This is where the various parts of the Limbic System are probably most affected. It implies that a lot of things can be done if someone is willing to go outside of their personal "box" and confront the reality of their world. This DOES NOT mean that you are "Crazy" or that "the pain is all in your head". When a doctor tells a patient that the pain is all in your head, it shows the doctor's ignorance about how pain is processed. It is not helpful at all, and most of the time it is very counter-productive. Patients become very defensive and try to totally ignore these important issues with the result that a whole area of possible treatment options is not well accepted and tends to be minimized in importance. Doctors will generally not want to deal with them. This is one of the reasons why physicians in California are required to take additional training in pain medicine every year.

The CHAOS and STRESSORS step, like all steps, goes "hand in hand" with the next step of BEHAVIORS, ATTITUDES, and BELIEFS. One can try to understand this problem at many different levels, from a purely superficial point of view to the deepest levels of one's being. The only approach that works is to examine the life at the deepest levels, which in itself may produce discomfort.

"An Unexamined Life Is Not Worth Living" (Socrates)

We all do things for a reason, and we are the summation of our life's experiences. Looking inside and making a commitment to do all that is necessary will result in a great improvement in pain.

What is chaos? The simplest way to think about it is not being in a state of the "warm and fuzzies" of childhood. At some point, in childhood, we lose our "warm and fuzzy" feelings as we experience more of life. We notice things that are fearful or do not make sense. Life happens, animals and loved ones die, and nothing is for certain. Worse, there can be more threatening situations of abuse and neglect, as well as other types of trauma. How we respond to these events and situations will determine our coping strategies as well as our ability to deal with challenges (such as pain). Looking inside will help determine those areas and skills that can be improved or helped, and in turn, develop abilities that may reduce one's pain perception and level. Healing these issues is very important to reducing pain.

What areas need to be examined? The various components of the Limbic System which control the the perception, integration, and interpretation of sensations and pain by the body and mind. Why? Because they directly modulate or change our perceptions of sensations as pain. Another reason is that we do have therapies and treatments for these various components of pain.

These areas are:






as well as the higher cortical functions that give meaning to those functions of the limbic system. These are the beliefs, attitudes, and meaning given to sensations that cause behavior.

Only then can one become proactive and find constructive therapies, goals, and steps to take, so that one's pain may be reduced. Our goal is to find things to do, and not remain "pathetic victims" of our situations. We are responsible for our thoughts, words, actions, and feelings. It is our own responsibility to understand them, acknowledge them, and accept control of them.

It is necessary to give up the phrases of "my pain makes me do this or that, or be this way or that". I hear all the time how "pain makes me grumpy" or "depressed", or all the other excuses for not accepting responsibility(being a victim). Pain may make it hard or difficult to do certain things, (and LIMITATIONS may need to be accepted), but


It is far more likely that pain is exacerbating or aggravating mood levels, emotions, rage, and fears that are already present (or tendencies that are already present) in a person. To be willing to deal with them is to go "OUTSIDE THE BOX" of our own world and to stop self-deception or self-betrayal (to stop kidding or lying to ourselves).

For example, my biggest complaint about the diagnosis of Fibromyalgia, besides that it is a useless diagnosis which is economically and politically driven, is its victimizing nature. Patients conclude that the reason for it is unknown so nothing can be done about it. This is reinforced by physicians and others who know nothing or very little about it, nor are willing to deal with it. Patients tend to assume the full mantle of victimhood and over time fall apart. It is never good to be a victim (more about this in the next step on behaviors). The only true victims are innocent children, and, perhaps, those who suffer a heavy object falling on them from space.

The degree of victimization or lack of willingness to assume responsibility for actions and consequences is assessed with every visit. This does not mean that the symptoms are not real, but only that the lack of an ability to improve one's situation or accept the job of taking action is not tolerable. I can do nothing with patients who enjoy being victims!

We are all human. Everyone faces life and its various roads and challenges at some level. Make no mistake, the road of chronic pain is very difficult. However, we can make proper decisions along the way that will make it less of a challenge. If not, we are making decisions by default that lead to more pain and disability. It is ours to choose! We are all on the same road. We may start at different points along the way, and proceed at different paces, but we need to keep going on the road in the right direction. The hard part is to make the decision to get on the right road and stay on it.

To a high degree, our choices determine how people respond to us and how we respond back to them. This is important in a marriage or a family. There is a high level of divorces in this country to start and chronic pain patients have an even higher rate of divorce. Chronic pain affects everyone in a family.

Another consequence of pain is how it affects our kids. Our decisions may lead to problems in children that are the same as being a child of an alcoholic or impaired parent. Children of a pain patient and, therefore, impaired parent, have the same issues and problems as growing up as a child of an alcoholic parent. Some of the issues or problems that children develop are: inability to maintain boundaries, getting walked on, becoming perfectionistic people-pleasers, compulsion to maintain control of others, lack of ability to form trust, lower self-esteem and confidence, inability to care for self, and lack of psychological independence or autonomy.

These are common and predictable problems that need to be addressed!

There are three wookbooks that I recommend to everyone to help master the skills needed for pain management. Wookbooks are just what the word says: Books that require you to work. You can master a lot of these skills on your own. It is even better if you have the guidance of a Pain Psychologist.


The books are: