Emotional pain counts

Here is something the pain field has known for a long time and addiction medicine is just catching up to: the brain processes emotional and physical pain in overlapping circuits. Grief, loneliness, rejection, and shame activate the same neural regions as a broken arm. The body cannot always tell the difference, and neither can you.

When a craving rises and you are sure it is your back, check the rest of your life first. Have you slept? Have you eaten? Did something happen this morning that made you feel small? Is it a date — an anniversary, a child's birthday, the day the divorce was final? More than half of relapses I have heard described, in my own life and in others, came from emotional pain dressed in physical pain's clothes.

This does not mean your physical pain is fake. It means your physical pain is sometimes loudest when there is emotional pain underneath it asking to be heard. The body will route emotion through the path of least resistance, and for long-term opioid users, that path is often the old injury site.

The protocol when this happens is gentle: do not deny the physical pain, but do not skip the emotional check. Sit down. Hand on heart. Ask yourself, 'Is there a feeling underneath this?' If there is, name it. If you cannot name it, call your circle and describe what you are feeling. Sometimes naming it out loud is enough to take the physical pain down two points on the scale.

Therapists trained in pain reprocessing therapy and somatic experiencing can teach you to do this work in depth. Many people in long-term opioid recovery find that working with a therapist on the emotional underlay of their pain reduces the physical pain more than any other single intervention.

You are not weak for having emotional pain. You are not lying about your physical pain. You are a human being whose body learned to absorb both kinds, and whose recovery includes learning to tell them apart.