Clean vs Dirty Pain

Pain presents itself in many forms. Throughout my journey I have become intimately familiar with pain. During my training to become a mental health counselor, I developed Rheumatoid Arthritis. From one perspective, it’s a great ironic story. Here I was, intentionally trying to learn how to heal other people’s pain and suffering, and meanwhile I had to learn how to deal with my own newfound suffering. From another perspective, it was serendipitous. Irvin Yalom[1] wrote, “Only the wounded healer can truly heal.”[2]  I am a quality practitioner because I experience, live through, and heal so much pain.

There is a concept that I really like when it comes to understanding the experience of pain: it’s the concept of clean pain and dirty pain. In this paradigm, clean pain is the pain experienced as a direct result of an injury. It’s the sting of a cut. It’s the nerves firing when you stub your toe. It’s the aches of your arthritic knee or your endometriosis.

Dirty pain, in contrast, is the pain we experience due to our psychological responses. It’s the thought “I hope I don’t need stitches, I’m supposed to pitch tomorrow.” It’s the judgment call someone makes when deciding if they can go to work not only because it will be incredibly difficult to stand and focus due to the chronic pain condition, yet at the same time they have to pay the rent. These thoughts are natural responses and help us figure out the best way to navigate our pain.

The ordinary thoughts that we label as dirty pain, tend to activate our stress responses. As such the body increases inflammation, and as a result increases physical pain. The body perceives pain through the activation of a chemical named Substance P. Substance P is activated in response to both emotional and psychic pain. Thus when you experience physical pain, you tend to have less tolerance for emotional pain, and vice versa. This also means that your mindbody’s normal reaction to pain is to increase the intensity of it!

Pain creates suffering; it also creates room for healing, recovery, and growth. We can develop some control over dirty pain once we figure out how it works within us. We can learn about how our individual stress response system works, and use healing practices, nutrition, relaxation techniques, and exercise to reduce inflammation. We can learn new coping skills like mindfulness tactics to navigate our automatic thoughts and feelings, which also will help us reduce pain. I use these practices to manage my own pain, and teach them to my clients. Like a tree shedding its branches sometimes we undergo pain and adapt so we can grow towards the light.


[1] It was Irvin Yalom’s writing that inspired me to pursue a career as a therapist. My sister recommended him, she’s the best.

[2] In his book Lying on the Couch.