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Why the 'pain threshold' is a fable

The pain threshold as we know it is a myth. There are no people with only a high or low pain threshold. 

Let us take the following example:

Stefan is a professional kickboxer. On Saturday evening he had an important match. He fought against Harry, who was a favorite for the fight. It was a very intense match, in which Stefan suffered some hard blows. Stefan hardly noticed any of the blows, not even when one of his teeth broke. His focus, the intoxication of the race and adrenaline made him feel hardly any pain. He finally won the game by knocking Harry out, and celebrated with his supporters for the rest of the evening without any problems.

It wasn't until the next day that Stefan really noticed how much pain he was in, especially on his teeth. He was very upset about that, because if he hated something it was the dentist. When he had to go to the dentist the next day, the pain seemed to get worse. He screamed at the anaesthetic and spent the rest of the painful treatment sweating and shivering. The pain was almost unbearable. 

Stimuli do not determine the pain

If the number of stimuli traveling through the nervous system were to determine the pain, Stefan would have had much more pain during the boxing match than at the dentist. But that was not the case. 

Stefan's pain threshold is also not 'constant'. During the competition it is high, at the dentist it is a lot lower. The pain threshold depends on the circumstances! Stefan has trained his pain threshold for boxing, but not for the dentist. In fact, because of his fear of the dentist, his pain threshold is suddenly a lot lower!

Stefan is not unique in this. The pain threshold of everyone depends on the circumstances, also called the context. Check for yourself, there must have been times in your life when you had little pain and discovered a bruise, or other damage, later on. Or moments when you felt a lot of pain but later on something turned out not to be wrong. 

In the case of chronic pain, the brain has learned to call for danger - and to create pain - in many circumstances. The more you listen to this pain, the more your brain becomes convinced that it is a good idea to create pain... Which means that in different circumstances the pain will continue to increase!

Tips for training your pain system

However, just as the boxer has learned to increase his pain threshold, anyone with chronic pain can apply the same strategies to also train your pain threshold in different circumstances. We can train our brains for certain circumstances, so that they don't shout 'DANGER' anymore in those circumstances. You do this as follows:

  1. Think of an activity that would like to expand, that gives you pleasure.
  2. Draw up a schedule in which you plan this activity on a daily basis.
  3. Extend the duration of the activity a little bit each day. Take really small steps!
  4. Keep to the schedule as much as possible, and don't skip it if you are in pain. Do at least 80% of your intended goal if you have a bad day, and no more than 120% if you have a good day.
  5. Don't get discouraged if you have to take a step back now and then. Pain is unpredictable and even if you work well (on yourself) the pain sometimes unfortunately comes around the corner. This has nothing to do with your efforts!
  6. Be patient. Your pain system may change, but it's not as fast as you'd like it to be. It may well take a few weeks before the first changes occur. Hang in there!

More guidance on how to decrease your pain