Chronic pain is at an epidemic level, affecting about a third of the adult population. In adolescents, the number of in-patient admissions rose 831 percent over a seven-year period. The reason? Many of these patients are treated for acute pain, when they are really suffering from Neurophysiologic Disorder (NPD). NPD requires a different treatment plan, and it’s one that may surprise you — expressive writing.
Chronic pain is stressful both physically and emotionally, and causes your body to secrete stress hormones, such as cortisol and adrenaline. NPD is a constellation of symptoms that occur after these hormones run rampant in your system. Over time, each organ system will either respond or shut down, resulting in disruptive physical symptoms.
Researchers see physical evidence of NPD when they look at functional brain MRI scans. In a study published in 2013, researchers looked at scans of patients who had acute back pain—pain for less than three months—and compared them to patients who had suffered chronic pain—for ten years or longer. The scans demonstrated that within 12 months of the onset of pain, the “driver” of the pain sensation switched from the acute pain center of the brain to the emotional center of the brain. (1)
Treatments that target acute pain only address the physical aspect, so they aren’t effective for someone with NPD. Patients with NPD have permanently imbedded pain pathways that need to be “disrupted” and “relearned.” They cannot be unlearned—it would be similar to trying to unlearn riding a bicycle.
Fortunately, if you follow the sequence below, you can creating alternate pathways:
- Awareness: Become aware of the effects that these disruptive pathways have on your body and nervous system.
- Separation: Create a space between these stimuli and the automatic responses. You have to let go in order to move forward.
- Reprogramming: The essence of cognitive behavioral therapy. Reprogramming fits in alternatives in the space between you and your thoughts that was created with the writing
And this is where writing comes in.
Writing separates you from your disturbing thoughts, so it can be used to help you let go. We are not our thoughts! When you create space between you and your thoughts, you can become connected to a bigger vision for your life—you are more than the pain you feel. Writing helps to reprogram the nervous system, so you can respond more appropriately to pain.
The first step is engaging in what I term “expressive writing,” and it’s an essential step in the process. It simply involves writing down any thoughts on a piece of paper and then destroying it. You destroy your text as a way to give you complete freedom to write whatever is on your mind. The more specific you can be, the more effective the writing process will be for you. The other reason to destroy the paper is to NOT analyze your thoughts. You are just directing more attention to them and reinforcing them. You are just separating from them; not fixing them.
I have seen many patients heal just by doing a version of this basic exercise. It was the first tool that I used to pulled myself out of a 15-year tailspin of chronic pain, so I know it works. The effects of expressive writing have also been well documented in the medical literature.
There are some general guidelines regarding how long you should write. My general recommendation is once or twice a day for five to twenty minutes. I view it as similar to brushing my teeth.
I have been writing like this for over 15 years. For many years, I wrote daily and now I write three or four times a week. Whenever I have stopped expressing my thoughts on paper, my symptoms recurred with two to three weeks.
Expressive writing is a remarkably effective tool, especially considering how simple it is. Try it and begin your healing. The Dangers of Positive Thinking
- Hashmi, JA et al. Shape shifting pain: chronification of back pain shifts representation from nociceptive to emotional circuits. Brain (2013); 136: 2751-2768.
Warning: Please note that most people do experience an early decrease in mood and sense of well-being. Pain may also initially increase. This is not a bad prognosis for a long-term beneficial effect. It is recommended that you limit the writing to about 20 minutes per time until you are feeling better. If you feel too uncomfortable, stop the writing immediately and contact your physician or mental health professional.