Let me summarize this series: the neurological and physiological changes caused by pain and fear bond them together. Fear and pain magnify each other. The fear of pain leads to avoidance of activity that is self-reinforcing. So-called pain behavior and non-organic signs, common in chronic pain patients, are indicators of significant distress associated with pain.

Pain and fear may go together like love and marriage but for many patients it is a marriage made in hell. Even if one understands that distress is a factor in one’s pain, this does not necessarily lead to reduction of either. Practicing mind-body techniques in the midst of disabling pain and significant distress is very difficult, to say the least. Many of the patients I’ve seen give up because they fail to achieve the results they hoped for after several months.

Please remember that the stress reduction practices mentioned in this series constitute only one aspect of the treatment of chronic pain. Learning to manage one’s distress is done in addition to whatever medical or other treatments are being used. It must be emphasized that fear, while important, is but one of many factors involved in the perception of pain. Other factors may need to be dealt with by pharmacological, physical or even surgical treatment.

Nevertheless, fear is something that must be addressed in almost all the patients I see with chronic pain because pain and fear involve the same or similar brain processes. Relaxation, meditation, biofeedback and mind-body techniques can modify those processes and to some degree, bring them under conscious control. The scientific evidence to support this is strong. But it takes courage and motivation to deliberately practice confronting one’s fear and pain. Patience and persistence are required because there are rarely dramatic results. Those I’ve seen improve have done so gradually and continue to practice to maintain their improvements.

Chronic pain is not a hopeless condition. This series has tried to show that even something as fundamental as the bond between pain and fear can be weakened. Furthermore, this is something best accomplished through individual effort, possibly reducing the reliance on other treatments. Now is the time to begin.