For many people living with chronic pain, it's a natural response to make the assumption that the pain they are experiencing doesn't indicate any real danger. After all, if you've been to the doctor (over, and over) and been told that nothing is wrong (again, and again), it makes sense that your trust in your body's pain alarm system is shaken. Your body was telling you that something is wrong, but all the doctors and medical tests say that there isn't anything to justify that pain response. They may have even told you that "it's all in your head" or accused you of "attention seeking" or "drug seeking" behaviors. Even if your doctor validated your experience, was compassionate and apologetic that they couldn't identify a reason for your pain, you still learn quickly that they can't help you. Furthermore, you will still get a bill for their time even if there is no treatment that fixes the problem, so it doesn't make sense to keep going.
When the pain is chronic, and doesn't have a clear cause or remedy, you will frequently have heard phrases like "suck it up buttercup", "it's all in your head you're fine", don't be such a drama queen" or "no pain, no gain", especially if the pain started as a child when adults were less likely to take you seriously.
It becomes a very practical coping mechanism to simply ignore the pain signals and stop talking about them. For people who experience pain constantly, if they stopped every time something hurt, they'd never get anything done and would spend most of their lives in bed. Many will therefore make the choice to keep doing things regardless of the pain. It will hurt whether they do things or not, so they might as well live life.
If we ignore all the pains and just continue to do whatever we please, we risk becoming over-doers and running ourselves into the ground. The fact is that pain does have a job in our bodies. We need it to tell us about legitimate danger.
For these individuals, Hurt Vs. Harm matters, because of the old proverbial story about the boy who cried wolf. The boy cried wolf several times when there was in fact no wolf threatening him. As a result, when there really was a wolf, and the boy cried wolf, no one believed him to come to his aid.
The fact is that ignoring pain can be dangerous. You would not say "no pain, no gain" to a child who cries because their hand is on a hot stovetop. The reality is that, leaving their hand on the stove top is only going to cause more severe burns and make it hurt more. The truth is that not all pain leads to gain, and like most cliches, you can't apply it to all situations.
That's why it is important to be able to differentiate pains that are hurting and pains that are harming us. While the hurt is very real, not all chronic pain indicates new tissue damage. (See Hurt Vs. Harm & Car Alarms: Interpreting Chronic Pain).
While it's rational to ignore the chronic pain signals that are "hurting" for many reasons, and it can actually be a useful strategy for improving chronic pain when paired with distraction techniques for "hurt pains", it doesn't help us if we ignore a "harm pain".
When we ignore "harm pains" our bodies will get frustrated with us. If the higher brain that does the cognitive processing in humans ignores the needs of the lower brain, eventually the lower brain will revolt.
For example, most people cannot forcibly drown themselves. Even a person who is experiencing significant suicidal ideation, won't be able to bring themselves to hold themselves under the water, their lower brain will take over and force their head above the surface to gasp for air. (We value all our readers as human beings, and living with chronic illness is hard. If you are experiencing suicidal thoughts, help is available, please reach out to the national mental health hotline by calling 988)
Our pain system works similarly, though in a more passive-aggressive way. Let's say your body gives you a pain signal, at a 3/10 intensity after you walk for 30 minutes and your body wanted you to sit down and rest. If you ignore your body, and keep walking for 60 minutes, the pain signal will escalate, perhaps to a 7/10 intensity. Eventually, it will become painful enough for you to listen to your body and sit and rest.
If this is a habit, your body will start to learn from the experience. If you could hear your nervous system talking to itself, the lower brain might be saying "Hmmm, she can't hear me...I must need to make my warning louder." If over time, the body realizes that you sit down at a 7/10 intensity, you may find that the 7/10 intensity starts to occur earlier and earlier. You might experience it at 45 minutes instead of 60 minutes, then at 30 minutes, or even sooner.
Ignoring "harm pains" over a prolonged period of time, may actually be sensitizing the body to pain more. If this is a pattern that has been learned for years, it may take some time for the lower brain to learn to trust the higher brain (you) again.
This is one reason that chronic pain is so common amongst professional/high level athletes, military veterans, and abuse survivors. These individuals lived a significant period of time in their lives where they did not or could not allow themselves to really process pain.
For people in the military, this is a survival skill. There are times in military combat when stopping to attend to an injury would mean losing your life, and pushing through the injury can get you to safety where the injury can be attended to later. In fairness, running on a sprained ankle, or even a gunshot wound to the leg is worth it if you are running for your life.
This is a mindset that is specifically cultivated in military training, along with other habits like strict obedience to following orders from commanding officers. While it may keep you alive in a war zone, that way of thinking can often overflow into everyday civilian life for years afterwards. In the absence of a commanding officer barking orders at you, when the lower brain is finally left to it's own devices, it can take back control with a vengeance. It can then insist that you process all the pain you have ignored for years, and give you overzealous signals about new injuries to make up for lost time.
For high level athletes, it may not have been life or death, but there are other things that motivate us. Professional football players play through all kinds of injuries because they decide that the paycheck, the fame, or just the love of the game are worth the price they are paying. They often also have access to high level medical treatments to cover up the pain for a while. Team doctors, athletic trainers, physical therapists, and other health care providers offer them a whole array of treatments to try and keep them in the game. While the doctors are usually well intentioned, and trying to provide relief in the short term, sometimes they and the athlete lose sight of the long term negative consequences that can follow.
Pain medication may cover up the pain, but playing on the injury may make it worse. Furthermore, the athlete is often set up for psychological failure. When everything centers around the sport, and then eventually they retire, or are injured to the point they can no longer perform, not only are they left with a broken body, but an identity crisis. The compounding physical and mental health struggles, in addition to access to money can lead athletes to dark places. It's not an uncommon story to hear of professional athletes who end up addicted to drugs and alcohol.
Lastly, let's consider survivors of abuse. Sadly, many abuse victims are children who have a limited ability to both recognize the abuse, and to know how to get help. They develop survival skills specific to their situation and the type of abuse. Some may attempt to rationalize the abuse as something they deserved. Others brains may respond by refusing to acknowledge or process the abuse entirely and repress the memory of it. The victim of the abuse is often just trying to make the best of a difficult situation that they have a limited ability to control or influence.
When these coping mechanisms are applied to pain processing however, it can muddy the waters. In addition to working with medical providers to rule out any actual tissue damage and treat it when present, professional counselling from a provider who specializes in the type of abuse the person experienced and pain psychology is often needed to help the individual heal.
If you believe that adverse childhood experiences may be affecting your pain processing, consider reviewing resources available from the Centers for Disease Control on the Adverse Childhood Experiences (ACE) Study. The ACE Questionnaire may serve as a starting point for you to evaluate if you have experienced childhood trauma that would benefit from professional counselling services. The ACE study also provides data on the prevalence of chronic illness and diseases later in life for people based on the number of adverse childhood experiences they had.
For the body's pain processing system to be healthy, we require balance. There is a right time to ignore pains that are legitimately hurting, but not harming us in order to help reprogram our nervous system. (See Hurt vs. Harm: Reprogramming the Pain Alarm)
There is also a time to recognize, that some pain is legitimately harming us, and take steps to respond accordingly. If you need help taking the next steps and aren't sure where to start, talk to your healthcare provider to connect you with local resources.
This article is intended for educational purposes and is not a replacement for individual medical or psychological advice. If you are interested in seeking individualized medical care for personal recommendations, call or book online to request an appointment.