Why does changing your pain story matter?
A Pain Story is separate from the physical sensation and contains the thoughts, opinions, expectations, feelings, and significance we attribute to the persisting pain. The story helps us make sense of the physical pain and develop an answer to the question of why we hurt.
As shown in the image above, the arrow containing our story often lands higher and appears bigger than the arrow representing the physical sensation. Further, the arrow holding our story is depicted with red fletching that could be indicative of heat, blood, or danger. A Zen parable that is often used when treating patients with chronic pain in Acceptance and Commitment Therapy (ACT) explains how our story can have a larger impact on our pain experience than the tissue damage itself.
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.
Understanding Your Problem is Critical for Recovery
Results of the 2022 Resolve Back Pain Trial showed that participants who gained an understanding of their problem reduced their pain by 80%. Yahoo! Yet, only 50% of the study subjects changed their understanding. Boohoo. The disconnect, according to Moseley in an interview with Joe Tatta PT, DPT is with the clinicians, “who are not effective enough at working with patients in a recovery mindset.” Moseley went on to emphasize the importance of patient involvement. Saying that patients have a requirement to do their work to recover while at the same time, health professionals need to shift to more of a coaching role.
At Pain Story Project we are coaches and therapists with education in pain science. We realize that helping people change their concept of persistent pain is primary to recovery. In addition, we appreciate that this information will not be effective unless it is personalized and directly applied to an individual’s life situation through active strategies (Moseley & Cormac 2024).
Just as important, we agree with Moseley’s comment that: “Education plus something active is the best treatment we have” (Tatta 2024). Which is why Pain Story Project should be seen as a partner to the numerous exercise-based treatment approaches for chronic musculoskeletal pain. There are many physical body remedies for ongoing pain, and we are offering an education focused compliment in the healing process.
Change Your Narrative – Join a Story Group
A blend of coaching, teaching, and community, our Story Groups offer a protected environment to delve into the beliefs, concepts, understandings, and other components of your story. While being supported yet challenged, these groups will help you:
- Identify the roots of your story
- Appreciate the role of others in your narrative
- Recognize and respectively ponder the recurring themes and tone of your tale
- Welcome new possibilities to dissolve conflicts and move the plot of your story to a successful resolution
Your story can change and so can your pain!
Learn more and register for our next group.
References
Tatta, J. (2020). Radical Relief: A Guide to Overcome Chronic Pain. OPTP.
Watson, J. A., Ryan, C. G., Cooper, L., Ellington, D., Whittle, R., Lavender, M., Dixon, J., Atkinson, G., Cooper, K., & Martin, D. J. (2019). Pain Neuroscience Education for Adults With Chronic Musculoskeletal Pain: A Mixed-Methods Systematic Review and Meta-Analysis. The journal of pain, 20(10), 1140.e1–1140.e22. https://doi.org/10.1016/j.jpain.2019.02.011
Lorimer Moseley, G., Leake, H. B., Beetsma, A. J., Watson, J. A., Butler, D. S., van der Mee, A., Stinson, J. N., Harvie, D., Palermo, T. M., Meeus, M., & Ryan, C. G. (2024). Teaching Patients About Pain: The Emergence of Pain Science Education, its Learning Frameworks and Delivery Strategies. The journal of pain, 25(5), 104425. https://doi.org/10.1016/j.jpain.2023.11.008
Caneiro, J. P., Bunzli, S., & O’Sullivan, P. (2021). Beliefs about the body and pain: the critical role in musculoskeletal pain management. Brazilian journal of physical therapy, 25(1), 17–29. https://doi.org/10.1016/j.bjpt.2020.06.003
Bagg, M. K., Wand, B. M., Cashin, A. G., Lee, H., Hübscher, M., Stanton, T. R., O’Connell, N. E., O’Hagan, E. T., Rizzo, R. R. N., Wewege, M. A., Rabey, M., Goodall, S., Saing, S., Lo, S. N., Luomajoki, H., Herbert, R. D., Maher, C. G., Moseley, G. L., & McAuley, J. H. (2022). Effect of Graded Sensorimotor Retraining on Pain Intensity in Patients With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA, 328(5), 430–439. https://doi.org/10.1001/jama.2022.9930
Joe Tatta, PT, DPT (2024, July 29). The New Science of Pain Science Education with Professor Lorimer Moseley, AO [Video]. Youtube. https://www.youtube.com/watch?v=3A-LEghRqww
Moseley GL & Ryan, CG 2024 Making pain education better: historical underpinnings & recent
innovations – a discussion paper. 2024 UPDATE. PETAL Discussion Papers. 23.01 url: https://www.petalcollaboration.org/uploads/1/4/4/1/144169171/moseley__ryan_petal_discussion_paper_update_220224.pdf
