A major obstacle to recognizing these self-sabotaging behaviors and achieving effective chronic pain management treatment is the denial system—a psychological defense mechanism that protects us from devastating pain and problems that is automatic and unconscious. Remember that this system of defense was developed to protect us from being overwhelmed by what I call Painful Reality.
There are situations when denial can help us cope with painful reality; e.g., the death of a loved one, an unforeseen medical crisis, etc. Unfortunately, denial can also prevent us from looking at or dealing with a situation that is causing life-damaging consequences.
If we don’t realize how serious our problem really is, it can be extremely difficult for us to find a solution. For example, many people have a mistaken belief that “I can’t be addicted because I’m in pain and a doctor gave me the medication.” This can be a type of denial if in fact they have been abusing or are addicted to their chronic pain management medication and experiencing life-damaging consequences. Denial can be even subtler than this. It can also lead people to behave in ways that are inconsistent with appropriate treatment recommendations.
There are four levels of denial. The first is a lack of information—in this case, what ineffective pain management or medication abuse/addiction really is. The above example demonstrates this first level—the mistaken belief that because a doctor prescribed the chronic pain management medication, there won’t be an addiction problem. The solution here is education and up-to-date information about addiction. It is crucial for people undergoing chronic pain management treatment to learn as much as possible about effective chronic pain management, pain disorders, and substance use disorders—i.e., prescription drug abuse or prescription drug addiction.
The second level of denial is conscious defensiveness. At this level we know that something is wrong, but we don’t want to look at the problem and face the pain of knowing. The solution is to recognize that there is an inner conflict occurring where one part of us knows there’s a problem, but another part doesn’t want to admit it. To resolve this conflict we must be willing to listen to the part that knows the truth and take action. The old saying “the truth will set you free” is certainly relevant in this case.
The third level is denial as an unconscious defense mechanism. We get to this level when we have stayed in the inner conflict, mentioned above, and the defensive voice keeps winning. Once this happens, denial becomes an automatic and unconscious defense mechanism. The solution is much more difficult. It usually takes an outside intervention, or what is called a motivational crisis, to break through this defense and allow us to know the truth, and then start addressing the problem. For some of my patients this motivational crisis was generated when their treating physicians became concerned about their mismanaged chronic pain or use/abuse of pain medication. For others it was family members intervening and urging them to seek help.
The fourth level is denial as a delusional system, which is the toughest level to address. This delusion is a mistaken belief that is firmly held to be true despite convincing evidence that it is not true. If someone was experiencing denial at this level, they probably wouldn’t be open to reading this blog. People at this level of denial usually need long-term psychotherapy to resolve their delusional system.
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. You can also check out my article Managing Pain Medication in Recovery.
To check out my upcoming trainings you can check out our Calendar page.
You can learn more about the Addiction-Free Pain Management® System at our website http://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.
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