There’s a kind of dividing line between where pain ends and the suffering your pain causes you begins. This same line marks the difference between the aspects of your pain experience that you have control over and the ones you don’t. ACT draws this line between the physical pain you feel and the way pain is interrupting or inhibiting your life, understanding them as two different kinds of pain. We call the first one “clean pain.” It’s a simple, immediate, physical sensation that tells us something’s wrong. An aching back, the sore wrists of carpal tunnel syndrome, tender spots, an old ankle injury that flares up regularly—these things are all clean pain.

What we call “dirty pain” is something quite different. Dirty pain is all the reactions you have to your physical pain (Hayes, Strosahl, and Wilson 1999). Dirty pain is the things your mind tells you about your physical pain. It’s the epithets that run through your head when you do something that puts you in pain. It’s the avoidance behaviors you engage to keep yourself from feeling pain. Dirty pain is your attempts to relieve yourself of pain where relief may not be possible.

Clean pain is just pain. Dirty pain is all the stuff that goes along with your pain. Dirty pain is where pain itself ends and suffering begins. Dirty pain is your attempts to control that which cannot be controlled, your attempts to fix that which cannot be repaired. Clean pain is a vital hum and a valuable messenger that comes along with existing in this world.

Dirty pain is the muck you get mired in trying to silence that hum. Clean pain is rooted in the part of your pain you have little control over. Working on your dirty pain, however, will prove to be very fruitful. It’s ironic that people who suffer from chronic pain are usually trying to do the opposite. They attempt to control their clean pain while letting their dirty pain run rampant. This is a mistake. It’s a mistake that’s reinforced by nearly everything we know, but it’s a mistake nonetheless.

excerpt from Living Beyond Your Pain: Using Acceptance and Commitment Therapy to Ease Chronic Pain by JoAnne Dahl, Ph.D., and Tobias Lundgren, MS