Pain Relief Through a New Understanding: Why Changing Your Story Matters
Your Pain Story is not a physical sensation, but rather the explanation you have devised to make sense of why you hurt. As shown in the image above, it often lands higher, appears bigger, has red fletching that is indicative of heat, blood, or danger, and can have a larger impact on your pain response than the tissue damage itself. To explore this more, let’s look at a Zen parable that is often used when treating patients with chronic pain in Acceptance and Commitment Therapy (ACT).
Zen Parable: The Second Arrow
This tale involves the very unfortunate incident of being struck by two arrows. The first material arrow, shot from an unknown source, lands in your skin and causes physical harm and great pain. The second arrow, a metaphorical arrow, is not launched from an external bow, but rather is hurled internally from your reaction to the first arrow. This second arrow denotes the resistance, the negative emotions, the focusing . . . in essence, the Pain Story that is attributed to the unpleasant sensation inflicted by the first arrow. It is said that this second arrow, the one of our own making, is bigger, more painful, and longer lasting than the first arrow that caused the actual damage to our body. The moral of this fable, then, is that your reaction (second arrow/story) to the physical injury (first arrow/sensation) can change how much you hurt. In other words, the degree of pain that is felt can be increased or decreased in accordance with your perspective. For example, you will most likely be really angry and hurt much more if you observe that the first arrow was deliberately aimed at you with intention to harm versus being accidental. In addition, your knowledge about injuries from arrow wounds, such as how serious they tend to be, how long they take to heal, if you are likely to have a full recovery, what the treatment is, and on and on will impact your level of discomfort. Viewing the wound as catastrophic, with a long healing time, and potential permanent loss of function will be more painful than a viewpoint of a mere flesh wound that will heal quickly. Although you cannot do anything about being hit by the first arrow in this tale, you do have a choice and can control the force of the second arrow through the story you tell around the circumstances of the pain. Helping you reframe your story where it is elevating your pain is the intention of Pain Story Project. And research has found that sharing your story can be the first step towards recovery.Research Supports Examining Your Pain Story
In fact, research by Watson et al. (2019) demonstrated that having patients tell their story was a key component in the implementation of Pain Science Education (PSE). Further, a review article on PSE by Moseley et al. (2024) referenced Watson’s paper and added the following clinical implementation guidance.First, a comprehensive assessment that allows the patient to tell their own story is likely to validate the patient’s experience, allow the clinician to identify the patient’s prior understanding and beliefs, and [. . .] identify those concepts that may be most important, and content that may be most suitable for that patient at that time and in that context.Hence, your story provides the clues to your treatment and recovery. Through sharing your narrative, the understandings, concepts, and beliefs that may be impeding your healing often become apparent and available for review and revision. Importantly, a study by Canerio et al. (2020) also emphasized the necessity of targeting beliefs in recovery with this statement. “Clinical guidelines recommend addressing unhelpful beliefs as the first line of treatment in all patients presenting with musculoskeletal pain.” In short, before any physical intervention is done such as ultrasound, exercise, anti-inflammatories, massage, and so forth, Canerio suggests that the patient’s beliefs are taken into account. Pause and take a moment to seriously consider that. Then ask yourself this question: Has anyone ever asked me what I believe about my pain? And going even further, has anyone ever asked you what you understand about your problem? In other words, do you understand what is causing your pain? Subsequent research has found that having an answer to this question is even more significant than changing beliefs.
