Before we start

If you have been hurting for a long time, this is not your fault.

After more than twenty years treating chronic pain, I see the same seven mistakes over and over. Every one of them is understandable. Every one of them is fixable.

You have probably tried a lot. Appointments, scans, medications, maybe injections or surgery. Advice from people who meant well. And still, the pain is there.

Here is what almost nobody explains: when pain persists for months or years, it is usually no longer a simple signal about damaged tissue. It has become a pattern, held in place by how the nervous system, the body, and daily life all interact.

That is genuinely good news, because patterns can change. But it also means the things that feel most natural to do, resting more, waiting for the pain to stop, protecting yourself, can quietly keep the pattern going.

What follows are the seven I see most often, and what to do instead.

Note

This guide is education, not medical advice, and reading it does not create a doctor-patient relationship. Always make decisions about your care together with your own healthcare providers.

01

Mistake One

Treating the MRI as the whole story

A scan comes back with words like bulging disc, degeneration, arthritis, and it feels like you finally have your answer. The trouble is that these same findings show up constantly in people who feel perfectly fine.

Studies that scan people with no pain at all find disc bulges and degenerative changes in a large share of them, and the older the group, the more common the findings. They are often better understood as wrinkles on the inside: signs of a life lived, not proof of the cause of your pain.

When a scan becomes your identity, it changes how you move. You brace. You avoid. And the avoidance itself feeds the pain.

The same scan, two different people

If the picture cannot tell you which person is hurting, the picture alone cannot be the explanation.

Do this instead

Treat imaging as one clue among several, not a verdict. Ask your doctor which findings actually match your symptoms, and let what you can safely do matter more than what the picture shows.

02

Mistake Two

Trying to rest your way out of it

Rest is the right medicine for a sprained ankle. It is the wrong medicine for pain that has lasted months.

Within days of reduced activity, muscles begin to lose strength, joints stiffen, and the whole system becomes less tolerant of load. So the next time you try to do something normal, it hurts more, which seems to prove that resting was right. It is a trap that closes slowly.

Meanwhile your nervous system is learning a lesson you never intended to teach it: that movement is dangerous, and the alarm should be louder next time.

What happens to your capacity

Both lines start in the same place. The difference is not how much pain you feel today, it is what you are able to do six months from now.

Do this instead

Treat movement as medicine with a dose. Find the amount you can do comfortably today, do that consistently, and increase it slightly as your body adapts. Hurt does not automatically mean harm.

03

Mistake Three

Riding the boom and bust cycle

A good day arrives. You feel almost normal, so you do everything you have been putting off: the garden, the deep clean, the long overdue errands. And then you pay for it for three days.

This is the most common pattern I see, and it is completely understandable. But each crash teaches the same lesson as complete rest: activity leads to pain. Over time the good days get shorter and the crashes get longer.

The alternative feels counterintuitive, because it means doing less than you could on your best days.

Two ways to spend the same energy

The jagged line is exhausting and goes nowhere. The steady line looks unimpressive day to day, and it is the one that climbs.

Do this instead

Set your daily amount based on what you could repeat on a bad day, not what you can manage on a good one. Consistency beats intensity, every time.

04

Mistake Four

Waiting for the one treatment that fixes everything

Medications, injections, procedures, devices: these are real tools, and I use them in my practice. But they work best when you understand what they are actually for.

A good injection does not repair your life. What it does is turn the pain down enough, for long enough, that you can finally do the harder work: moving more, sleeping better, rebuilding capacity. It opens a window.

When people expect the treatment itself to be the cure, the window opens and then quietly closes again, and the disappointment makes the next attempt feel more urgent and less likely to work.

What a good treatment actually does

Passive treatments buy you an opportunity. What you do with the opportunity is what changes the trajectory.

Do this instead

Before any procedure, ask your doctor: what will this let me do that I cannot do now, and for how long? Then plan what you will do with that window before it opens.

05

Mistake Five

Ignoring sleep, stress, and what you eat

These sound like lifestyle advice, the sort of thing people say when they have run out of real suggestions. They are not. They are three of the most powerful volume controls on your pain, and they are the ones you actually hold.

Poor sleep measurably increases pain sensitivity the very next day, and pain disrupts sleep, so the two feed each other. Ongoing stress keeps cortisol and other stress chemistry elevated, which amplifies how pain is processed. And eating patterns can either drive or calm the low-grade inflammation that keeps the system primed.

None of these is the cause of your pain. All of them change how loud it is.

Three dials you control

You may not be able to switch pain off. You can almost always turn it down a few notches, starting tonight.

Do this instead

Pick the one that is worst right now and improve it slightly this week. A consistent bedtime, a ten minute daily wind-down, one better meal a day. Small and repeated beats ambitious and abandoned.

06

Mistake Six

Putting your life on hold until the pain is gone

It is the most reasonable plan in the world: get better first, then return to the things you love. The trouble is that waiting is not neutral.

Every month spent on the sidelines means less strength, fewer good moments, more isolation, and more time for pain to become the main thing about your life. The waiting itself becomes part of the problem.

People who do best are rarely the ones whose pain disappeared first. They are the ones who started moving back toward what mattered to them while it still hurt, in whatever modified form was possible.

Two roads from today

Function usually returns before comfort does. Waiting for comfort first often means waiting for both.

Do this instead

Name one thing you have stopped doing that genuinely matters to you. Find the smallest modified version you could do this week, and do that version. Then build from there.

07

Mistake Seven

Going it alone, without a plan

A tip from a neighbour. A video at midnight. A supplement someone swore by. A new stretch, a new diet, a new device, each one tried for a week or two and then abandoned when it does not deliver.

This is not a lack of discipline. It is what happens when nobody has explained the underlying mechanism, so every option looks equally plausible and every setback feels like starting over.

Once you understand why pain persists, the noise sorts itself out. You can tell which advice fits the mechanism and which does not, and a flare stops meaning failure and starts being something you have a plan for.

Scattered effort versus one direction

The same amount of effort. The difference is whether it all points the same way.

Do this instead

Learn the mechanism first, then choose one plan and give it long enough to work. Decide in advance what you will do on a flare-up day, so a hard week does not undo a good month.

Where to go from here

Understanding is the part that changes everything

If you recognised yourself in several of these, that is the normal response, and it is genuinely encouraging. Each one of these mistakes is a place where something can change.

Knowing the mistakes is the first step. Knowing what to do instead, in what order, and how to keep going on the hard days, is what The Pain Playbook was built to teach: twenty-two short video lessons, the complete ebook, and practical tools you can use at home.

Join The Pain Playbook program

Twenty-two short video lessons from Dr. Hedaya, the complete ebook, a printable recovery toolkit, and a private member community, built to take you from understanding your pain to a plan you can actually follow. One-time payment, learn at your own pace.

thepainplaybook.com

Adam J. Hedaya MD · Board Certified, American Board of Pain Medicine · Board Certified, American Board of Psychiatry & Neurology. This guide is educational and is not individualized medical advice, diagnosis, or treatment.

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