Chronic pain

Gate theory useful – it’s not just about the stimulus coming to your nerve endings. That signal has to pass through a gate, to register in your brain, and different things affect whether the gate is more or less open or closed.

A feature of many chronic health conditions, eg juvenile idiopathic arthritis, migraine. Often a feature of chronic fatigue syndrome. Can be part of a functional disorder such as functional abdominal pain. In a limb, can lead to reflex sympathetic dystrophy. But often unexplained.

Think about PTSD – it’s all “in your head” but that doesn’t mean it’s nothing. Or phantom limb pain – there isn’t even a true signal coming from the limb, but you still feel pain.

Pain is performative – no one gets credit for trying to cope and hide it. But you can be accuse of “laying it on thick”.

Having a diagnosis helps socially. 

Pain can make you a different person from who you were. Impatience and irritability can be understood, besides an inability to do some activities that might be important to identity (and to relieving stress). Social isolation is common.

Chronic pain also steals any sense of your future because it is too intolerable to imagine more pain. 

Fear needs to be detached from pain. 

Acceptance therapy – not to accept eternity of pain but to focus on progress and function. 

[Haider Warraich podcast with Kate Bowler]