“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” —Viktor Frankl



In his book Man’s Search for Meaning, Dr. Frankl wrote about the psychological impact of life as a prisoner in the Nazi camps of World War II. His mother, father, brother, and wife were all killed in the camps. Dr. Frankl describes in chilling detail how his captors took from him virtually everything of personal value and basic human dignity.

The only thing that the Nazis were unable to take away was his choice as to how to respond to the deprivation, degradation, and to which he was subjected. He made a conscious decision to focus his energies on “owning” that small but all-important space between the stimulus (whatever was said or done to him) and his response to it. His ability to retain that degree of psycho- autonomy in the most horrific circumstances imaginable provides a remarkable example of intrapersonal strength, grace under extreme duress, the power of personal choice, and the Serenity Prayer in action.



Physical pain has distinct biological and psychological components that effectively represent stimulus and response. The biology of pain is the signal transmitted through the central that “something is wrong.” The psychology of pain is the interpretation or meaning we give to that pain signal—the internal and beliefs about it which then drive our emotional reactions. Suffering results from mental and emotional responses to pain. The biological and psychological facets of combine to become like a smoke detector that goes on and stays on, continuously sounding a harrowing alarm at high volume.

Recovery from chronic pain distinguishes between the actual pain and the suffering it causes, and focuses on achieving relief from that suffering. Pain is unavoidable; suffering is not. It occurs in response to thoughts such as: “Why me?!” “It isn’t fair!” “This is horrible!” “I can’t stand it!”



Suffering in general, as well as specific to chronic pain, is a function of imbalances in physical, mental, emotional, and/or spiritual functioning. Because whatever affects the mind or the body will inevitably affect the other, regardless of which side of the fence an issue originates, imbalances in thinking can create imbalances in physical, emotional, and spiritual functioning. Recovery from any significant condition or life challenge is a gradual, progressive, and ongoing process of restoring balance in these areas.



Suffering is both a cause and an effect of the catastrophic cognitions and distressing emotions associated with chronic pain: , irritability, , , , frustration, , , , hopelessness, and helplessness. only makes situations we believe to be “bad,” worse. Many people, including those who do not suffer from chronic pain, can ruminate on something by continuously and unproductively replaying it in their minds or magnifying the negative aspects of it. Our thoughts have the capacity to make us miserable, and negative thinking can be especially insidious, feeding on itself, with the potential to become a self-fulfilling and self-defeating prophecy.



For people with chronic pain, there is a direct correlation between negative thinking and the level of pain they experience. It’s a vicious circle wherein pain triggers negative thoughts and self-talk which translate to feelings that coincide with suffering, and increases muscle tension and . That, in turn, amplifies pain signals, triggering more of them.

The progression is essentially as follows: Pain leads to negative thoughts/self-talk/beliefs lead to feelings of frustration/anger/anxiety/fear/sadness/depression/hopelessness lead to suffering leads to muscle tension and stress lead to more pain leads to increased negative thoughts/self-talk/beliefs lead to increased frustration/anger/anxiety/fear/sadness/depression/hopelessness leads to greater suffering, and so on. The longer such a cycle continues, the more out of balance a person becomes.



Suffering can be modified when people become consciously aware of this chain reaction and learn how to respond differently to their pain. The process of pain recovery includes dramatically changing the negative progression starting with regaining cognitive and emotional balance through the application of acceptance strategies and practices. Reestablishing balance counteracts the above deviation-amplifying dynamics: conscious awareness of negative thinking/self-talk and how it sets off the cascade of events that fuels suffering leads to mindful acceptance and detached observation of negative thinking/self-talk lead to tamping down/minimizing of suffering leads to decreased feelings of frustration/anger/anxiety/fear/sadness/depression/hopelessness lead to lower stress and muscle tension leads to less pain.



Is this easy? Of course not. However, it is absolutely possible. By adjusting our thinking, and how we think about our thinking, we can change our emotional responses, the extent to which we suffer (or not), our level of tension and stress, and in turn, our experience of pain.

Copyright 2014 Dan Mager, MSW.