Dr. Ben Bobrow is chief medical officer for The Pain Project.

Our minds are bombarded with negative thoughts and visions of horrible events that may happen to us, but most don’t actually occur.  These types of negative thoughts wreak havoc on our emotions, our endocrine and cardiovascular systems, essentially our entire bodies. 

Since the 1990s, despite huge increases in medical treatments (e.g., MRIs, CT scans, medications, and procedures) in the U.S. for back and neck pain, joint pain, headaches, abdominal pain, and chronic pain in general, disability rates have not improved.  Chronic pain now affects an estimated 100 million Americans, or one out of three of us and costs our country ~ $650 Billion annually! 

Understanding Chronic Pain

State-of-the-art brain science using special MRI brain scanners have given us new insights.  One of these key findings is the significant change found in the brain structure of people who suffer from chronic pain compared to those who don’t. 

We know that chronic pain signals can remain active in the nervous system for years after an injury.  Sometimes pain even arises in the absence of any injury. Numerous studies confirm that our attitudes towards pain, particularly fear, anger, excessive worrying, and continuously focusing on pain, produce a cycle of pain that leads to inactivity, deconditioning, and low self-esteem. 

This does not mean that chronic pain is less real than acute pain. Rather it underscores that there is much more to chronic pain than only the physical (biological) aspect and that we need to view chronic pain from a broader perspective. 

Ways to Treat Chronic Pain

Fortunately, there are powerful non-drug techniques we can use to combat the damaging emotions that perpetuate pain.  These are not circus magician “smoke and mirrors” techniques, but rather real and well-studied operational practices.

One tool is called reframing.  Reframing encompasses recognizing our unhelpful thoughts and swapping them out with more constructive or adaptive ones.  You can also think of reframing as changing your viewpoint on a given circumstance to give it a more positive or constructive meaning

For example, I often hear individuals with chronic pain say, “My pain treatment has been an absolute failure.”  Instead, they could reframe their situation by asking, “Which portion of the treatment gave me some relief?  What part was somewhat helpful?” 

Another available tool shown to significantly improve chronic pain is called self-efficacy – that’s our confidence in our ability to achieve intended results.  Self-efficacy is gained when we succeed and therefore believe we will be successful. Higher levels of self-efficacy have been associated with much lower levels of pain and disability.      

Even individuals who are confident in other aspects of their lives (e.g., highly successful professionals) can lose their self-efficacy when they have chronic pain.  Re-locating the self-efficacy mindsets towards chronic pain is crucial. An example of self-efficacy is recalling the areas where you have overcome adversity and have persevered.  Then looking at managing chronic pain as just another challenge where you were able to “get er done” despite hardship.  Those neuroscience studies have confirmed it is important to have this type of mindset regarding chronic pain. 

Another helpful tool for individuals suffering from chronic pain is self-management.  I hear a lot of patients talk about their doctor managing their pain.  But the most vital person managing pain is the patient.  We would benefit from moving away from the notion where we always need a doctor to manage us.  Chronic pain self-management provides a sense of control that can be life changing.

Visit thepainproject.com where a trained pain therapist can help you master these life changing skills.


Dr. Ben Bobrow is a Distinguished Professor of Emergency Medicine at the University of Arizona College of Medicine and Co-Director of the Arizona Emergency Medicine Research Center. He also serves as the Medical Director for the Bureau of Emergency Medical Services and Trauma System at the Arizona Department of Health Service s.