Controlling Your Pain Baseline

What if your biggest breakthrough in recovery isn’t eliminating pain, but learning how to keep it from getting worse?

In this episode of The Talking Rehab Podcast, Dr. Fred Bagares reframes one of the most overlooked wins in rehabilitation: baseline control. He shares why stability is not settling, but actually the foundation for lowering pain later—and how patients who master it often achieve better long-term outcomes than those chasing quick fixes.

Through Maria’s story—a nurse whose daily pain spikes used to derail her life—you’ll see how controlling the climb from a 4 to a 9 was the first step to regaining her evenings, her energy, and her freedom.

You’ll also hear why the “scoreboard mindset” of obsessing over pain numbers can sabotage progress, and how neuroscience, psychology, and everyday analogies—from marathon training to money management—support a different way forward.

🕰 Timestamps & Key Themes:
[00:00] The counterintuitive breakthrough: controlling vs. eliminating pain
[02:00] Why pain numbers (like the scoreboard) don’t measure real progress
[03:00] Maria’s story: from daily crashes to evening stability
[05:00] Two wins of recovery: baseline control and baseline reduction
[07:00] Neuroscience & psychology: why consistency calms the system
[08:00] Real-life markers of success beyond the pain scale
[09:00] The cultural blind spot: why stability feels “boring” but changes everything
[10:00] A new definition of healing: adding predictability, trust, and freedom

Transcript

0:00

What if the biggest breakthrough in your recovery isn't making the pain disappear, but learning how to keep it from getting worse? Most people would call that unsettling, but I consider it the very first step. Today we're exploring why controlling your baseline might be the most undervalued skill in rehabilitation and how mastering it changes everything about your recovery and trajectory. I'm Dr. Fred b Garris, and this is the Talking Rehab podcast where we challenge the conventional wisdom about recovery and healing. Quick favor, before we dive in. If this podcast has changed how you think about your body or your recovery, hit that subscribe button. It's free. It takes two seconds, and it's how we keep bringing you these conversations every week. No fluff. Just real talk about what actually works. Thanks for being here. Now let's get into it. Here's how most recovery stories begin. Someone walks into my clinic, sits down and says, hey Doc, I just need this pain to be gone and I completely get that pain. Hijacks your attention. It's disruptive, exhausting, and it makes perfect sense why you want it to go away completely. But what makes this complicated is when you only measure your progress by the presence of pain, it makes it really difficult to see how much you are actually improving when we measure progress only by what is no longer present. I tell my son all the time that when he's playing in a game, watching the scoreboard during the game doesn't actually help you. In the best case scenario, you're winning and a lot of people will start to act accordingly. They back off. They don't try as hard. On the other hand, if you're losing, it doesn't always motivate people. It actually makes them feel like they're going to lose the game. It can make it really hard to watch the rest of the game if you're constantly just watching the scoreboard. Similarly, if you're only focusing on the pain, your pain level stays the same and every day feels like a failure. Every treatment that doesn't immediately drop the number feels like it's wasted time and money. Just like losing weight. If you step on a scale every morning expecting to see a different number, you start questioning the entire diet and why you're doing it. If the number doesn't even change, your clothes could actually fit you better and you feel stronger. But if that number doesn't change, a lot of people don't feel like they've made any progress. This all or nothing mindset is the enemy of real progress. Let me tell you about Maria, a nurse who came to see me last spring. She started every day at a pain level of a four out of 10. It was fairly manageable and she was able to be functional throughout the day, but by the lunch break, she'd hit a seven, 10 pain, and by the end of the shift she was consistently around a nine out of 10. She told me that she loves what she does for work, but she's not sure how long she can keep living like this. Something had to change. Instead of focusing solely on getting the four down to a zero, we worked on a different problem preventing the daily climb to a nine out of 10. We build strategies around movement, breaks, positioning and energy management. After eight weeks, something remarkable happened. Maria was still waking up at a four, but she was finishing her 12 hour shift at a five. Her first response when I asked how she was doing was, it's fine, but my pain isn't really any better. After second and a little bit more probing, she started to think about it a little bit more and she said, wait. I cooked dinner last night. I helped my daughter with her homework, and I actually had energy left at the end of the day. That's when things really started to click for her. Stability of symptoms isn't the absence of progress, it's the platform for everything else. Not everyone embraces this approach immediately. I've had patients say. If the number on my pain scale isn't going down, how is this even helping? Aren't you just managing my symptoms instead of fixing the problem? And to be honest, that's a fear pushback. We've been conditioned by decades of healthcare messaging that healing means elimination. Fix it, and just get rid of it. Anything less feels like a compromise. But here's where I challenge that type of thinking in every other area of life, we understand that stability precedes growth. When you're learning to drive, you master staying in your lane before you worry about parallel parking. When you're building wealth, you establish emergency savings before making aggressive investments. When you're training for a marathon, you build consistent mileage before you focus on speed work. So why should pain recovery be any different? Why should we skip the foundation and jump straight to the advanced techniques? Here's how I reframe progress for my patients. There are actually two distinct victories in pain management. The first win is baseline control. This is the pain that you wake up with consistently there, and it's fairly predictable. If you start your day at a four out of 10, the goal is to end at a four out of 10. No spikes, no crashes, no surprises. That derail your plans. That's definitely a win. Number two is baseline pain reduction. This is where that four gradually becomes a three, then a two. But this can only happen reliably once you've mastered the first one. Let me talk about why this approach works both neurologically and psychologically. From a nervous system's perspective, chronic pain often evolves what we call central sensitization. Your pain alarm system has become hypersensitive. It's like a smoke detector that goes off when you burn toast instead of waiting for an actual fire. When you achieve baseline stability, you're essentially communicating safety to that oversensitive system. You are showing your nervous system that movement is normal, that activity does not equal danger, and that your body can be trusted. Studies show that unpredictable variable pain is often more distressing than constant pain. Even at higher levels, your brain can adapt to and cope with consistency in ways it struggles. Your brain can adapt to consistent pain levels, but it can really struggle with volatile or spikes of pain. Psychologically stability builds what research calls self-efficacy, confidence in your ability to manage challenges. Instead of bracing for the inevitable evening crash, you start to trust your body again. That's a very powerful mental shift. There was a recent study that looked at people who live with chronic back pain. The group that focused first on stability, keeping their pain predictable, tended to have better long-term outcomes than the group that chased immediate pain reduction. They tended to be more active, more optimistic, and paradoxically ended up with lower pain scores at the end of the two year mark. So what does that successful baseline actually look like in your daily life? It might be finishing your workday without needing to collapse on the couch, playing with your grandchildren, without paying for it in the morning, sleeping through the night instead of waking up at 3:00 AM in discomfort, Making plans for the weekend without that nagging voice. Wondering if you'll feel well enough to follow through. These aren't minor victories. They're major improvements in your quality of life. They are signs that you've created a stable foundation for further progress. But here's the challenge. Unfortunately, our culture doesn't always celebrate stability. We celebrate breakthroughs, body transformations before and after photos. Steady progress feels boring compared to dramatic change. Think about the people in your life who you admire. I'm willing to bet that their success came not from one dramatic moment, but from consistency. Stable daily practices compounded over time. If you're dealing with chronic pain right now. Let me ask you one simple question. What's the smallest thing that you can change about your life that would create the biggest change in your baseline pain? Maybe it's setting a timer to move every 30 minutes during your workday. Maybe it's ending your day with five minutes of gentle stretching. Regardless of how you feel, maybe it's tracking not just your pain level, but also your overall energy and mood alongside it so you can start to spot these patterns. The key is choosing something so small that it feels almost trivial, that trivial things done consistently creates extraordinary results. Let me leave you with this thought. Healing isn't always about elimination. Eliminating pain, eliminating limitations, eliminating problems. Sometimes healing is about addition. Adding predictability, adding trust in your body, adding confidence in your ability to show up in your life. The goal isn't just to lower the numbers on a pain scale. The goal is where pain doesn't call the shots, where you can make plans and keep them, where you can be present for the people and activities that matter to you. Sometimes the fastest path to that freedom starts not by limiting pain, but by learning to prevent it from escalating. So once you understand your baseline pain and what it responds to, then you can start to build momentum and keep moving forward. If this perspective resonates with you, I'd love to hear about it even better. If you know someone who's frustrated by slow progress, please share this episode with them, because sometimes the breakthrough you're looking for starts with celebrating the stability that you're building right now. Thanks again for listening. Thank you for listening to The Talking Rehab podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement filled day. Take care.