Ascellus Blog

How to Shut the Gate to Stop Chronic Pain

October 22, 2018

How to Shut the Gate to Stop Chronic Pain


You might call it mind over matter, or, mind over pain. It’s the ability to deal with pain by thinking good thoughts. And everybody has it. It’s just a matter of learning the techniques to do it properly.

It is one of the cornerstones of cognitive behavioral therapy for chronic pain (CBT-CP). Injured workers are surprised that they can reduce — or even eliminate their chronic pain, just by changing their thinking.

Here’s one of the exercises that demonstrates the power of our thoughts. We first tell the injured worker to identify her thoughts and emotions. If she is telling herself, ‘I can’t cope with this pain,’ we ask her to instead tell herself, ‘I can cope with this pain,’ even if she doesn’t believe it at all. The brain and pain response don’t know she doesn’t believe it. She has essentially tricked her brain, which responds by turning off the fight-flight-freeze response and, in doing so, closes the ‘pain gate.’

Why it Works

Just as movement and activity can close the pain gate, on an UP PAIN basis – the trip through the spinal cord to the brain, thoughts and emotions can do the same thing in the reverse, on a DOWN PAIN basis – the trip from the brain to the injury. Remember, pain is a perception and involves a complex mix of thoughts, emotions, environmental factors and physical stimuli.

People who are anxious or depressed often find it difficult, if not impossible to cope with their pain. While they and others might believe their pain is causing their negative emotions, the reverse is also true. By telling themselves positive messages, they can start to change the way their brains deal with pain signals.

What they are doing through positive thoughts is decreasing the stress arousal response and activating the neurotransmitters that inhibit the gate from opening. The pain gate has closed, so the pain the injured worker felt becomes much less intense.

There are many ways to help change an injured worker’s thoughts and emotions, such as meditation, mindfulness, and relaxing training. The key is to find what works best for each person. One injured worker may have more results from yoga, while another might find breathing exercises are more effective. A properly trained CBT psychologist can show the injured worker various techniques to help determine which are the better coping mechanisms for him.

It should be noted that CBT-CP is not a long term venture. CBT is very different from classic psychotherapy. It is a brief intervention and is goal oriented. Injured workers who receive CBT-CP are given ‘homework’ and expected to complete it. They learn to take control over their pain and their bodies. It is truly remarkable to see an injured worker who has suffered with chronic pain be able to take back his life and return to function, and even to work.

CBT-CP and Workers’ Compensation

You might ask if this is so straightforward and simple, why don’t all medical providers who deal with chronic pain patients use this. There are a couple of reasons.

Unfortunately, medical schools don’t usually teach courses in managing chronic pain, but instead focus on diagnosing and treating specific diseases. In recent years, the prescribing of opioids has become one of the primary methods of treating chronic pain. The attention and resources paid to the current opioid epidemic in this country is starting to change that, at least in the workers’ compensation system. With that change has come more attention on CBT-CP, but informing and training providers to use a strategy that is brand new to many of them will take time.

Ascellus – Integrated Medical Case Solutions – is the premier behavioral medicine network for pain and trauma response with evidence-based outcomes and a proven track record for transforming workers’ compensation cases. Ascellus makes intervention efficient with a national network of 1,500+ psychologists and psychiatrists in all 50 states.

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Ascellus bridges the gap between mental and physical health to accelerate recovery for our nation's workforce. By connecting the workers' compensation industry with our expert behavioral care and evidence-based treatments, we deliver high-quality outcomes, helping injured workers reemerge with increased strength, purpose and resilience in the workplace.