Optimize Effectiveness
for corrective exercise
Minimize Discomfort
during exercise
Accelerate Results
to full health
Add to Cart

Pain and Emotion Graph

Invertabelt > Blog > Pain and Emotion Graph

Your Perception, Your Experience, Your Beliefs

As the title indicates, this section is all about you!  In the introduction of this Guide I mentioned that self-treatment and assessment of pain is actually a journey of self-discovery.  This process involves looking at our feelings, fears, anxieties and beliefs all in context of our pain and our lives.  This section of the guide is going to force you to challenge your beliefs and perception of your injuries.

Let’s be honest, no one wishes to have their beliefs challenged, it can be extremely difficult. In fact, I debated adding this section into the guide because as many of us know, when our core values are challenged most people’s first reaction is to shut down. This was discussed previously is a form of confirmation bias.

I decided to keep this section in the guide for two reasons.  First, I personally believe we must be in the right frame of mind to help effectively change our pain long term.  Secondly, the research supports that our pre-existing beliefs regarding our pain is one of the key variables effecting recovery.

For example, individuals who are concerned about losing their job, finances or feel as if they are a victim are more likely to experience persistent pain. Similarly, individuals dealing with depression have a much higher chance of chronic pain.

These are components that we need to gain awareness of and discussed during treatment. A comprehensive rehab approach that addresses these risk factors (when relevant) and physical factors is best supported by evidence.  Later in this section we will help you identify if you may be more at risk for these factors.

Early in my career, I tried to avoid discussing a patient’s feelings and perceptions.  I focused primarily on the physical and biological component of pain.  After some time with a patient, I would realize that physically the patient had potential for recovery; however, mentally their perceptions and attitudes toward their pain were a large barrier to pain relief.  If we have a negative perception regarding our pain and outcome, then chances for a good recovery drop significantly.

At first, I would try to sway these patient’s opinions and perceptions by using soft and gentle methods, which I found had little to no effect on their personal beliefs.

As a have become older and more confident as a therapist I am able to determine right away if the patient has potential to improve just by how they feel regarding their pain and symptoms.  As we have discussed earlier, pain is very personal and individualized.  After years of treating patients, clinicians can gather a sense of a patient’s perception and belief system fairly quickly in the treatment process.  The irony is that many patients and individuals are blind to the belief’s attitudes and biases, and there for they become self-limiting.

If I determine one’s belief system is a major barrier to recovery then I will address it right away.  I attempt to get the “elephant out of the room.”  Being transparent and forthcoming regarding the need to address each patients beliefs and its impact on recovery, gives us the optimal chance to recover.

By including this section of the guide, I decided to give you the same curtesy.  We need to cut straight to our beliefs.  If there are barriers and they are not addressed, we do not stand a chance of managing our symptoms.

Feelings and beliefs are a large part of the self-discovery journey.  Challenging your thoughts, perceptions, your own history and experience with your pain is difficult.  Asking the tough questions of why we feel the way we feel, starts to move down a path that some health professionals and patients aren’t comfortable with traveling.  We must look deep within and knock down any barriers that we ourselves have put up.

Recently I attend a course of about 150 physical therapists that discussed this topic.  We were asked, “Before, during, and after an assessment, what are the different patient beliefs, actions, or core values that predict a poor pain outcome?”  Below is the list generated by the therapists:

  • General treatment skepticism versus treatment acceptance
  • Chronic long standing 10+ years of pain that is self-reported to never get better and never change
  • Statements that include

o   “I can’t have surgery or MRI or injection until we complete therapy”

o   “I need my notes for my attorney and I will be requesting notes”

  • General pessimistic view on healthcare or poor relationship with family doctor
  • Poor prior experience with rehab OT, PT, ST, nursing, medical doctor
  • Poor understanding of the need for rehab, or “why am I here?”
  • No current pain management strategy?

o   Medications aren’t working

o   Ice/heat/rest/lying down-nothing helps and nothing will ever help!

  • General sense of people not being engaged, distracted, or outright no buy in?
  • Seeking a magic bullet/solution

o   looking for very specific “Answer”

o   looking for very specific treatment

  • General anger/frustration and feeling of helplessness

That is a significant list.  Having those feelings and reactions does not doom your recovery, but we must address these concepts.  Informally, you can look through the list and decide if you have experienced any of these feelings or thoughts.  If so ask why?

I think it is also important to examine common themes that this list represents.  To summarize, poor outcomes are contributed by core beliefs that suggest being a victim, or that someone else should be responsible for fixing the problem. The belief that they have been in pain for so long and they have to accept the current state of pain.  Some individuals have been to dozens of healthcare professionals with no change- why would this treatment be different? The individual had been here, there, and everywhere, with multiple explanations but no real answers.  Maybe they believe therapy and rehab is just another stop in a long line of failure.


Brief Injury Perception Survey

If you would like a more formal examination of your beliefs then I challenge you to take the quiz below.   The 7 questions are taken from a Brief Injury Perception Survey, a standardized test that measures perception of pain. I encourage you to answer them honestly and to examine and challenge your thoughts.  Look within and see if some of your thoughts, beliefs, fears, and anxieties are holding back your recovery.  You may score the exam officially via the google excel doc link HERE.

  1. To what degree has your injury had a negative effect on you?


0        1         2             3             4             5             6              7            8           9          10

No affect                                                                                             Severe affect


  1. How long do you think your symptoms will continue?


0         1         2             3             4             5             6              7            8           9          10

A very                                                                                                 Forever

short time



  1. Thinking of all of the symptoms that have arisen as a result of your injury, are you experiencing:


0         1         2             3             4             5             6              7            8           9          10

No symptoms                                                                                     Many

at all                                                                                                     symptoms


  1. How severe are the symptoms that you’re experiencing as a result of your injury?


0         1         2             3             4             5             6              7            8           9          10

No symptoms                                                                                     Many symptoms


  1. How concerned are you about your symptoms?


0         1         2             3             4             5             6              7            8           9          10

Not at                                                                                                  Extremely

all concerned                                                                                      concerned


  1. How easily do you feel it would be to injure yourself further?


0         1         2             3             4             5             6              7            8           9          10

No more easily                                                                                    I could                                      very easily be

injured further


  1. How much has your injury affected you emotionally?


0         1         2             3             4             5             6              7            8           9          10

Not at all                                                                                              Extremely affected

Now that you have taken the quick perception quiz, you can now gauge how your preconceived thoughts may be impacting your recovery. You may score the exam officially via the google excel doc link HERE.

The google excel document will automatically calculate a perception risk score of 1, 2, or 3.   If you fall into the category number 3, it indicates that your core beliefs and perceptions regarding your injury may be a key contributing factor to your continued pain and potential recovery.  Additionally, counseling or at least candid conversations with a health care provider is recommended.  Category 2 indicates a moderate barrier and category 1 indicates a very low barrier and minimal risk.

If you fall into a category 1 or 2 it is time to begin challenging those beliefs.  The contents of this cookbook will help change and shift your thoughts regarding your pain.  Keep an open mind and continue to refer back to the scale after completing each section.  Record your results. Let us see if we can alter our perceptions and change our pain!