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  • Heather Koubek

This tricky thing called pain

Updated: Feb 5

Pain. Non terminally diagnosed pain (terminally diagnosed is a different animal altogether.) It’s a phenomenon I deal with every day. With my clients. With my family. In my own body. There are those who have occasional episodes of lasting pain. Some suffer with chronic pain syndromes every day, for years on end. In my decades of doing social work and bodywork, I have noticed that levels of pain can usually track pretty accurately with our emotional states. Then I heard Rachel Zoffness, PhD, pain psychologist, speak recently and it all came together.

Let me start with this simple revelation: pain is not only influenced by the biological mechanisms involved. The biological piece is tissue damage (“tissue” meaning soft tissues like muscles, joints, nerves, organs etc.) Tissue damage then sends signals to the brain that we are in danger. A cascade of responses follow, one of them being the experience of physical pain and discomfort. This is an innate and efficient safety mechanism for us living beings. It signals us to stop what we are doing and address the damage. It’s an alarm of sorts.


The biological mechanism is important. But it is not the only direct influence on the levels of pain we experience. Dr. Zoffness talks about the biopsychosocial factors that influence how we perceive and experience pain. The Biopsychosocial model systematically considers biological, psychological, and social factors and their complex interactions in understanding our overall emotional and physical health. This means that the assessment of pain goes beyond the physical (bio.) It should equally include examination of your psychological/emotional state (psycho) and the environment in which you exist in (social). These three stimuli should be examined equivalently under the microscope when assessing pain levels.


What does this mean? It means that these 3 factors (bio-psycho-social) hold equal importance in regards to how we experience pain. For example, two people of comparable build and age sprain their ankle. The ligaments are similarly injured. Pain naturally follows. One person feels the pain all day long. One only feels it when they put weight on it. How is this possible? Assessment of pain goes beyond the standard 1-10 pain scale, the actual injury and comorbidities (bio). It should also include the following: assessment of what one's past relationship to pain has been like. What is one's familial relationship with pain, i.e. did they grow up with a family member in chronic pain (psycho)? What is their current environment like at work or at home? What kind of support do they have in their lives? What kind of external stressors are present (social)? Dr. Zoffness puts so eloquently into words what I could not. We all have an internal “pain dial”, one that can be turned up or down. These three factors together have direct influence on how high or low our pain dial is set to, i.e how much pain we experience.


Concurrently as you seek out a pain management specialist, including these observations will be extremely useful. As per my usual stance, your best bet is to first connect with your own body. Do this kindly, mindfully, without judgement or fear. Examine where the pain arises, where else it refers to, what makes it better or worse, what times of day or night it changes. Start a daily journal documenting all of this so you can see concrete patterns and regain some sense of control over the pain experience. Now take a further step back and look at the daily personal and professional stressors in your life. Does exacerbation of the pain coincide with stressful points in your day? Are you able to ease some of those stressors as you begin this journey to healing? One last thing: take a look at your emotional state. What was it like before the start of the pain? What is it like now?



You do not have to live a life in pain. This is not your lot in life. Connecting to your own beautiful and complex biopsychosocial experience will lead you to recovery. If you come armed with this nuanced self-assessment when approaching a medical specialist, you are actually helping them create a more personalized treatment plan that will be more likely to succeed in the long term. PLEASE pick up Rachel Zoffness The Pain Management Workbook!! This manual will take you step by step into how to begin this journey towards a life in which pain is no longer your main driving influence. She writes honestly, frankly and in language easily understood by us regular folks, engaging you through reading the text and filling out the manual, back into yourself. Pain, when examined with this 3 dimensional approach, can actually be a doorway into a better understanding of ourselves and our collective, subjective experience we call life.



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