“Pain is inevitable. Suffering is optional.” — often attributed to Haruki Murakami, and true whoever said it first.
The title of this piece is deliberate. Not “Do you have chronic pain?” but How do you do chronic pain? Because here is the plain and simple truth of the matter; pain is not a thing you have, like a wallet or a set of keys. It is a thing your body and mind are doing, right now, in this moment, below your conscious awareness. And anything that is being done can be done differently. Stay with me, because that one shift in grammar is the doorway to everything that follows.
Why does pain persist and become “chronic pain”?
If you have ever wondered why pain hangs around long after the injury has healed — or why it turned up in the first place with no injury at all — then read on. You may just discover that there is a better way to alleviate the symptoms than the one you have been offered.
Let me tell you about a client of mine. I’ll call her Carol, and as always I’ve changed the details to protect her privacy. Carol came to see me with a shoulder that had hurt for eleven years. Eleven! She had the scans, the injections, the physio, the “learn to live with it” talk. The scans, by the way, were clear. There was nothing left to heal. And yet every morning the shoulder greeted her before she had even opened her eyes.
“So when did it start?” I asked her.
“Oh, I lifted something awkwardly at work,” she said. Then, after a pause, “…the week my mum went into the home.”
Carol had told that story to a dozen professionals. Not one had asked about the second half of the sentence. Why? Because the medical model isn’t looking for it. It looks for tissue damage, and when it can’t find any it reaches for the prescription pad. That isn’t a criticism of doctors; it’s a criticism of the frame — I’ve written elsewhere about why pain isn’t the problem, our medical model is. A model that treats symptoms will only ever manage pain. It never asks the pain what it is for.
What current science says about chronic pain and nociception
Let’s be fair to the science, because it has come a long way. “Chronic” pain is defined as any pain lasting more than three months — outlasting the usual healing process, often getting worse, often coming and going with no obvious pattern. The signalling system underneath it is called nociception: sensory nerves send messages up to the brain, and the brain decides whether those messages add up to a threat. If it decides yes, you feel pain.
Read that last sentence again, because it is the whole game. The brain decides. Pain isn’t measured at the injury and posted upstairs like a parcel; it is manufactured in the brain as a best guess about how much danger you are in. It is, as Professor Mark Johnson and I put it in our paper on somatoform symptoms in clinical practice, very often an illusion of tissue damage produced by an overprotective brain.
So what does the pharmaceutical industry do with that insight? It designs drugs to interrupt the signal. For acute pain — the broken leg, the operation — that is a blessing, full stop. But for pain that has outlived its injury, you are turning down the volume on a smoke alarm without asking why it keeps going off. There is no fire in the kitchen. Something else is setting it off, from somewhere the scanner can’t see.
The missing piece: an image that fires in a split second
Here is what I believe was happening to Carol, and what I have watched happen in thousands of people over thirty years.
In a moment of emotional overwhelm — her mother going into a home, the guilt, the grief, the “I should be coping better than this” — her mind took a snapshot. Not a memory in the sense of a story she could tell; something faster and far more primitive than that. I call it an Emotional Memory Image, or EMI, and it forms in a split second, below conscious awareness, at the exact moment the body is flooded with stress hormones. The image and the stress response are wired together in that instant, the way a smell and a memory are wired together. Neurons that fire together, wire together — Hebb’s old rule.
From then on, whenever anything in Carol’s world resembled that snapshot — a phone call from the home, a certain time of the evening, the particular ache of lifting something while feeling helpless — the image fired, the stress response fired with it, and her overprotective brain did what overprotective brains do. It raised the alarm. It produced pain in the shoulder, because the shoulder was where the alarm had been wired in the first place. Eleven years of a smoke alarm going off with no fire.
This is what Mark and I mean when we talk about “sticky” pain. The pain isn’t stuck in the tissue; it is stuck to an image. And notice something important: the image is not the injury. Carol did not have an EMI of a shoulder. She had an EMI of a moment of overwhelm that happened to include a shoulder. That is why I ask, quite seriously, whether undiagnosed trauma could be the cause of your dis-ease — and I spell it dis-ease on purpose, because that hyphen is where the whole answer lives. A body at ease does not manufacture pain. A body that is not at ease will find a way to tell you, and if you are not listening, it will shout.
There is another layer to this, and it’s one we explored in a paper on Past Adversity Influencing Now — the PAIN framework, if you’ll forgive the acronym. The very word “chronic” does something to a person. It is a sentence, in both senses. The day Carol was told her pain was chronic, her unconscious mind took that as an instruction: this is permanent, this is who you are now. The label itself can set the stickiness harder. So could your thoughts be driving your chronic pain? Not your conscious thoughts — you can’t think your way out of what emotion got you into — but the below-conscious ones, the images and the sentences your protector has filed away as fact? Yes. Every single day.
The body–mind worker’s approach to chronic pain and dis-ease
So what do we do about it? We don’t argue with nociception; the science is sound and we use it. But instead of trying to interrupt the signal on its way up, we go to the place the alarm is being triggered from.
When I work with someone, I am not listening to their story — or rather, I am listening to it with one ear while I watch with both eyes. Because the EMI gives itself away. The moment I ask about the shoulder, Carol’s eyes flick up and to the left, her breath catches for a fraction of a second, one shoulder (guess which) lifts a couple of millimetres. She has no idea she is doing any of it. That micro-expression is the image firing, live, in front of me. It is the “screen” — the space in front of her where the mind projects what it is guarding against.
Once we can see it, we can work with it. I invite the client to become a curious observer of their own response — not to relive the story, not to dig up eleven years of narrative, but simply to notice, in this moment, what the body just did. And then to try to think about the problem while looking somewhere else. It sounds too simple to work, doesn’t it? That’s what Carol said. And yet the moment she couldn’t find the image in its usual place, the alarm had nothing to fire from. We call this Split-Second Unlearning, because if the image was learned in a split second, it can be unlearned in one too. The neuroscience calls it firing out of sync: cells that fire apart, wire apart.
Carol’s shoulder didn’t vanish in a puff of smoke. What went was the alarm. Within a month she had stopped mentioning the shoulder and started talking about her mum instead — which, of course, was the conversation the pain had been trying to have all along.
So here, in one line, is the whole approach:
No chronic pain stimulus = no chronic pain.
Take away the image the alarm is wired to, and the overprotective brain has nothing to protect you from. It stands down. The tissue was fine all along; it just needed the brain to believe it.
A small experiment, before you go
I’d like you to try something, and it will take thirty seconds. Bring to mind your pain — not the diagnosis, the actual feeling of it. Now, without moving your head, notice where your eyes want to go. Up? Down? Off to one side? Most people find they are looking at a very particular spot in the space in front of them, and they have never once noticed it before. That spot is not nothing. That, my friend, is the screen.
You don’t have to do anything with it yet. Just know that the thing you have been calling “my chronic pain” for years has an address — and an address can be visited.
Where to go from here
If this has struck a chord, none of the roads ahead involve another prescription. You can start on your own with the Chronic No More programme, or the Chronic Pain self-hypnosis download, both of which walk you through finding and clearing the image at your own pace. You can read what happened when other people did exactly that in my client stories — the woman who had no recurrence of pain after one session is a good place to begin. Or, if you would rather do this with me in the room, you can read about the Hudson Method and decide whether you are ready for a MindReset.
Whichever road you take, take it gently and take it curious. Your pain has been trying to get your attention for a very long time. Cheer up — you have just started listening.