Do you live with pain that clinicians have not been able to explain, or that different clinicians have different explanations for? Does the pain get worse when you are stressed, and temporarily improve when you are distracted by enjoyable things? Are there triggers that reliably bring on the pain that don’t physically touch your body, e.g. inclement weather, or meeting a certain person, or doing a certain task?
If so, you might be living with neuropathic pain. It’s a real and debilitating condition that can be frustrating to explain and difficult to get help with. People who suffer from neuropathic pain are often left to feel like it is all in their head, which can cause feelings of shame and lead to them suffering in silence with a condition that is actually treatable. Counselling and psychotherapy are one way of treating it.
Pain psychologist Alan Gordon, in his book The Way Out, makes a compelling case that chronic neuropathic pain is best understood as the fear of pain. Not pain caused by ongoing damage or injury, but pain generated by a nervous system that has learned to expect danger — and keeps sounding the alarm even when the original threat is long gone. It is like a smoke detector that goes off when you make toast. The detector is working perfectly, but it makes the same sound when you make toast as when there is a genuine emergency.
When we experience pain, especially over a long period, we naturally become afraid of it. We brace for it, avoid things that might trigger it, and scan our bodies for signs that it’s getting worse. Understandable as this is, it can make things worse — because that fear and vigilance tell the nervous system that there really is something to worry about, which turns up the volume on the pain signals. Pain causes fear, fear causes more pain, and the cycle repeats.
This is where counselling and psychotherapy come in — not as a way of telling you the pain is “just psychological,” but as a way of breaking that feedback loop that keeps you in pain.
Gordon identifies three things that, in combination, can genuinely help the nervous system stand down: mindfulness, self-compassion, and developing a sense of safety. Let’s take each in turn.
Mindfulness can help you to develop some equanimity about your pain. Currently, you might tense up when you notice pain and think something like, “This is terrible. It’s getting worse. My plans for today are wrecked.” It is possible to practice a different approach, to bring some curiosity to those sensations, to briefly notice some of the feelings rather than pushing them away. Some people find this hard at first and you might benefit from some guidance; another person to help you “dip into” those feelings without getting lost in them. Over time, practicing this sends a quiet message to your brain that the pain, while unpleasant, is not actually a catastrophe. And a nervous system that feels less threatened gradually produces less pain.
Self-compassion is important because chronic pain almost always comes with a side order of emotional suffering. Many people blame themselves for not being better yet, feel guilty about letting others down, and might push themselves hard to appear “normal.” All of that stress and self-criticism keeps the nervous system in a state of high alert. Learning to treat yourself with the same warmth you would offer a good friend in your situation is not a soft option — it actively calms the nervous system and reduces the emotional fuel feeding the pain.
Cultivating safety is perhaps the most important piece of all. The nervous system only begins to quieten down when it genuinely feels safe. A good therapist can help you build that sense of safety — in your body, in your relationships, and in your day-to-day life — slowly and carefully, at a pace that works for you.
None of this is a quick fix. But for many people with neuropathic pain, it represents something they may have stopped believing in: a real path toward getting better.
Jay Hellings is a Gestalt Therapist in advanced training. They have their own experience of a long term health condition (chronic fatigue) and have found the concepts in The Way Out useful in improving their own health.