As a child I had no fear of going to the dentist until I had a tooth pulled without local anesthetic. Afterward it took years before I stopped flinching at the mere thought of going to the dentist. Getting me to go, even for a check up, became a trial.

The point of telling you this is to give an example of how we learn to fear the things that hurt us and we then learn to avoid those things. Someone whose back pain gets worse whenever vacuuming, quickly learns to avoid it if possible or be less thorough. Even the thought of vacuuming may lead to apprehension. By avoiding the painful activity fear is reduced. The relief one feels by avoiding pain is a strong reward that reinforces avoidance.

Furthermore, suppose the person with back pain had to do the vacuuming despite his or her fear. The physiological/neurological reactions caused by fear, so much like those caused by pain, will be increased by the actual pain experienced while vacuuming. This heightened response may lead to the perception of greater pain, greater fear or both.

The above is an example of synergy: Fear may increase pain and pain may increase fear, precisely because they are so strongly associated. It is not so much that fear causes pain or vice versa but that each can magnify the other. It is relatively simple to see from this how a vicious cycle can follow in which the affected person can become increasingly disabled. If pain and/or fear become great enough the person with pain will eventually stop vacuuming or doing anything that might cause pain – even if that activity was not that painful to begin with.

I see many people in my practice who are practically paralyzed by their pain, seemingly out of proportion to their condition. In light of the synergistic relationship between pain and fear it is easier to understand their plight. Given what I have already written previously about pain being a feeling, it must be emphasized that what they feel is real. To make matters worse, the loss of physical fitness that accompanies inactivity can adversely affect mechanical factors contributing to pain, thereby causing even more deterioration.

All of the preceding gives us a clue to how we can deal with the bond between pain and fear. If learning plays a role in strengthening this bond it is logical that learning can also help weaken it. We can learn to reduce our fear and we can learn to do things in ways that cause less pain. More on this in the next post.