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The link between pain and fear

At first glance, you might not expect that pain and fear have much to do with each other. Pain is pain, and fear is fear, right? But, of course, I wouldn't write this blog if there was more to it than we think...

Earlier you could read that pain and fear are both 'warning systems' of our body with quite a few similarities. In a nutshell: in order to become less anxious, we regularly have to do exciting things, and in order to get less pain, we regularly have to do things that cause pain. Preferably constructive and regular. 

But what I am thinking about today is how pain can lead to more fear. Because pain is such a feeling, we want as little of it as possible. What happens is that we become a little afraid of activities that have previously led to pain.


A personal example

Let me take a personal example. On a skiing holiday a few years ago, a skier flew up against my right shoulder in full speed, while I was slowly snowboarding (it was in one of those 'slow' areas, but the skier didn't take that into account...). After a couple of weeks of taking it easy, I decided to go back to work out. I noticed that I was a bit tense. After the first training I got 'radiating pain' from my right arm a day later. My left shoulder also started to hurt! While I knew for sure that there was nothing wrong with that. I tried to do what I am writing about here. Keep moving, continue to build up your sport calmly and practice many arm movements (especially making crazy movements helps!). The first few days were very exciting, with the fear that I might help my whole arm and shoulder to the destruction (which is not logical at all, but still). Gradually the pain became less, my shoulder on the left was 'ok' again pretty quickly, and the 'really injured' shoulder was free of pain after a couple of weeks. As I started practicing more, the tension also decreased. 

What you see in my own (true!) example, and probably also recognize, is that it can be very exciting to pick up activities that previously led to pain. Our brains are constructed in such a way that they want to protect you optimally, but unfortunately they fail to do so. This not only causes more pain, but also more fear (for pain!). One warning system lights up the other, as it were.


Fear and predictions

A characteristic fitting to fear is that there is always a prediction attached to it:

  • My back breaks when I lift groceries
  • If I do too much, I'll break my shoulder.
  • My knee wears out even more if I cycle a lot...

Almost everyone with pain makes such predictions, because our brains are made that way. The unconscious warning systems in our brains are making predictions all day long. 


What do you do about it?

The warning systems in our brains are unfortunately learning something special in new things. It helps a little, but not enough, to read a lot. Reading about pain and fear provides understanding, which is the first step, but not less pain and fear. To reduce your pain and anxiety, you will have to 'prove' the warning systems that they are wrong. 

A very nice way to do this is called 'exposure in small steps'. The idea is that you first write down what your biggest fear is. For example: When I lift the groceries, something breaks in my back. The more you write about this, the better! What will happen next? How do you notice that something is broken? What should you do next? 

What you then do is exactly what the fear evokes. Start small, for example with a light bag of groceries and build up slowly. And most importantly: Find out if your doomsday scenario has come true? Is your back broken? Did the ambulance have to come? Did you have to lie down for four days? Do you have a plaster cast all over your body? If not, what has experience taught you? 

Please note that this is not so much about 'pain'. Pain is a warner. Your body probably hurts when you think about the activity you're afraid of, because your brain thinks it's doing you a favour. Check whether there is really damage, apart from the pain. The more you do and dare to do, the more warnings will dim - but this takes time. 

Does this sound too dangerous to you? Exposure in steps (gradual exposure) is a scientifically proven treatment for pain complaints, in which the Dutch even take the lead! It can be very helpful to have a good practitioner with you if you would like to pick this up yourself (google on gradual exposure in case of pain). 

More guidance on how to decrease your pain