, pain, loss, etc. But the more you fight reality the less you actually deal with it. Sometimes I think it's because we've just become tired of the suffering,, and without a support system and values or hope that help us endure, we just can't. Especially if you're lonely. But a big part of this is that many parents either 1) shield their kids from painful experiences of childhood or 2) are simply not present for their kids' pain, and the result in both cases is many kids have no skills or experience to cope with discomfort. No confidence that THEY CAN. People grow up to become adults who can't deal with the inevitable discomfort and pain we will ALL experience once our parents stop controlling every aspect of our lives.

  185. @Liza I've had pain in my knees due to an autoimmune disease since I was 3. I've had pain ever since. I've done PT my whole life, had a lot of painful treatments,taken a variety of meds, had ops, and curtailed my activity, or not, as my docs advised. I know that life involves pain. When I wasn't flaring I did field work, hiked, biked, lifted weights, did yoga, went dancing, etc., etc. I didn't run or do impact-heavy exercise because that kind of thing left me in agony. The other stuff? Painful, always. I wore knee braces, used NSAIDS, iced, and stopped when it got too bad, but I managed my pain well for 3 decades. Being pain free never occurred to me because I can't remember a time without pain. Then I slipped a disc, had back surgery, and developed chronic pain in my back, buttock, hip and leg. I've tried everything, but no dice. I lost a great career, a PhD, my partner, etc. I live in poverty. I've been too disabled to work for a decade. I barely leave the house. I take opioids and some other meds, and I use a lot of non-med modalities too. Pain management taught me that I don't need to fear that I'll make it worse, which definitely helped, but I'm still very limited and often in too much pain to stand. Don't assume that those who take opioids are taking the easy way out, that we're not managing our pain, or that we expect to be pain-free. I use the meds as part of my pain management and many others do the same. Don't judge us just because your experience is different.

  186. The opposite is also true. Pleasure is also relative. Much depends on personal disciple and can be acquired with practice. Buddhism has a lot on this subject and that is 2500 years old !!! There are many philosophies dealing with this. Stoicism, for example. Let us remember: what we call reality( including feeling), it is mostly appearance.

  187. @surajit It's true that our state of mind has an obvious effect on how we feel - our minds are powerful things. But your comment is a little, shall I say, separated from the reality of many people. You insult them by calling their reality an appearance without any empathy for their agony. Your words are therefore beyond empty, and can actually contribute to suffering. Many people do have distress that is bound up deep inside, put there by negligent or abusive parental behavior, that affects their quality of life until they die. It can affect pain response, inflammation and immune system, addictive tendencies, and of course common mental and emotional health problems. Thinking happy thoughts and telling yourself "nothing is actually real so it's ok" isn't helpful. That's called zoning out. It's not helpful. Anyone who thinks deep-seated distress or trauma from the past might be affecting their quality of life or happiness should look up cptsd - Pete Walker has some good reading. Painful but liberating.

  188. @M H Buddha suffered from back pain for most of life. After 500 years, when Jesus was crucified, he too suffered and died. Any pain is regretable, forget terrible pain. As far as chronic pain is concerned, the less said the better. That's why we need to discuss it, to make the suffering less. People like me believe that it can be made less painful by using our mind, practice,getting counsel etc. But it will always be with us and that's the point.

  189. Great way to make people feel guilty and helpless over feeling pain. I broke my arm. I felt pain immediately. I still feel it, and I know exactly what is causing it - pain messages from nerves in my arm. Sure it's better sometimes. Sometimes it's worse. No matter where you think pain comes from, it's real. Sometimes, a brain exercise will work; sometimes it won't. I know I have real pain, and I know exactly what is causing it.

  190. @akamai Many commenters seem to agree - it's totally not worth finding ways to mitigate pain in child burn victims, use music therapy, stress reduction and VR to help relieve surgical pain, make people feel safe so they feel less pain and distress. Not if it makes you feel guilty. I don't know how old you are, but that comment was very millennial. "Outlaw all things that make me feel bad." It's seriously dysfunctional to expect others to abandon their useful work because of how it makes you feel. Plug your ears if you can't handle the truth. I've had a lot of pain caused my anxiety and trauma. Knowing that my state of mind and level of exhaustion effect my body and my pain has offered a kind of relief. Why does everyone, not just you, have a problem with that? Unresolved emotional issues.

  191. As a long retired athlete and life-long risk taker, a survivor of several near-fatal accidents and their consequent medical adventures, I have a long term, complex relationship with severe pain, both chronic & acute. My history of trauma & the chronic pain that follows, could not be meaningfully presented here. What can I contribute to this discussion, that hasn't been well explored by the article or those commenting? Perhaps an insight on the subjective experience that we call "pain". There is no greater abstraction than somebody else's pain. Regardless of the intensity on the 1 to 10 scale, or a few vague adjectives (crushing, dull, lacerating, blinding, etc), we struggle to meaningfully communicate these most personal experiences. Few individuals are able or willing to fully internalizing the agony represented by our words and non-verbal communications. Truly extreme pain, that is your personal limit, causing you the onset of physiological shock, the collapse of pulse-rate & blood pressure (been there/done that) is life's most unpleasant offering. It is the most real, uncontrollable, inescapable state of being. There is no ability to sense time. It is also a rare experience, usually non-survivable outside an Emergency Room or Operating Suite at onset. The idea that truly severe pain can be mitigated by distracting sensations or pleasant thoughts is oxymoronic. The mind is incapable of thought. The placebo effect & the techniques that depend on it, have no meaning.

  192. @mike4vfr I have never read a more accurate or authentic or moving description of pain. I no longer will answer the question of where I am on the pain scale telling them it’s nonsense.

  193. @mike4vfr: Dear Mike- You forgot to mention the 45-60 minutes when you are in shock and your body is pumping out endorphins. NO pain then. After that brief respite, it is all downhill and you will never be out of pain again when you have chronic pain. This entire "medical" article needs a rebuttal by pain patients and their physicians. I for one am tired of hearing the constant propaganda that has flooded the media recently over opioids. I can't take any NSAIDS. I only have 50% of both optic nerves in both eyes left functioning due to glaucoma. ( Another Irony).NSAIDS further damage your eye sight, and glaucoma never gets better, only worse.Acetominophen does not work for me. I have to ask for opioids as nothing else treats my chronic pain. How many people will now become alcoholics or buy street heroin both of which are unsafe since adequate opioids are now banned. Who knows? But the states will get more tax revenues from liquor sales.

  194. With due respect, chronic pain is devastating and life-changing. This can be especially true with back-related injuries and resulting nerve damage. It includes a failed back surgery, a long list of medically documented pathologies, all of which are degenerative. Articles like this remind me of the 'mind over matter' argument. Having worked at and tried multiple modalities, it is a fallacy. All studies can ask or document what the study is trying to prove through industry-specified [insurance, health care, workers comp., et.al.] to reach a predetermined conclusion. As someone, who has tried multiple modalities, pain program, alternative medicine, current medical practice, it is disheartening to see the continued diminishment of those who try to overcome, constantly work to change, and yet, by dint of level of injury, continue to struggle to walk, be independent, and live with a high level of pain on a daily basis. There is no panacea and the placebo effect is short-lived.

  195. @HMT And something that’s rarely mentioned is how much energy is expended doing this. And who lives your life and goes to your job when you are humming in the zen forest.

  196. I did.

  197. Extreme pain changes the way we perceive, not merely what we perceive. It affects memory, perception, and attention. We can overmaster that by mental effort, but the effects can be subtle avoiding mitigation, and the resource required is likely to be finite. Thus the concept that pain is an illusion of the senses like beauty is utterly wrong. (no sources to hand) To substantiate this, earlier this year my chronic injury did its thing with especial gusto, and for hours I was in agony. I say for hours because by around hour four I couldn't remember who I was or what I'd done to cause the pain. There was only pain, burning from within me and consuming me. When a sun flares and dies it must feel like that. It was not an elective, because I the elector became the illusion. It ceased when I finally passed out.

  198. @Walsh that is why chronic pain sufferers usually have “comorbidities” —I love that word. Depression, anxiety, sleep issues—and round and round we go. And the things we should to alleviate these, like exercise, are all the more difficult. So as I say to people—walk a mile in my shoes!

  199. There was a faith healer of Deal Who said, "Although pain isn't real, If I sit on a pin And it punctures my skin I dislike what I fancy I feel."

  200. Aside to the other sufferers objecting to the author's claim - reading your accounts made me feel less alone. It will not stop 'Mr Bigpain', but you've made me feel less alone.

  201. @Walsh Interesting, isn't it, how defensive the commenters are on what could be a factor in their pain. The writer isn't suggesting that pain is simply a case of "mind over matter," only that thinking about pain in a different way can help alleviate it, not eliminate it. As a mental health counselor, I know that psychic pain can be somewhat relieved in a similar way.

  202. @Jackie okay take away the “psychic pain” and a lot of us are left with just good old fashion pain—as a migraine sufferer, it is “all in my head” but it’s physical not psychic and if you’ve never had a migraine or a cluster or an icepick headache, I suggest you sit down and be quiet because you have No Clue😡

  203. @Jackie How incredibly patronizing. Perhaps us disabled folks who ARE in pain are absolutely sick to death of folks who AREN'T in pain telling us how we should handle things **they know absolutely nothing about.** You know, what's really funny, my 84 year old mother recently developed a chronic pain problem. Up to now, she's been pretty healthy. But it put her down for almost a month. When she got out of bed, she's not walking properly. She's weaker. She can't do the things she used to. For lack of a better description, she's "old" now. (This scares me.) You know, like *I've been* for the last 10 years bc I'm disabled. She told me, "Now I understand how you feel. I know why you were so angry with me." Being in pain wore her out. It changed her. Maybe @Jackie you should try having some empathy, some time before you're 84, and get old, sick, or disabled--1 in 5 people in the US has some kind of disability. It can happen to you. You will be just as incensed as we are when some boneheaded, ableist, know-it-alls tell you that "thinking about pain a different way" can make your pain go away. When you actually know about what works for your pain and what doesn't work for your pain. Because IT'S YOUR PAIN and you've had it a good long time. And unlike the ignorant, ableist jerks spouting nonsense at you, you're NOT IGNORANT about it. When you don't know whence you speak, your mouth is best used for chewing. Go have a snack, and try listening.

  204. These kinds of articles tend to cause me problems with some of my family and friends. I have chronic pain from a spinal chord injury about 20 years ago. That plus the other physical symptoms make life interesting enough but when those folks read that this MD says “pain is an opinion” and “it’s all in your head”.....they tell me about it. Now it will take me months to undo the damage that such generalizations do to a lay person’s perceptions of pain. Remember that those with chronic pain are not usually treated with great sympathy nor are we barely tolerated by those close to us when we don’t recover from our illness or injury quickly.

  205. @Mishka Fernung exactly. They can’t relate to what is invisible. Most people can’t.

  206. “There are no nerves dedicated to sensing and transmitting pain.” ????? What is your source on this? What about A-delta fibers, or the small type C unmyelinated sensory fibers? They do not sense “pain” per se, but they are very preferentially involved in carrying the sensations that are perceived as painful. They seem to be preferentially stimulated by heat or sharp objects. They also heavily innervate tissues beside the skin that are particularly pain-inducing, such as the deep pulp of your teeth, or the periosteum (outer layer) of bone. I think that your own pain-perception system could use a little recalibration. Try having a wisdom tooth pulled.

  207. By "dedicated to sensing and transmitting" pain, I believe the author is saying that no one nerve serves that purpose alone. He is not saying no nerves transmit pain. You have interpreted the meaning incorrectly. Just like your brain can do with pain. As a nurse and one who has experience the pain of childbirth and herniated discs, I understand and agree with what the author is saying.

  208. @RDJ I also was pretty startled by that statement. There are tons of studies going back for decades that show that there are indeed nerves dedicated to sensing and transmitting pain. RDJ is absolutely correct. It is true that the body, notably the spinal cord, has mechanisms for gating how much pain information reaches our consciousness, but that fact doesn't mean that pain is just an opinion. This article is nonsense, and its main thrust is to discount the experiences of people who do indeed suffer from real pain.

  209. Pain is fear and anxiety. Pain is real when nerve endings sense biological changes and an immune response with inflammation . Inflammation is the two edged sword of pain. Manage the cause of pain and utilize techniques developed over eons to overcome the onslaught of chronic pain. If females have birthed babies using only breathing techniques without epidurals etc. then we have proof that some of us can endure better than others.

  210. @nursejacki As someone who has 3 separate degenerative diseases in my spine and has lived with severe chronic pain for 27 years, I find your statement that "pain is fear and anxiety" both insulting and ignorant. You obviously do not have the experience or education needed to comment on the origin of other people's pain. As my mother says - you are talking when you should be listening.

  211. @WCL My favorite one is: When you don't know whence you speak, your mouth is best used for chewing. While pain can cause fear and anxiety and fear and anxiety can certainly heighten pain, it's not a tautology. In many, MANY cases, the medical establishment itself doesn't know why someone is in pain. There may be numerous small causes...

  212. At times I've numbed surface pain by meditating on how it specifically feels, but not chronic pain.

  213. “Pain is in your head” is an excuse western medicine practitioners use to not look beyond than their siloed discipline. Neurologists said it to me many times to explain my debilitating migraines. Their advice wasn’t helpful, nor is the article. As it turns out, my pain was triggered from a severe depletion of vitamins B and D in my body, that began months earlier when I took antibiotics for an infection, which killed all the good bacteria in my gut limiting my body’s ability to properly absorb nutrients. Probiotics and vitamin shots cured my migraines. Pain is a signal that something is out of alignment that needs care. Fortunately an eastern medicine practitioner took the time to ask questions, listen, and help me resolve it.

  214. @Rachel I’m glad you’ve “cured” your migraines—very few people have done that. The list of “cures” I’ve tried and the medications I’ve tried is as long as my arm. I like many migraineurs am preventative meds and abortive meds. I’m down to two migraines a month which I consider to be my “cure”!

  215. @Rachel It took me a decade to find out that my migraines are almost exclusively triggered by: 1) hormones: menopause helped 2) gluten sensitivity: now if I could just detox from pizza! Oddly, I didn't have gluten sensitivity until I lived in the county for a decade where the groundwater was thick with Round Up from where they sprayed it all over every crop in the area. It ruined my stomach.

  216. @Dejah that’s nice—mine were triggered by Lyme Disease and fundamentally altered my brain—left me with chronic daily headaches that easily tip up to migraines. Those are hereditary so short of removing my brain, I’m stuck. I’ve tried every trick, every diet, every medication. What keeps me sane is a handful of pills, Botox and a huge sense of humor.

  217. As a chronic pain sufferer I was fortunate to have found a 12 Step support group called Chronic Pain Anonymous. It taught me that fighting my pain is useless--you'll always lose. Acceptance is the key. CPA literally saved my life. There are in-person as well as video meetings worldwide. Go to chronicpainanonymous.org for more information.

  218. @Randy Watson Thanks for this one!

  219. Years ago, before I had accumulated the injuries & experiences that inform my perceptions of pain today, I remember various sources advocating hypnosis as the be all & end all of pain management. Much as the more contemporary fads (accupuncture, art therapy, etc.) are gleefully foisted on every pain sufferer within earshot today, it offered a real perception of improvement. As it turned out, the sustained benefits were rare and usually most important for sufferers of relatively mild to moderate pain. Hypnosis seems to have largely disappeared from medical pain management. There is no doubt, in my experience, that having some sense of control is hugely beneficial, even if the actual reduction in pain level is not as dramatic as the sufferer would hope. Having opioids on hand when pain levels peak, and being able to reverse the trajectory that would otherwise lead to outright agony, is the essence of medical pain management. I have been blessed for the last 13 years by the exceptional care of a prominent, highly regarded specialist. There is an important psychological aspect to pain. The anatomical focus of the pain and the specific sensations can greatly effect the degree of suffering. In my experience, relatively mild pain emanating from old spine fractures is far more distressing than intense pain from my two prosthetic knees. Having the meds necessary to exercise some control are life-saving in the face of the resulting depression.

  220. Acupuncture, which has been practiced for thousands of years, can hardly be termed “a fad”.

  221. @Carey, all these mind over matter techniques are great if they work for you. Stop reading here if I threaten to burst that fragile bubble. It's placebo effect, powerful & beneficial, if it works for you. For most living with moderate to severe chronic pain, they just doesn't provide sustained, functional relief. Too often advocates of such modalities have little long-standing personal experience with serious pain but do have an illusion of moral superiority they derive from rejecting opioids. Many placebo modality advocates make a comfortable living with their services. Great, if they can do so without steering patients/clients away from other techniques that provide more effective pain control. There are too many chiropractors willing to terrorize pain sufferers with the threat of relapse that will be inevitable with even one missed "Adjustment". The abuse of opioids has caused hundreds of thousands of deaths and left millions of survivors behind to mourn. Opioids are powerful, even miraculous, when prescribed to responsible patients. Pain patients and their family members must be forcefully reminded that just one extra pill, taken to recapture the euphoria that can occur with first exposure (but quickly fades after that), is the direct path to a pattern of futile, ever increasing consumption, then to addiction and a probable overdose. Within days, the initial euphoria disappears, there is no high for those who maintain their prescribed dosage, there is just less pain.

  222. @mike4vfr Agreed! Knowing that I have meds that will reduce the pain if it peaks past a certain point reduces my anxiety, which helps to keep my pain levels from peaking.

  223. I had appendicitis a few years ago with accompanying pain but once I got on the gurney in the hallway off the ER the pain was gone. That didn’t stop the ER doctor from trying to get me to take opioids, I finally took a Tylenol to get him to stop.

  224. Anyone who says things like pain is an opinion or it can be managed with your thoughts hasn't experienced kidney stones.

  225. The author refers to his own experience with kidney stones—he knew that pain. I worked on a pediatric burns unit. The children seemed to experience more pain at night than during the day, even though we changed their dressing during the day. Nighttime can be scary, especially for a child in an alien environment—pain is felt more acutely. Also, during the day there was a lot going on in the unit. Physical therapy was a constant presence, and balls were always flying through the air. To work in the unit was to be a dodge-baller. But this activity kept the children active, helped prevent contractures, and distracted them from focusing on pain. The brain is like the cellphone. It can do a lot, if you know how to use it.

  226. @Lydia S or gout!

  227. @Lydia S I interpreted his comments differently. (I've had severe chronic pain for 27 years). I believe he acknowledged the pain but found some relief knowing it was about to be addressed. My own experience is chronic pain can be managed, not eliminated. One part of pain management is how I approach it. The more I focus on it the worse I feel. If I can distract myself with more pleasurable stimuli, I feel better. That's what works for me and I believe this is the type of behavior the author is encouraging. I've never had a kidney stone so maybe my pain is different.

  228. I had had chronic pain for almost ten years before I saw a doctor who explained the brain--pain connection to me. Just having her validate my pain--yes, you had an injury and yes, your brain is receiving pain signals and yes, the pain signals stem from your injury--while also explaining that my body has a hyper-sensitive alarm system and I have to work on telling my brain: yes, I heard you, I know about the injury, but it is no big deal, so you can stop sending the pain signals now, was extraordinarily helpful. My experience with this doctor was in sharp contrast to the experiences that I had had with other doctors (amazingly enough, doctors who were also pain specialists). They simply dismissed my pain and said that they could find no explanation, which, of course, increased my level of stress, and, thus, my levels of pain. There is an excellent lecture (Chronic Pain - Is it All in Their Head?) available on Youtube by Dr. Daniel Clauw at the University of Michigan Medical School that explains all this.

  229. Why do medical doctors and nurses NOT use Hypnosis when one is experiencing pain.? If it is all in the brain, why do they not treat it right then, to stop the pain using the brain/hypnosis.? Then teach self-hypnosis to patient. Seems this might be the simplest way, and stop giving one all the pain pills. I am sure many doctors would consider this not medicine.

  230. This is really silly as not everyone can be hypnotized.

  231. @M. Henry Self Hypnosis is very effective and Lamaze, in my opinion,is related to it. I have found it helpful in the past. However, it takes practice and is time consuming. Much easier to give someone a pill. I think it would be great if it were part of medical intervention for chronic pain patients and also for childbirth if insurance would pay for it.

  232. @M. Henry : Not all can be hypnotized. Chronic pain is a different animal than acute pain. I can't wait until you have a chronic pain situation and then have to realize you are treated as almost a criminal to get the necessary medications. Just because some fools decided to abuse drugs, the innocent are treated worse than your pet dog, cat or horse, or bird is treated by the vet.

  233. Okay if pain is just in my brain then what is my migraine? An argument my brain is having...with my brain?👹

  234. Could very well be—perhaps there's a way to make it agree with itself that just hasn’t been discovered yet.

  235. @Gerithegreek518 well it’s been over 25 years—when I find it I’ll let you know. And I have cervical fusion to so my neck also sings along in harmony😍

  236. Betsy: I have had four surgical procedures to my back, the last of which was a fusion. I am personally acquainted with pain.

  237. I have endometrial cancer stage 4 that went to my spine. Before I received radiation treatments I was on heavy pain medication. The radiation reduced the tumor in my spine and I am no longer on pain medicine. I'm also a visual artist married to a musician. I have lots of love in my life for family, my husband, friends. I know the healing power of art, music, nature, and love. I don't understand the point of this piece. It seems anecdotal. There are plenty of people out there living with excruciating physical pain. Ok it comes from how we're wired, but unless you turn off those centers in the brain that signals how much pain you're in people will still have the experiences of pain. What the writer seems to explaining is a difference without a point. Didn't we know this already? Also pain is telling us something is wrong. Masking pain can be harmful especially if your brain is telling you about a symptom that is treatable.

  238. Vipassana meditation has been valuable for me, for physical and emotional pains.Love it.

  239. I experience A painful genetic disease of the spine . Mindfulness pain meds surgeries injections nerve burning procedures tens units physical therapy- all help some. I don’t believe this article is very thoughtfully prepared. Most pain is dealt best with a multi faceted approach.

  240. Has there been any mention of the Lamaze method of working through pain in childbirth? My Lamaze teacher used the word "psychoprophylaxis" to describe the way we were basically distracting our bodies from the pain.

  241. @Heather H Acute pain is WAY different than chronic pain. I can't really explain it except to say that it is. Having experiences both, it just is. You have to be here. I often use Lamaze breathing for kidney stone pain--I get them chronically--which spikes and passes. Or during Physical Therapy when the PT stretches my frozen shoulder, which can be incredibly painful. And of course, I had an unmedicated childbirth. It's simply not the same. Chronic pain is more like water that carries sand. It washes over your mind, emotions, and spirit, and of course, your body. It wears you down. Little by little by little, it bleaches you away until you are a pale shadow of the person you used to be. Years go by, and you find yourself doing less and less. As those of us disabled say, "I don't have the spoons." It takes multiple spoons every day, just to do basic tasks, because it HURTS to do them, because you are so worn down by pain and there is less of what makes you YOU. You keep going by sheer force of will, but you run out of will. So you cry more easily. You just can't. You are unable. Then folks tell you, "if you'd just try harder." You want to scream at them. They have NO concept how hard you're trying already. "Maybe you could use lamaze breathing." Then you smile and try not to curse under your breath and call them all sorts of unprintable things. Acute pain and chronic pain... different animals.

  242. @Heather H I’d love to distract my migraine pain away but since it’s in my brain how exactly shall I use my brain to distract my pain away?

  243. It works with childbirth but maybe something else will work with migraines.

  244. I like how the author waits until the final third of the piece to point out that you can't think all your pain away. Responsible journalism folks - put the important information at a point where people have stopped reading! People in chronic pain already have to deal with friends, relatives, employers and doctors telling them their pain isn't as bad as they think, that it's all in their head, mind over matter, etc. while we struggle just to get through the day. While without a doubt some minor pain can be dealt with this way, people with serious pain can't wish it away - believe me, if we could, we would do so in a heartbeat.

  245. @BT Logan Thank you for making what should be obvious points, but are regularly disregarded by otherwise intelligent people. Pets reliably respond to pain medicine, and not to placebos. We should be able to agree that this demonstrates that pain is real, and that pain medicine hasan independently benificial effect, without dismissing the benefits of distraction. It is perplexing that, without beniefit of personal experience, people often assume that the pain sufferer is exaggerating or unmotivated to try effective countermeasures.

  246. @Greg Yes! A doctor friend who was skeptical about acupuncture (which appears to interrupt the pathway between pain and brain) went to China to learn from acu masters. In his first lesson, the master brought in a donkey which was braying in pain from a bad tooth. The master applied acupuncture and removed the tooth. The donkey was complely still and docile, stopped braying, and trotted off afterwards as though nothing had happened. The Western doctor was impressed enough to become a certified acupuncturist, and used it successfully on his patients. Pain can be interrupted. But even animals know it is real.

  247. @POV must be nice—didn’t work for me😒

  248. "The pain is all in your head." "I know, that's why it hurts so much!" Too much of how "we" experience, interpret and act. Not enough about how Austin feels, except sometimes he apparently is grumpy. Agree with the individuals who have commented here about their particular experience.

  249. This strikes me as one of those articles meant to absolve the Doctors and the hospitals and whoever else that can't/ won't/ aren't going to provide pain relief for people THEY KNOW are in agony. Also for people who conflate spraining an ankle or a minor cut with bone-on-bone never-getting-better arthritis or a lingering back injury. Well, thanks for the advice. Next time I wake up with shooting pain because I rolled over the wrong way in the night, I'll order up that Zen Garden or hop out of bed and do some yoga. Do you know what also works for pain? Sitting immobile for the better part of the day, whether that's "thinking about your loved one", staring at the TV, or just lying there, unable to join your friends or family anymore in the activities you once enjoyed.

  250. @Samazama I went in for a sinus lift and implant and am allergic to NSAIDs. The procedure causes a lot of swelling and pain and I was given nothing because 2 days of pain meds is apparently the devil now. That is the net result of the war on opiates. The allergy to NSAIDS apparently is a drug addict red flag.

  251. "Pain is an opinion" is a gross over-simplification. It may work for statistically few individuals but to the rest of us, pain is real and we cannot "think it away". Taking sedatives with pain killers doesn't help. For chronic pain sufferers, they are caught in a bind. The abuse of opioids by many has resulted a dilemma for those who need the drugs to relieve pain, forcing them to carefully ration their intake so as not to have their supply cut off by the medical establishment.

  252. @styleman Mindbody medicine is not about just thinking away the pain. It takes a lot of practice, and it's about unlearning beliefs about pain that can make the pain worse. Do these techniques work for everyone? No. But from VentureBeat about Curable, an app that teaches MindBody techniques to treat chronic pain, "70% percent of Curable users report experiencing “some degree” of relief from physical symptoms after 30 days of using the app, and 30 percent of people say they experience improved quality of life." This is only after 30 days, it took longer for me to do the bulk of the unlearning & I keep getting better.

  253. @Sing I've had 3 dogs go through surgeries, amputations, and cancer. We could ALWAYS tell when they were comfortable or in pain. Did they have "beliefs about pain" that affected its level? I don't think so, but we could ALWAYS tell that the steroids and opiates worked - until it didn't. Maybe you think that we're so different from the other animals that we have a hidden power to ignore or refuse pain? There was a recent article here about a lady that couldn't feel pain, and how researchers discovered a rare genetic mutation that, like mole rats, makes her impervious to pain. Maybe you should contact those researchers and let them know that they're wrong, and that the lady and mole rats just have different opinions about the neural signals that the rest of the animal kingdom interprets as extremely noxious stimuli to be avoided atalmost any cost. People in severe chronic pain are willing to trade risk for pain relief, but what do they know?

  254. @styleman as well- forgot to add, Mindbody medicine does not say your pain is not real. It is very real. It says that our thoughts and beliefs about pain can sometimes activate our neurological pain pathways when they don't need to be activated. That means that if you change your thoughts about pain, you could potentially reduce the amount of pain you feel. As well, "pain is an opinion" means that pain is your brain's opinion. When your brain perceives there to be a threat, it can activate those pain pathways. But, just because your brain perceives there to be a threat doesn't mean there actually is one. For example, lots of people are afraid of bugs, even though a lot of bugs aren't dangerous to humans. So, it is your brain's opinion that there is a threat, and that you need to be in pain at that moment. So, if we can calm down our nervous system, we may be able to calm down the pain as well. I used Curable to unlearn these patterns around some pain & severe fatigue and it has really helped me.

  255. Five years ago I shattered my elbow, had a 6 hour operation and three months later got complex regional pain syndrome. An agony. Fortunately I was chosen to work with a group of doctors doing research on pain and for a year I was taught and at times taught to cheat my brain to manage the pain. Now I can even have root canal treatment without panic. Last week I went to my family doctor and he said it was a miracle. I said it was people who cared and constant hard work.

  256. The problem with chronic pain and mental “tricks” (meditation, distraction, etc.) to reduce it is the same as the physical remedies (heat, cold, stretching, rest and/or activity) to reduce it. It’s all temporary. No one can have a life tied to doing all these treatments all the time. That’s why Pain medication will always be a necessary part of a chronic pain patient’s treatment plan. Because the optimal word here is chronic. Acute pain is more effectively treated with mental and physical therapy. Chronic pain needs a break in not only the pain cycle but also a just a break from the constant consequences of living an handicapped life. The responsible use of opioids allows a patient with relentless daily pain not only to have a life, but to promote a sense of control and relief that enhances their mental state. People who want to stop feeling pain take enough medication to stop pain. Those who want to feel nothing take enough medication to feel nothing. That’s the difference between abuse and use.

  257. What is this piece doing in the National News section of the NYT? Is it not enough that many news stories carry large photos that take up more space than the text they are meant to illustrate? Is the NYT's coverage of hard news going by the wayside, or is it all in my mind? Is this article on pain meant in some way as a metaphor for what's happening to content on the page?

  258. @kdd you don’t think pain is a national problem—well you’re lucky you’re not one of the millions of sufferers👹

  259. You are aware there is a national epidemic of drug addiction, yes? You know that many addictions begin with pain medications ordered for acute pain? Are you aware that as a consequence many people with chronic pain are no longer able to obtain the pain medications they are used to for pain control? This is a nationwide concern—not for everyone but for some people everywhere.

  260. @Gerithegreek518 In the "research" conducted to determine there are more deaths from the use of prescription opiods than ever - chronic patients were lumped in with people who have addictions, go to the streets to get their drugs when they are no longer prescribed, and die. Chronic patients are not drug addicts. We are using opiods to try to LIVE not die. One last irony is the willingness to provide patients with medicinal marijuana as part of their treatment. I'm trying to contribute to this world, not smoke or vape or use a tincture that keeps me loopy at home with no life whatsoever. REALLY?!!

  261. Once the OPIOD drumbeat started & continued to get louder & louder, you just knew they were going to throw the baby out with the bathwater. That it was all going to go to extremes. That people suffering real pain were going to be denied besmirched & ridiculed. Some of your assumptions here are plain ridiculous. It's "an opinion" ? But ... I better stop right here. The editors what like it much if I write what should really be said.

  262. In 2007, i had an accident where my car was hit head on at 65 mph by a woman running a red light.I was stopped. When I add up all the expenses and operations for the arthritis caused by the accident, I need a daily low dose Fentanyl patch to walk on my feet. I AM GETTING MY FIFTH SURGERY FOR FOOT DAMAGE THIS DECEMBER. We are talking about ongoing constant pain. The alternative would be not walking and living in a wheelchair. Anyone who has not experienced chronic pain should shut up.They know nothing.

  263. @Pat Nixon Agreed. There is nothing as difficult as the mental, emotional and physical stresses that affect everything we can do, every day. It's so hard to explain how much chronic pain closes your circle of life. If I could "brain wave" this pain out of my life, I would!! Writers who get their articles published in the NY Times about this subject should not be allowed the right to hurt so many people who suffer every day, who take their prescriptions properly, who TRY to live. Austin Frakt and his group should walk in our shoes before spouting that pain is an opinion. Nice catch-phrase, but so deeply WRONG.

  264. I’ve read that swearing when you do something like stubbing your toe measurably decreases the pain you feel. And presumably, the stronger and longer the the cursing the more efficacious the remedy. “Darn or “ow” have very little effect!

  265. My experience tells me this is true.

  266. @Nancy I believe that there are clinical trials tending to show this. If I remember correctly, they used exposure to cold, not toe stubbing. Yes, the stronger curses worked better than "drat it!"

  267. Nearly every day I see something written by a doctor or health care provider and it's a little too much. Most especially over reported is related to pain control. We save all heard, read, etc., about the opioid problem and the stats show that doctors have been prescribing less for the last couple of years. Move on to other important topics, please!

  268. @mary barter, don't forget all the commercials about medications. Sometimes I feel they are suggestions and give your unconscious mind a reason to get sick.

  269. When pain became "the 5th vital sign," it lead to over treatment and overuse of opioids. Pain is a symptom, not a vital sign. Vital signs -- blood pressure, respiratory rate, heart rate, temperature -- can be measured objectively. All of us experience pain. A lot of it, can be mitigated by practicing somatic movement. There's nothing mystifying about somatic movement. We can use our brains to reverse our sensory motor amnesia, to regain ease of movement, releasing our pain, without medications or people doing something TO us (a chiropractor, physical therapist, massage therapist). I know, it might sound woo-woo, but it works! thinksomatics.com

  270. I was hit by a car while riding my bike. Within 24 hours, I wasn't able to turn my head to the right, or straighten my right arm. Every muscle in that area of my body, as well as into my torso was contracted, holding onto the trauma at the moment of impact. X-rays showed arthritis in my neck. Most people would jump to the conclusion that must be the problem. I said, "So? I didn't develop arthritis in 24 hours. What's the real problem?" To which no one had an answer, other than bodywork, stretches and strengthening. Nothing helped. It got worse to the point it that just to stand and walk was excruciatingly painful. Then I discovered Clinical Somatics. I learned how the brain controls what the body does. I had been getting worse because standard protocols were fighting my nervous system with force and over effort, making my body contract more. With Somatics I learned simple movements called pandiculations. These simple, gentle movements retrained my brain to release my muscles to their natural resting length. Instead of trying to change the body, I learned to change my brain and take back voluntary control of how my body functions. We *learn* our motor patterns, good and bad, and since the brain is "plastic" we can learn new skills at any age! I could have given up, habituated not only my pain patterns, but my thinking patterns as well. Somatics is all about choices. I chose to get better, with time, patience, curiosity and love. You can too. thinksomatics.com

  271. This sounds really airy-fairy to me. I went to a doctor after years of excruciating pain down my leg which I self-diagnosed as recurring from a herniated disk years ago... and the pain turned out to be emanating from disks that were completely gone in my cervical area due to an extremely odd walking posture due to scoliosis when I was in my teens...I can't get back my disks, but a proper diagnosis with x-rays lent me to ask for physiotherapy and now I am 68 years old with the VO2 capacity of the average 27 year old female...pain is not just in your head - the head sometimes communicates a real problem.

  272. When I was first brought to the burn unit, I had no idea what debridement was and had no fear of it per se. I was full of narcotics and whatever else they gave me. I had no clue what awaited. Then they started debriding, with doses of narcotics many times greater than what I had already been given and with doses much higher than anyone ever takes outpatient. The pain was excruciating, blinding, my teeth actually chattered, and I thought I would die from the pain, which the meds unfortunately do not touch. It wasn’t fear. It wasn’t an opinion. It wasn’t a candidate for distraction. It was biology. I was horribly and deeply burned. The nurses and techs were cutting away, scraping away burned tissue from gaping open wounds that were screaming in pain. I invite the author of this article and the smug commentators suggesting that a patient can control this to spend some time in the burn unit—preferably as a patient.

  273. @P I have lived with chronic, often debilitating, lower back pain despite six back surgeries, including two fusions and implantation of a spinal cord stimulator. So, I understand pain. First, though I have never experienced what you did, I can comprehend the excruciating pain of debriding that you went through as I went thru excruciating nerve pain following two back surgeries in 48 hours last July. I still don't think it compares to what you went through and I am sorry for what you experienced; no human being should have to go through that. I am sorry for the long lead in but I have one comment on your post. The pain that you went thru during debriding was acute pain. The author here is talking about chronic pain. I don't think any mindfulness or other techniques could diminish the pain that you went thru at the time, and I don't think that the author would disagree. I can attest to the benefits of these techniques for chronic pain. I don't know if you are still experiencing chronic pain from your injury, but I would refer you to the Mayo Clinic's Pain Rehabilitation program. The 13 minute video at their website does an excellent job of describing how the brain and nerves reset themselves to signal more and more pain even though there is no biological or mechanical reason for the pain. I am trying right now to get into the program. https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/overview

  274. I appreciate your response but mindfulness techniques are just so much pap to chronic pain sufferers. What works for you (trying to reprogram) does not work for everyone. There is a lot of biology involved that cannot be reprogrammed. There is physical damage that can’t be re- thought. The pain is not always from old pathways of injuries that are healed. Many people have ongoing chronic conditions that should not be dismissed as remnants of acute pain. It will not pass and is both chronic and acute. I honestly hate the distinction. When the pain continues it is chronic and no less acute in its presentation in many circumstances. Yet even you are convinced that once you are out of the hospital and the icu, this pain just requires some reprogramming. I am truly glad that the technique is working for you. Please understand that there are many others who have tried everything and need direct pain relief. Articles like this make it nearly impossible to get. Other people’s addiction problems should never guide medical decisions for an individual.

  275. I am not sure why people (including pain professionals) think that "chronic" pain is "less than" acute pain. If someone has horrible pain that just happened, it's labeled as "acute" and taken seriously. If they have the *same* pain six months, or six years, later, for whatever reason, a label of "chronic" is applied and the person is supposed to meditate or use an app.

  276. So much anger seems to have been generated by this article, I have to wonder if people read it through to the end. The author did not say individuals with chronic pain do not exist in actuality. Nor did he say that pain, while it may be generated by the brain, exists only in the brain. Nor did he say that alternative therapies are successful for everyone. Nor did he say that these approaches relieve everyone or every kind of pain. Nor did he say that pain exists only in the weak. Nor did he say those with pain should feel guilty about having pain. I don’t believe the author meant to do anything with this information other than try to help some folks. Sheesh!

  277. @Gerithegreek518 You said: "I don’t believe the author meant to do anything with this information other than try to help some folks. Sheesh!" I kind of do. The trend is to diminish reality.

  278. I've had 3 dogs go through various surgeries, amputations, and cancer. We could tell when they were comfortable or in pain, and tell when the steroids and opiates given for pain worked - until they didn't. Did those dogs have "beliefs about pain" that affected its level? - How silly! The people who think that we're so different from the other animals that we have a unique ability to ignore or refuse pain should read the recent NY Times article about the lady that couldn't feel pain. Researchers discovered that she has a rare genetic mutation that, like the mole rats, makes her impervious to pain. If they still believe that pain is just an opinion," they should contact those researchers and let them know that they're wrong, and that the lady and mole rats just have different opinions about the neural signals that the rest of the animal kingdom interprets as extremely noxious stimuli to be avoided atalmost any cost. People in severe chronic pain are willing to trade risk for pain relief, but I suppose that's just their opinion.

  279. @Greg, I am working as an animal rescuer and wildlife rehabilitator for the past 20 years and have seen all sorts of injuries in animals. They react different to chronic pain than humans. They do not have that ability to form an opinion and they also can't feel sorry for themselves to make it worse. They simply deal with it. Having said that, I have seen dogs where humans felt sorry for them and they picked up on that emotion. Being the pleasers they are.... you see where I am going with this? That also works for grief. Often it's the pet owner that keeps the dog grieving over a loss of another while they would have gotten over it by themselves within a day or 2.

  280. @Birgit I'm a retired acute and chronic care nurse, and, like almost any seasoned healthcare professional or veterinarian, can usually spot a person or animal in pain from across the parking lot or field. I suppose, since we have forward looking binocular vision, it shouldn't be surprising that, like other predators, we can spot the weakened members of the herd. I have to disagree that humans respond "differently" to chronic pain. We wait until the need to move is greater before we initiate activity on a painful limb/joint. We use compensatory motions to minimize motion of the afflicted body part. We are animals too, and, except for our heightened intelligence and ability to communicate, we share all the same emotional and instinctual traits with them.

  281. I disagree . Learned helplessness was studied in dogs. Dogs are emotional beings . How do you know what they think and feel?