NeuroBehavioral Programs has identified the following twelve common resistances to pain reduction. During the treatment process certified NeuroBehavioral Therapists use specific strategies to eliminate these resistances as they surface for patients. Addressing these common resistances is an important part of gaining long-term control over pain and an important differentiating piece that makes the NeuroBehavioral Programs treatment for pain management successful.
- The patient thinks that being able to block pain psychologically
must mean the pain or injury isn’t real.
IF I can turn off this pain, THEN the pain must not be real.
This resistance usually operates consciously as a form of disbelief and represents a blending of two issues. First, being told that the brain is the place where pain signals register may cause the patient to think it means the pain is all in his or her mind. Second, being told that it’s possible to control pain using the mind may cause the patient to think it means that the pain experience is somehow imagined and therefore not real. - The patient feels entitled to have pain relief without
having to actively participate in using psychological techniques.
IF I didn’t cause this injury, THEN I shouldn’t have to be responsible for fixing it.
This resistance appears to center around issues of justice and equity in human relationships. Getting pain relief effortlessly by taking a pill can be seen symbolically as part of a package of reparations owed to the victim. - The patient fears returning to the job and finding out
that he or she is no longer able to do the work.
IF I reduce this pain, THEN I’ll have to return to my job and maybe I’ll find out I’m not able to do the work anymore.
The thought of not being able to do work patients know or love is disturbing and they often would rather not think about it. - The patient believes that pain is necessary as a governor
to limit activity to avoid additional injury.
IF I reduce all this pain, THEN I might forget I’m injured and re-injure myself.
This resistance is frequently seen in highly physical people and ex-athletes. It’s a common finding in patients who are successful at reducing pain but not quite to a zero level. Often these patients say, “I know myself too well. I know that if I’m pain free I’m going to overdo it. I need some pain to remind me to go slow and not hurt myself.” - The patient fears failing at a new career now that it’s
no longer possible to return to the old one.
IF I reduce this pain, THEN I’ll have to go back to school to retrain for a new career and I’m afraid I won’t be able to learn or keep up with others.
This includes worry about being able to handle returning to the classroom and aptitude for retraining. It reactivates emotional reactions to prior educational experiences, which may have been unpleasant for blue-collar workers. - The patient has existential concerns that now he or she
has to make more conscious life choices.
IF I reduce this pain, THEN I’ll have to face questions [or stop facing questions] about who I am and what I’m capable of.
The meaning of life, what’s valuable and important, has been heightened as a result of the pain experience. Choices about how to live and what to do have become more conscious. What previously was a job the person may have stumbled into now carries a larger symbolic loading of identity and meaning. Consequences of decisions become more conscious. The burden of choice that comes with living more authentically increases, causing discomfort. Fear of regret emerges. For the psychologically sophisticated, on the other end of the scale, pain can be a launch pad for psychological growth - The patient believes that pain relief equates with or
indicates acceptance or forgiveness of the agent who injured him
or her.
IF I reduce this pain, THEN I’ll have to forgive you for what you’ve done to me.
In this resistance, pain relief has become symbolically associated with forgiveness. Often pain and anger have become fused and equivalent. This may include anger at an insurance company or at a person whose negligence may have caused the injury. - The patient believes that pain entitles him or her to
take time off.
IF I reduce this pain, THEN I’ll lose my chance to get a break for a while.
This resistance is sometimes seen in someone who’s been a breadwinner all of his or her life and wants a break. This is actually rare, though, as the other costs of chronic pain generally greatly outweigh this temporary benefit. - The patient believes that pain entitles him or her to
be taken care of.
IF I reduce this pain, THEN I’ll lose my chance to be taken care of in ways I can’t allow myself to admit that I want.
Latent dependency needs may emerge when someone playing the “sick patient” role under chronic pain conditions thinks it’s safe to let them out. Cultural conditioning may play a role in this resistance for those raised in cultures given to preferential treatment of children and deferential treatment of males. - The patient believes that pain entitles him or her to
be taken care of for past suffering.
IF I reduce this pain, THEN I won’t be able to collect on all the past injustices I’ve suffered.
This resistance is often submerged under the surface behavior of patients who complain bitterly of past treatment by physicians or insurance companies. Professionals often refer to these patients as injustice collectors. Anger gives these difficult patients a sense of power and purpose, and the negativity tends to close them to change. - The patient has incorporated the pain into his or her
self-identity.
IF I reduce this pain, THEN I’ll lose a part of myself.
This resistance is often surprising to patients who may feel strangely empty or like something is being taken away from them when their pain reduces. Some patients use pain as a badge of courage. And many patients have said that as strange as it may seem, pain was their friend. - The patient’s pain supports an addiction that can’t
be admitted at a conscious level.
IF I reduce this pain, THEN I won’t be able to justify taking opiates, which I crave but can’t admit I’ve become addicted to.
Patients who’ve become skilled at psychological pain reduction but whose pain levels suddenly increase while their use of psychological pain management decreases may have this resistance.
