If you ask a room full of people for their definition of denial you’ll get a roomful of definitions. In fact I do ask both patient groups and my clinical training groups to share their own personal definitions—not dictionary definitions—of denial. I’ll list some of the most common responses I receive below.

1. Honest dishonesty
2. I don’t have a problem—no not me!
3. A coping tool
4. Being stuck in a problem and not knowing I’m stuck
5. Lying to myself
6. Not seeing a problem
7. Believing I don’t have a problem
8. A defense mechanism
9. Don’t even know I am lying (D.E.N.I.A.L.)
10. Clueless to danger

I could go on for a lot longer but I’m sure you get the idea. So what I want to do here is to share my working definition of denial so you’ll know what I mean when I use this term. The first part of this definition is that denial is an automatic and unconscious reaction. A person doesn’t say “I think I’ll use denial now.” It’s a reaction that has an important purpose—to protect us. Denial is a psychological defense system that we learn all through our life-span starting in early childhood. Denial protects us from what I call Painful Reality. What I mean by this is when situations seem too overwhelming and we believe we can’t handle a situation our defenses come on line to help protect us. Another general definition of denial I also find helpful is:  Denial is the natural tendency to avoid the pain that is caused by recognizing the presence, severity and responsibility for dealing with serious problems. 

Denial is a set of automatic and unconscious reactions

It is a psychological self-protection defense system

Its purpose is to protects us from painful reality

In fact, denial can sometimes become a very important coping tool for us. Imagine what would happen if you had to always be consciously aware of all the painful situations that you experienced throughout your life. What condition do you think you would be in? I think I’d be in a padded cell somewhere. Sometimes denial helps us cope with life.

Unfortunately, unrecognized denial can lead to severe consequences. For example the population I work with is people with chronic pain and many of them have coexisting additive disorders but are in denial about what the addiction is doing to them and those they love.

To learn more about chronic pain management and denial please check out my article From Denial to Effective Pain Management that you can download for free on our Article page. To learn about two skill trainings coming up in Sacramento California designed to teach treatment strategies for people living with chronic pain and coexisting disorders including addiction and prescription drug abuse please Click Here.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people in chronic pain or are living with chronic pain and have any resistance or denial and want to learn how to develop a plan for helping to identify and manage denial please go to our Publications page and check out my book the Denial Management Counseling for Effective Pain Management Workbook. To purchase this book please Click Here.

To listen to a radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Today effective chronic pain management systematically approaches the treatment of pain at three levels (bio-psycho-social) simultaneously.  This means using physical treatments to reduce the intensity of physical pain.  It also means using psychological treatments to identify and change the thoughts, feelings, and behaviors that are making the pain more intense and replacing them with positive thinking, as well as feeling and behavior management skills that can reduce the intensity of the pain. 

Finally, effective chronic pain management must involve not only the pain patient, but also the significant people in their life who can help them to develop a social and cultural context in which to experience their pain in a way that will reduce suffering.

Biological pain is a signal that something is going wrong with the body.  The biological, or physical, pain sensations are critical to human survival. Without pain we would have no way of knowing that something was wrong with our body. So without pain we would be unable to take action to correct the problem or deal with the situation that is causing our pain.

Psychological Pain results from the meaning that the brain assigns to the pain signal.  The psychological symptoms include both cognitive (thinking changes) and emotional (uncomfortable feelings) that lead to suffering. Most people are not able to differentiate between the physical and psychological. All they know is “I hurt.” For effective pain management you need to learn all you can about your pain.

Social and Cultural Pain, results from the social and cultural meaning assigned by other people to the pain experience, and whether or not the pain is recognized as being severe enough to warrant a socially approved sick role.  These three components determine whether the signal from the body to the brain is interpreted as pain or suffering. 

Imagine the Following Vignette

Bob is his college’s star football player.  In last week’s homecoming game Bob scored the winning touchdown but broke his arm in the process.  This week Bob is sitting on the bench with a cast on his arm that everyone has signed.  This cast and how he earned it are seen as an honorable reason for him to be sitting on the bench.  In that same game Karl, a big hulking lineman, “tweaked” his back and was also sitting on the bench this week.  Unlike Bob, Karl doesn’t have an observable injury and people were asking him why he wasn’t out on the field helping his team.  Karl is much more apt than Bob to experience shame/guilt, which will probably amplify his pain symptoms.

Unfortunately, there are also many obstacles that can get in the way of developing an effective chronic pain management plan.  To learn more about how to avoid or effectively cope with some of these road blocks please check out my article Overcoming Obstacles for Effecitve Chronic Pain Management that you can download for free on our Ariticles page.

To learn about two skill trainings coming up in Sacramento California designed to teach treatment strategies for people living with chronic pain and coexisting disorders including disorders including addiction please Click Here.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people in chronic pain and want to learn how to develop a plan for managing their pain and coexisting psychological disorders including depression or addiction effectively please go to our Publications page and check out my book the Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To listen to a recent radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.

The negative consequences more than double when patients undergoing chronic pain management experience both addictive disorders and pain disorders.  Addictive disorders lead to one universe of biopsychosocial problems, and the pain disorders lead to a different set of problems.  1 + 1 no longer equals 2, rather 1+ 1 now equals 3 or more.  This is called synergism.  Synergism is a condition where the combined action is greater in total effect than the sum of the individual effects.

In 1996 I conducted research to begin developing the first clinical skills training for Addiction Free Pain Management®.  What I looked for was information on people who had chronic pain and co-existing addiction.  What I found was disturbing.  There wasn’t much there! 

What I did find was a large amount of data on people with addiction and an abundance of information about people who had chronic pain.  But I couldn’t find much that addressed someone who suffered with both conditions. 

During my research I also surveyed addiction and pain programs to find out what happened to these people when they tried to seek help.  What I discovered was when they went into an addiction treatment program the entire focus was on the addictive disorder.  Unfortunately, their pain was not adequately addressed.  The addiction programs really struggled with what to do about the chronic pain management. 

Now if that same person went into a pain clinic for chronic pain management, the entire focus was on the chronic pain, and maybe the physiological pain.  On the other hand, the pain clinics struggled with what to do when people were acting out with the addiction.  I realized that the focus needs to be on concurrent treatment for both pain and addiction. 

Addiction treatment programs cover about a third of the problem (the Addictive Disorder Zone) when dealing with a chronic pain patient.  The pain clinics cover a different third of the problem (the Pain Disorder Zone).  Each of the above modalities when implemented independently misses about two thirds of the problem.

Sometimes addiction treatment centers recognize the need to refer a patient to a pain specialist or the pain clinics refer a patient to an addiction specialist.  This is definitely an improvement.  Now about two thirds of the patient’s needs are being addressed (both the Addictive Disorder Zone and the Pain Disorder Zone).  But what about the third zone?

The third area is what I coined the Addiction Pain Syndrome Zone™.  This is why I developed the Addiction-Free Pain Management® (APM) System; so treatment providers can learn how to effectively deal with both conditions concurrently.

To learn more about this synergistic phenomenon and how it impacted one of my chronic pain management patients—Mary—please check out my article Understanding the Addiction-Pain Syndrome™ that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you or a loved one is undergoing chronic pain management, especially if you’re in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publications page and check out my book the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To learn about two skill trainings coming up in Sacramento California designed to teach treatment strategies for people undergoing chronic pain management who also experience coexisting disorders including addiction please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To listen to a radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.