Pain Desensitization: How to Overcome Fear of Chronic Pain

By Gabriella Kelly-Davies, PNN Columnist

Something common to us all is a dislike of pain. Sudden or acute pain is a warning signal that something is wrong. When it strikes, we try to escape from it by taking a pain reliever, distracting ourselves, resting or seeing a health professional.

This approach usually works after an injury or surgery while waiting for the damaged tissues to heal and the acute pain to settle. But it is not as effective for chronic pain when the cause of the pain is a malfunction in the processing of pain signals in the central nervous system, rather than tissue damage.

While chronic pain is not generally a warning sign, the brain may still see it as a threat. It prompts the same avoidance behaviors we use for acute pain. Many people living with chronic pain are so fearful of triggering a flare up, they avoid anything they believe exacerbates their pain. This fear can be so intense it prompts them to leave the workforce prematurely, stop doing usual daily activities such as shopping and housework, and give up doing all the things that previously gave them pleasure.

Australian psychologist Michael Nicholas, PhD, was worried that many of his patients at the Michael J. Cousins Pain Management and Research Centre in Sydney limited their daily activities to avoid pain. Some patients even tried staying in bed all day to prevent provoking their pain.

Nicholas wondered whether an exposure technique used by psychologists to treat phobias such as fear of heights could be applied to pain management. In exposure therapy, psychologists create a safe environment, then gradually expose an individual to the thing they fear. With repeated exposures in a safe environment, anxiety and fear can be reduced.

“I thought exposure therapy might reduce the fear of pain and the resulting avoidance behaviors,” Nicholas told me. “This would mean training the brain to learn not to react to chronic pain. I started encouraging my patients to sit quietly for 20 minutes, acknowledge their pain, but not react to it. After doing this repeatedly over a few weeks, many patients told me their pain was still there, but they were no longer so bothered by it. They lost the urge to escape from it.”

Nicholas described the technique as pain desensitization because his patients were familiar with the idea of pain sensitization, and he thought this could be a way of countering that effect.

For the last few decades, Nicholas and his colleagues have used this approach in the multidisciplinary pain management programs at their center. As with learning any new skill, he says mastering pain desensitization takes a lot of practice.

“You’ve got to practice pain desensitization regularly,” Nicholas explained. “Often people aren’t prepared to do that.” He likens it to lifting weights at the gym to build up muscle strength, something that usually takes weeks or even months.

“If you’re trying to change the way your brain responds to pain; you’ve got to do a lot of workouts. It can take up to two to three months of daily practice to master pain desensitization. But once you get the hang of it, it reduces the distress caused by your pain.”

I learned pain desensitization in 2008 in a three-week pain management program. It took me several weeks of twice-daily practice to fully grasp it, but I soon incorporated it into my usual routine. For years it has been a seamless part of my day, and I practice it regularly, especially when I have a flare-up.

Learning Pain Desensitization

Try making pain desensitization a part of your daily relaxation practice. Close your eyes, take a deep breath and let it out slowly, focusing your mind on breathing calmly. After a couple of minutes of gentle breathing and relaxing, turn your attention to the pain. If you have several painful sites, choose one of them.

While focusing attention on the pain, try not to think about how bad it is. You can’t stop yourself from thinking, but you don’t have to respond to the thoughts. Just let thoughts pass you by like a leaf floating on the stream. Calmly focus on the sensation you call pain and see what happens. Don’t try to change the pain or attempt to make it go away because that is trying to escape from it. Simply let it be there and continue relaxing.

Sometimes the pain might start to feel worse because you are used to trying to escape from it. If this happens, continue with your breathing exercises and any increase in pain will settle. Try to observe your pain as calmly as possible, almost as if it is in someone else’s body. Or imagine you are doing a scientific experiment and focus on the pain like a scientist might observe a leaf or a bug under a microscope. Be as objective as possible, without reacting emotionally to it.

If your mind wanders, bring it gently back to focusing on the pain. Continue relaxing and use your breathing exercises to calm yourself. Keep this up for about 15 to 20 minutes and see what happens. Look at it as a type of experiment and evaluate what you notice. Remember, you’re just allowing yourself to experience the pain that will be there anyway, even if sometimes masked by medications. You aren’t doing anything that can harm you.

By allowing yourself to feel the pain repeatedly, you can habituate to it, because our brains naturally habituate to repetitive stimuli. This effect is similar to what happens when you put a new painting on your living room wall. At first, you notice it whenever you walk past it. But after a while you notice it less. You remain aware that it’s there, but you don’t notice it as much.

Don’t expect too much too soon. Just keep practicing because eventually you will retrain your brain to not respond with alarm to the pain. You’ll find that as you get better at desensitizing, you also become more relaxed when feeling your pain.

Once you have learned the technique, try it whenever your pain starts to trouble you, particularly during exercise or other activities that aggravate your pain. If pain stops you from falling asleep, try desensitizing in bed at night.

Start with a mix of long and short sessions -- two or three 20-minute sessions each day. In between, try brief sessions of one to two minutes whenever you notice your pain or when exercising. After a few weeks it will become a habit and you’ll find yourself doing it without realizing it.

Pain desensitization isn’t a miracle cure for chronic pain. Instead, it is one of the many techniques used in multidisciplinary pain management programs to modify the experience of pain. Importantly, it helps people reduce the impact of pain on their life.

“You have to see it as a training exercise, not as a gimmick,” Nicholas advises. “It’s a skill you’ve got to learn, like learning to play tennis. But as with tennis, once you’ve mastered it, you’ll find you do it automatically without thinking. Many people are surprised by how effective it can be for reducing the distress caused by their pain.”

Gabriella Kelly-Davies is a biographer who lives with chronic migraine.  She recently authored “Breaking Through the Pain Barrier,” a biography of trailblazing Australian pain specialist Dr. Michael Cousins. Gabriella is President of Life Stories Australia Association and founder of Share your life story.