The F-Words of Chronic Pain, and How to Find Freedom
Every single one of us has had experiences of pain. And every single one of us has responded, at one or another time, in ways that are entirely natural and human, and at the same time amplify the experience of suffering, and pain itself.
Most of these responses are actually meant to happen in response to acute pain. Pain is, after all, a protective response, and it is designed to make us pause, avoid, constrict, resist. But responses that are helpful for acute pain might not be so helpful for chronic pain. They can make our pain or symptoms worse, or get in the way of fully living our lives.
When pain has persisted, we might find ourselves enacting cognitive, emotional, and behavioral patterns that, while completely understandable, bring about or feed into fearful intensity and urgency, amplifying or perpetuating the pain cycle.
In this blog, I'll share some of the ways in which these patterns show up, and some practices to lean into something different that can hopefully invite expansion and flexibility. As you continue reading, see if you can invite curiosity and a recognition of the fact that it is simply human to respond in these ways.
The 12 F’s (and counting)
This list starts with 7 F's as explained by Dr. Howard Schubiner. It builds on more F's I've identified myself, and some I've heard named by dear colleagues. You might come up with new F's yourself. The purpose of naming them is not to bring judgment, but to illuminate patterns and grow in awareness so you can start to nourish something different and find greater ease and Freedom.
Focusing/Fixating on the pain/symptom. I usually describe this type of focus as a kind of hawk-eyed watchfulness that amplifies the importance of the symptom, or the space it takes up in our field of awareness and life.
Fighting the pain. Our energy gets drawn into an antagonism that creates constriction and tightness, that amplifies patterns of neuromuscular tension and emotional aversion, and this heightens the stress response in our bodymind.
Fearing the pain. This fear gets bigger every time we buy into the narrative of "if my symptom shows up, I can't live my life", and can be amplified by unhelpful things we've heard in medical encounters.
Trying to Fix the pain (or making it wrong). Particularly if we are naturally drawn to a problem solving attitude, we are trying absolutely everything to fix this. But the more we try to fix it, to push it away, the more we engage with the energy of fight and focus, and the more we reinforce the message that our symptom is bad, which heightens the danger signals and amplifies the protection response of our bodymind.
Getting Frustrated.
Trying to Figure this out relentlessly with the energy of an obsessed detective.
Freaking out (h/t Brad Fanestil)
Falling into a Funk every time the symptom shows up.
Faulting yourself (h/t Becca Kennedy) / Flagellating (h/t Lara Birk). Beating yourself up or getting caught up in self-judgment and self-blame for having pain or symptoms, for experiencing a flare up or "lack of progress" in your healing (or for the fact that you’re getting caught in one of the F’s).
Forcing yourself to follow "shoulds" and powering or pushing through things, knuckling down without honoring what you truly need or feel called towards (h/t Lara Birk). This can include trying to force healing, or setting deadlines.
Futurizing. Seeing today's difficulties as a preview of things to come, and expecting the very worst outcome, e.g. "oh no, here we go again, things will never get better... I had been doing so well, but now this, this is terrible". Futurizing is friends with catastrophizing.
Frantically searching for explanations on search engines, chat GPT/Claude, forums, etc., which usually yields even scarier findings and thoughts, or endless lists of rigid rules and routines to follow.
And as long as we are on the F's, we can also invite an awareness of our responses to stress and trauma: Fight, Flight, Freeze, and Fawn. Fawning will lead us to try to please or placate those around us to gain safety, suppressing our own needs in the process.
If while reading this you're identifying many of the responses in how you react in the presence of pain or other symptoms, welcome to being human! And congratulations, you are on the way to inviting other ways of responding.
I know how tempting it can be to judge ourselves, or to pile on more fixing, fighting, etc. Take this example: You find yourself freaking out about your persistent back pain, and frantically searching for scarier and scarier rare-and-difficult-to-identify diseases online, or for new treatments. You then realise you're doing this and berate yourself for doing it again. There can also be a pull to fight or fix, or (add in the rest of the F's)… these patterns themselves, which only invites more of the same. Like trying to fix the urge to fix. Or freaking out about the fact that you're freaking out. You get the drift.
So many of my clients ask: But how do I stop myself from fearing pain? On a most immediate level, my honest answer is I don’t know how to do that. I don’t know how to not feel one of the most natural and primary human emotions, to banish fear. And I don’t know that that is what we want to do, or what we need to do. What I feel called to do is to get more spacious. Make loving and compassionate space for fear, frustration, sorrow. Invite courage, curiosity, clarity, creativity. Nourish connection, lovingkindness, play, joy. Lean into the values that are important to us and do the things that matter, even in the presence of fear, and pain.
At another level, as we do this, as we reclaim the lives we want to live and de-couple pain from the things we care about, our nervous system catches up to the fact that the thing we fear the most is not actually pain, but losing our lives to pain. And if pain can co-exist with our lives, with connection, with joy, it stops being the dreaded monster, it starts to dissipate. And we start realizing that we can choose the way we respond to emotions. If I can stay with frustration and make loving space for it, perhaps I will be able to lean into a practice of self-compassion, or sway to lovely music instead of going into another ChatGPT rabbit hole.
The point is not to judge ourselves for responding in ways that are only natural, or to get caught in layer upon layer of making ourselves wrong. The point is to notice, invite compassion and curiosity, and cultivate new ways of relating to our experience. So perhaps instead of wondering how to stop doing this, you can get curious about what other ways of responding you can invite.
How To Weave New Neural Pathways
There is not one right way to do this. Different things work for different people at different times. I am sharing some options below, for you to experiment and play with.
Notice, Celebrate, Pivot
Notice what you're doing. For instance: I am going into Fixing mode.
Celebrate: Actively acknowledge and celebrate that you caught this pattern. Clap, smile, say "yay me!" out loud, do a little silly dance, whatever works for you. The sillier and more playful the better. If you're feeling too self-conscious, maybe offer yourself a smile and a gentle tap on the shoulder.
Pivot: Choose a supportive practice that helps you cultivate what you want to grow. Do a short self-compassion practice, lean into something you're grateful for, reach out to a friend to wish them a good day, listen to a story of recovery, engage in some mindful movement.
Lean Into Self-Compassion
One of my favorite ways to do this is Kristin Neff's Self-Compassion Break:
Bring one or two hands to your heart.
Acknowledge that this is difficult. You can say "This is a moment of suffering”, “This hurts”, “This is stressful”, “This is so hard”.
Recognize that suffering is part of life, that everyone suffers and that there are others around the world who are feeling how you are feeling right now. You can say “Suffering is part of being human”, “We all struggle in our lives”, “I am not alone in this experience”.
Invite kindness and compassion to yourself and your experience. You can say “May I be kind to myself in this difficult moment", “May I accept myself as I am”, “May I be safe”, “May I offer myself compassion”, “May I find freedom from suffering”.
You can modify the words in whatever way reminds you that you're human, that it's natural and understandable to respond in this way (with whatever F is being engaged at the moment), and that you can also choose to invite kindness to your experience. Use whatever words feel supportive, soothing, comforting. If you struggle to come up with the words or connect with yourself in this way, you can imagine what you would say to a beloved friend who was suffering in this way.
Another favourite practice of mine is Soften, Soothe, and Allow. You can practice with me here.
Get Curious About Underlying Emotions and Make Space for Them
Some of these responses are actually protecting us from emotions that feel too big or overwhelming: grief, sorrow, anger. Sometimes about the pain or symptom itself, sometimes about other things happening in our lives, including challenging relationships.
Allow Your Experience to Be What It Is
Just for this moment. Drop your shoulders, soften your jaw, let go of any clenching, release the drive to fix or fight or change anything, just for this moment. It doesn't mean you're giving up, it doesn't mean this will go on forever. Just for this moment, let yourself be with what is.
You can explore more practices to open up to your experience here.
This list of possibilities is not comprehensive, just a place to start. Some of them might not feel accessible at any given moment, and that's OK. These are practices and skills we cultivate and grow.
Bringing awareness to your F's is a great first step. If you'd like my support as you explore these practices and find what works for you, I'd love to work together. You can book an In-Depth Assessment or a Wayfinding Session to get started.
If you're a practitioner, and you'd like to integrate these insights into your practice and your life, I'd love to support you. Learn more here, or drop me a line.
About the author:
Dr. Lilia Graue is a physician, psychotherapist, and mindbody healing mentor.
After living with chronic pain for more than a decade, she found freedom through an integrative mindbody approach grounded in neuroscience, mindfulness, and compassion.
She is passionate about helping people who are living with chronic pain, fatigue, long COVID, and other persistent symptoms to find freedom and reconnect with joy, vitality, purpose, and agency. She also loves mentoring fellow practitioners—therapists, coaches, and clinicians— to support them in creating trauma-integrative, relational, and sustainable healing spaces, while keeping their sanity and their passion and thriving personally.
With over 25 years of experience in medicine and psychotherapy, Lilia’s work prioritizes consent, curiosity, and co-creation, honoring individual context, systemic influences, and the power of genuine relationship in supporting long-term change and healing. She works with people globally in both English and Spanish.
Originally from Mexico City, she currently lives in London with her husband and the two rescue cats who own them, Ziggy and Lupito. In addition to her work, she loves spending time in nature, baking, reading, traveling, and enjoying live music.
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