Writing & Journaling to Help Manage Chronic Pain

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David Hanscom, M.D.

Anxiety is a universal and necessary part of the human experience. It is a protective mechanism. When you feel threatened or cannot meet a basic need, such as air, food or water, you will take action to solve the situation and decrease your anxiety. Not being in pain is a basic human need. Your first reaction to pain is anxiety and if you cannot relieve your pain the next response will be anger. When you are experiencing chronic pain you are truly trapped and your frustration levels will rise to intense levels. The term I use is “The Abyss,” which is anxiety x anger x time.

It is important to understand the link between anxiety and anger. Anxiety causes the need for control. Anger results from loss of control. Therefore anger is really “high anxiety.”

Using the Mind Body concept we look at pain, anxiety and anger in terms of neurological pathways. Just like an athlete, artist or musician lays down routine pathways with repetition and practice, your brain lays down pathways or circuits in response to repeated pain, anxiety and frustration. Once you have a pathway of any kind in your nervous system, it is permanent and can always be triggered. So what can you do?

The answer is simple and effective. You create “detours” around the pathways. There are many ways of doing this but I have found one foundational step to be critical. That is the task of writing down your negative thoughts and immediately throwing them away.

This sounds too easy. Why would you do this?

New neurological pathways are created by connecting thoughts with:

  • Thoughts
  • Emotions
  • Experiences
  • Physical sensations

When you have written down these negative/disruptive thoughts, you make a “space” for yourself outside of the thoughts. The reason to throw them away quickly is not to get rid of them but to help you to write more freely. Do not take these thoughts personally or seriously. They are just chronic emotional circuits tied in with your pain. They have nothing to do with who you really are. Writing down these thoughts creates an awareness of the source of your anxiety and frustration. You now have a chance to choose a different response to a given stressor. As you continue to make more thoughtful, skillful choices, your brain will grow new neurons and form more functional connections.

There are three parts to re-programming your nervous system:

  1. Awareness – become aware of your repeating nerve pathways/circuits.
  2. Detachment –take a step back to see what is really going on.
  3. Laying down new circuits/pathways – new pathways can bypass troublesome older ones and quiet them down.

The key to increasing your chances to resolve your chronic pain is your ability and willingness to let go of the anger and anxiety associated with it. The emotion and pain pathways are so closely linked that it is only possible to experience meaningful pain relief when you break this connection. Separating your emotions from your pain pathway is a learned skill and writing is an essential tool.

Writing down negative thoughts is a process you may need to do for the rest of your life. This practice is not a philosophy but a practical tool to reprogram the nervous system. Consider it a self-care action similar to brushing your teeth.

Steps to Get There

  • Learn about how the brain lays down pathways by reading, The Talent Code by Dan Coyle.
  • After you have become comfortable with free writing, read Feeling Good by David Burns, M.D. Dr. Burns has developed structured formats that are very effective. Learn to write in the “three-column technique.”
  • Once you have made progress with your anxiety, engage in the tools suggested by Fred Luskin, Ph.D., in Forgive for Good. He discusses his four research projects out of Stanford on forgiveness and provides strategies that will enable you to experience the mental and physical benefits of forgiveness.
  • Unlearn Your Pain by Howard Schubiner, M.D., clearly explains the Mind Body Syndrome. It includes many suggestions for how to create more functional pain free circuits in your brain.
  • The Hoffman Institute website provides a framework for examining your life in terms of patterns and Mind Body Concepts. It is an effective eight-day, in-house, reprogramming process that can be considered later in your healing.
  • Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain (www.back-in-control.com) This resource provides a method to create an action plan based on the principles delineated in the book of the same name.


  • The Talent Code by Daniel Coyle
  • Feeling Good by David D. Burns, M.D.
  • Forgive for Good by Fred Luskin, Ph.D.
  • Unlearn Your Pain by Howard Schubiner, M.D.
  • The Hoffman Institute, http://www.hoffmaninstitute.org/
  • Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain by David Hanscom, M.D., http://www.back-in-control.com