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Pain and Fear

Okay, clearly a person in pain can't do the above. Or can they? Each person assesses the risk of an activity or movement in relation to potential injury. For example, a normal person doesn't lift up a car. First of all they can't, secondly they can get hurt (exception: reported cases of parents lifting cars off of children with superhuman bursts of muscle power).

A patient brought in a quote today that connected this for me. The truth that many people never understand, until it is too late, is that the more you try to avoid suffering the more you suffer because smaller and more insignificant things begin to torture you in proportion to your fear of being hurt. (Thomas Merton).

This really connected because I see a lot of my patients who suffer from chronic pain avoiding activity, exercise, even movement in order to avoid pain. However, I've learned that it often accomplishes the opposite. The pain pathways are heightened and the muscles are tightened when we are afraid, avoid, and obsess about movements and activities. Part of healing is learning to let go and move more naturally more fluidly, more comfortably.

Patients come in unable to bend (flex) past a 90 degree angle. Sometimes (injuries, other processes), they simply can't-- it's too painful. Other times, they report being afraid or being told by other practitioners to "be careful". How long can you "be careful" when it's chronic pain and there is no specific, significant cause found?

I tell them to gradually start moving more, exercising more... at follow-up visits, they invariably move more (flex better at the waist, for example) and feel better. Of course there's more to it than this. But Merton really hits it with "the more you try to avoid suffering....

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