Scott This is Scott. Every Tuesday and Thursday at 6 am I work out with three other guys. Scott is our personal trainer and this is his picture at the gym on Halloween. He is a little unusual in that he laughs at us – the whole time we are working out. He pushes us hard and the more we “complain” the more he works us – and keeps laughing. Of course we also end up laughing. It doesn’t matter what lines we give him he will one-up us. It is impressive in that we have some excellent complainers in our group. I am paying you for this?? It hit me one day that people pay me to do whatever I can to relieve their pain and I am paying Scott to inflict pain – some days quite a bit of it. Yet I come out of my workout invigorated and refreshed. My day is always better and my mood is light. That is in spite of the fact that my patients keep asking me the rest of the day if I am in pain. My back and right knee is stiff after my sessions with him. I limp and have a hard time getting out of the chair after a patient visit. Although I am uncomfortable I don’t really perceive it as pain either during the workout or the rest of the day. What is going on? I don’t have a particularly high pain tolerance. Choice I think it is because I have a choice. I make a decision to get out of bed early and spend time at the gym. We have a great time in spite of a lot of physical sensations that are often not that pleasant. But I could always leave or quit working out with this group. In chronic pain you have no choice. You are trapped by an unpleasant sensation. Feeling trapped causes anger and over time it can become a rage. Contrast the same uncomfortable sensations combined with deep anger versus laughing and having a complete choice over how much pain you are going to allow to be inflicted on you. Interpreting signals Every time the body sends a pain signal to your brain it has to be interpreted as pleasant or unpleasant. When the sensation is combined with a pleasurable experience (and I hate to admit to Scott I am having a good time) it is a completely different situation then when these sensations are combined with fear and anger. The final perception is dramatically different. Make no mistake about it. Pain is a perception and is interpreted only through your nervous system. It is confusing in that although the pain is felt at the point of origin it is perceived only in your head. All pain is “in your head. If you think otherwise, “wake up”. The quest If you are on a quest to “find the source” of your pain or you are convinced that “the doctor is missing something” you are stuck. In fact you are being trapped by the same disease that is also contributing to your chronic pain – the Mind Body Syndrome. Obsessive thought patterns are one of the classic symptoms that also blocks treatment. I liken them to phantom limb pain where pain persists in the leg after it is amputated. The pain circuits keep spinning. So can obsessive thought patterns. Patients frequently have undergone many tests for years without an answer and cannot stop going to the doctor to have more them done. The need to “find an answer” is an endless pilgrimage. I enjoy my workouts with Scott and my friends because I have a choice. I experienced years of chronic pain in where I had no choice. It was extraordinarily unpleasant beyond words. Your choice Right now you may not feel like you have much say about your pain. But you do have a choice to learn about the various components, engage in effective treatments and take full responsibility for solving it. I ended my quest for an “answer” in 2002 in that somehow I realized that the answer to my pain was there was no answer. I made a decision to live my life with or without the pain. It happened on Mother’s Day. As I took back complete control of my life my pain eventually disappeared. I did not make the decision in order to get rid of the pain. That was an unexpected bonus. It is what happens to my patients as they reach that point and make that same choice. With a deep commitment becoming pain free is the rule, not the exception. Make a choice to live. You only have one shot at this life.