Dr James Alexander, PhD- Psychologist

In the final chapter of 'The Hidden Psychology of Pain', i discuss the importance of the psychological sense of time, and being in the present moment. When pain has become chronic, expectations of it always being there become well entrenched- this is not neurotic, but is based on one's experience up to that point in time. As with any unfavourable circumstance, we tend to build a narrative or story around the experience. It usually has three components:- our current experience (i am in pain now); our past experience (i have been in pain for two years); and a future prediction (based on past and current experience, i predict that i will be in pain tomorrow). There are many problems with this natural way of joining the past, present and future. One of the main problems, when doing this in regards to pain, is that the anticipation of pain is often worse than the experience of being in pain now. Our ability to cope with adversity in the present moment results from a combination of both the current situation (including the resources and limitations inherent to the situation) and who we are in that particular moment. Solutions to problems, to the extent that they can be found at all, result from this combination. If i have a flat tyre that needs changing, the situation itself will have resources in it (eg. a wheel brace and jack in my car) as well as limitations (my spare tyre is flat).The solution to the problem then results from a combination of the situation and me in that situation (eg. i know how to use a wheel brace and jack,or how to get help with it). Solutions to problems do not occur without 'me' (the relevant person) being in the situation. As such, when we anticipate problems, because we are guessing about a future event which is not yet happening, 'we' are not yet in the situation itself. As such, no solution to the problem is possible as a major component of a solution ('the person) is not actually yet in the situation. When seriously considering an unsolvable problem, anxiety is often experienced as we tend to feel helpless in relation to it.

It is the same with chronic pain. When we anticipate being in pain tomorrow, there is nothing we are able to do about it in terms of coping, simply because we are not yet in tomorrow in order to be able to cope with it- we can only cope now, not in some time in the future. Coping is not yet possible. As a result, we tend to dread tomorrow (if it is a bleak possibility we are thinking about). Researchers have demonstrated experimentally that the anticipation of pain is worse than the actual experience of pain. The story that we tell ourselves is very important.If our story is full of expectations about being in pain (e.g i will not enjoy my child's wedding because i will be in too much pain to actively participate), then we are adding additional layers of psychological distress. This can have the effect of exacerbating the existing pain.

While being 'mindful' is not the magic bullet to pain which its advocates suggest, there is value in cultivating an ability to simply remain with what is- not with what might/might not be. We can generally cope with 'what is'- we may not like it, but we rarely ever die or psychologically fall apart because of adversity (i am aware that this does happen sometimes, but usually not). Every moment is different from the last. Any guess we make about the next moment is just that- a guess. All scientists know that guesses, or hypotheses about the future are only ever discussed in terms of probabilities- things that may or may not happen. It is a reasonable hypothesis that if i hit this particular button on my key board, the corresponding letter will appear on the screen. But is it an absolute certainty? Any number of electrical problems could occur to stop this result from happening, so the hypothesis can only be stated with, for example, a high degree of confidence like 99%. It is the same with chronic pain. Every new moment is different. We may be convinced that the next moment will involve the same amount of pain as the last, but variations in an individual's experience of pain argues against this. The fact is that we never know what the next year, month, week, day or even moment will bring us. As long as we are convinced that it must include unmanagable pain, because thats what the last moment gave us, then we are adding to our burden of psychological distress and this is likely to have a worsening impact on our pain. This theme is discussed more in the final chapter of 'The Hidden Psychology of Pain', and research demonstrating the deleterious effects of pain anticipation is discussed in the linked article.

http://www.sciencedaily.com/releases/2013/11/131121184216.htm#.Uo_ta7S1_LE.email