If we accept that pain and fear interact with each other in a vicious cycle, each magnifying the other, it follows that whatever may reduce one may also reduce the other. One might even say that it is the very strength of their bond that allows us to weaken it.

This is not so paradoxical as it sounds. Pain and fear share the ability to induce physiological/neurological changes that we call stress. Can we learn to modify those responses? The answer is yes. Individuals can learn to exert at least some control over their responses to stress. Biofeedback, relaxation training, meditation and exercise have all been shown to decrease physiological stress responses, particularly when practiced repeatedly. If one is able to maintain a lower than usual level of physiological/neurological arousal while being exposed to the object of one’s fear again and again, the object’s ability to cause fear will weaken. This principle of learning has been very successfully applied in the psychological treatment of many anxiety related disorders.

The object of fear can be anything, including pain. Furthermore, the exposure does not have to take place in the real world but can occur in the mind. If one can simply imagine going to the dentist or doing the vacuuming (or doing anything that raises one’s stress levels) while staying more relaxed than one otherwise would, the link between the dentist (or vacuuming) and fear will start to weaken. With repeated imaginary success, one could graduate to practice in the real world with a certain amount of confidence in one’s ability to keep stress levels down.

The above has obvious implications for the management of chronic pain. Reducing apprehension or anxiety related to performing tasks that hurt is a significant step toward being able to perform them. Furthermore, lowered arousal levels may also mean lowered pain intensity and this adds to the ability to function. Reducing the stress response can lead to less pain and less fear that in turn lead to less stress: the vicious cycle can be turned into a beneficial one.

It cannot be emphasized enough how important repetitive practice is to achieving some degree of success in controlling physiological/neurological stress responses. Pain and fear have great power but they are not invincible. This post has shown one way to get at their bond. There are more.