The Emotional Side of Chronic Pain: Psychosomatic Awareness and Practice

“Psychosomatic” is a loaded word. Many interpret it as “not real” or associate it with being a hypochondriac. In reality, “psycho” simply refers to the mental side of the equation and “somatic” refers to the body. Put it together and you have mind-body pain. In other words… pain.

This is a massive subject, but let’s start with two basic principles:

1) While all pain (especially chronic pain) originates from mental / emotional / spiritual factors, they DO manifest as physical issues. It could be as simple as tension in the neck and shoulders from a stressful day or much more complex chronic patterns, imbalances, and misalignments.

2) Often, the initial cause of the pain has long passed and has become chronic. In its place: a fear loop of learned pain.

Learned pain plays a major role in most chronic pain. Here are two examples:

1) Chronic, protective tension surrounds the area and creates symptoms of a problem no longer physically present.

2) Anticipation of pain that previously occurred at a certain point in the body, a particular time of day, or occurred in a specific way, causes us to inhibit proper movement patterns at those times, places, or areas in the body. This type of fearful anticipation ensures continued dysfunction and pain.

In many cases, we have a learned response that needs to be “unlearned” and a muscular pattern that needs to be corrected. I prefer to address these simultaneously, but neither can be eliminated entirely if you’re still unknowingly participating in the initial cause of the pain. In other words, you’re unlikely to find or follow through with lasting physical solutions if you’re still in complete alignment with the cause of your pain.

Example: Lower back pain is frequently correlated with stress around finances. If you haven’t addressed or begun to shift your relationship to the “painful” subject – a mindset of scarcity, fear of instability – you’re unlikely to solve it by physical means alone. At best, you’ll get temporary relief of symptoms that constantly come back.

This is where context comes in. When someone shows up for a consultation with me, the first thing I get a sense of is whether this person is still in an emotional holding pattern, or if they simply need to address the physical remnants and “end the loop”.

These days, I’m happy to say that the people who come to me are almost always ready to go straight to this stage. However, we all have emotional holding patterns somewhere. An introspective physical practice can be a great catalyst to illuminate and release such patterns, but it requires a more nuanced approach than either a “no pain, no gain” mindset, or a complete avoidance of weak and uncomfortable areas of practice.

Essentially, there are 4 steps to address a painful area with your physical practice:

1) Look for the pattern

Assess and correct poor motor functions that have replaced our innate physical intelligence to orchestrate movement in the affected areas(s). (This step may not be ideal to pursue without high level professional help, but you can still get tremendous benefit by starting at step 2).

2) Find the pain point(s) and use micro-movements to gradually expose and dissolve the pain

Find an entry point in your body that allows you to rebuild trust with bringing movement into the affected areas, i.e. find the proper “micro-dose” of the poison that does NOT cause pain and allows you to gradually short-circuit the anticipated pain response to these positions, movements, angles, etc. The movements that make the best starting point resemble the movements that created the original pain but are scaled back so much that they are in fact VERY easy.

3) Follow up with CONSISTENT, SMALL micro-steps. 

Don’t go from easy to hard in one step… or even five. Drag out the initial stages to make sure you don’t lose forward momentum, create setbacks, or risk returning to anticipating pain. But, also be sure to plan for the long-term so your progressions eventually scale beyond “rehab” level. Getting out of pain is not a separate road from pursuing higher physical goals. It’s simply a better on-ramp.

4) Restore full-body physical intelligence

Address movement from a bigger picture perspective. If the targeted areas aren’t integrated into a more cohesive whole, we remain segmented and do not finish the healing process. Again, your long-term orientation should be about a complete physical practice, not just rehab of that one area in isolation.

A final note of make-or-break importance: The great irony is that a long-term approach and mindset yields much better short-term results than a short-term mindset. Do not underestimate how much more juice there is at the beginning of a long journey than at the end of a shortcut.

Think big, start slow.

For those that want a little more depth, continue reading below:

I’ve found over and over in correcting chronic pain issues that if a weak or inactive area is contributing to the problem (and it generally always is), the vast majority of the pain tends to go away as soon as you’ve established a new connection and are on track to restoring balance. This happens long before you’ve had much time to fully rebuild or heal the affected tissues.

For instance, let’s say you’ve been experiencing shoulder pain when you reach overhead. In this situation, it’s commonly thought that the pain is solely due to weakness in the muscles responsible for external rotation (rear deltoid, teres minor, infraspinatus). However, most people stop here when it doesn’t magically fix their pain. This is where the “connection” comes in. Strengthening that area in isolation only gives it the capacity to support your shoulder, it doesn’t teach it how.

Once you have the ability to feel that area from the isolation exercise, you have to practice using it while you perform the very motion causing pain. Strengthening must be paired with learning. In this case, a helpful exercise would be to slowly raise both arms overhead while focusing on bringing awareness into synchronizing the movement of the shoulder blade with the movement of the arm. By doing this, you will “connect” the important scapular muscles (including the rotator cuff muscles) to the painful area that they are intended to stabilize. Simply learning how to better engage and support your body is at least half of the battle.

In most cases, a substantial reduction or elimination of pain will occur from the very first session with a new client once we’ve isolated and then re-integrated the weak link in the chain. Some version of this can be applied to imbalances anywhere in the body. Again, relief need not wait until you’ve reached a magic strength threshold. In short, strength and learning are both important and are ideally addressed concurrently.

It appears that our bodies’ pain signals (or lack thereof) reflect not just our current state of being, but whether we’re on the right path. Pain can be an amazing gift that points us toward places we already want to go. If your chosen path out of pain doesn’t level up your body and life as a whole, it likely isn’t your path out of pain.

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1 thought on “The Emotional Side of Chronic Pain: Psychosomatic Awareness and Practice”

  1. Hi Paul, I’m intrigued with your approach that accepts pain, modulates awareness and encourages use and healing at an appropriate, customized pace. Being Canadian I cannot find your credentials on google apart from the RYT (Registered Yoga teacher). It might be helpful for readers to be encouraged to seek medical attention, and undergo imagery and neuromuscular, (electromyographic) studies to confirm or rule out treatable pain such as frozen shoulder or spinal nerve impingement syndromes etc. Some chronic pain syndromes are thought to be a result of reverberating pain circuits in the brain, far removed from the original stimulus in the peripheral body. There are cases of intractable chronic pain that resolve with deep brain stimulation as a last resort in a new frontier. (Like a pacemaker wire that can be reset remotely to deliver more or less current). Thank you for the hope you extend to so many suffering pain and the healing service you provide. “Alleviating pain is the work of the divine”. -Hippocrates


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