The Twelve Steps of Chronic Pain – The Steps As A Bow

Chronic pain and control issues – Surrendering the fight with pain

Chronic pain sufferers are some of the most hope-filled people in the world. They can descend into hopelessness, too. Our issues with control dovetail here. The Twelve Steps of Chronic Pain – The Steps As A Bow can help the chronic pain sufferer in recovery regain their footing by helping to reset the stress response, calm the mind, and find inner peace and contentment.

Please Note: “The Twelve Steps of Chronic Pain – The Steps As A Bow” is rooted in the work of Alcoholics Anonymous but is my own interpretation of how we can use The Twelve Steps to help chronic pain sufferers. These Steps are not referring to or in any way affiliated with Chronic Pain Anonymous (CPA).

Like all addicts, we are control freaks. Chronic pain sufferers take their compulsion for control to the next level. Here’s how this works:

We feel enough sensation that we are uncomfortable in our skin.

We cannot escape it, though we do what we can to not feel all the sensory signals firing inside us.

We try in every way possible to control this situation.

Our body is doing its best to get a signal through warning us to change what we are doing.

In chronic pain, the signal persists, beyond pain medication, and beyond whatever behaviors we originally brought to the situation.

Our doctors, more often than not, know nothing more than to give us medication to numb the signal.

We continue to feel the sensations even though we use what we think can mediate or calm these signals.

We decide we will continue the hunt for another way to control our experience – the opposite of accepting what we are feeling.

The metaphor I use here is to imagine that you are standing at the bottom of Niagara Falls and pushing up on the water, trying to make it stop flowing.

See how hopeless the outcome of this attempt is?

Here is an amazing paradox of being a chronic pain sufferer –

Where we are desperate to control our situation and come up against a continuous “no” from our attempts, in the absence of a better alternative, we continue.

This is hope in the face of all odds.

It is also classic insanity: doing the same thing in hopes of a different outcome.

This hopefulness – despite such a track record of failure – keeps us coming back to try and try again, even when all we have experienced is defeat in this arena.

Our brains change so much from the experience of chronic pain – we are utterly rattled.

We fight the sensations, but ultimately, we end up fighting ourselves.

The concept of surrender –  to the pain or anything else – is a foreign concept. It sure was for me.

So, we as chronic pain sufferers are caught in a war with intense sensation in a body we cannot escape, given medication to numb but not heal the pain, do what we can to control what we feel, and end up in a war with ourselves. The miracle is that we continue as we seek a solution. In my case, for years I continued, intuitively feeling that solution just beyond my reach.

At some point, we reach a sacred bottom. We have had enough. We’re done, and we know it. Surrendering to the pain becomes our only option. It is in this surrender point, the bow, that we turn into our powerful healing field where the miracle begins anew in a heretofore unimaginable form.

In this surrender, where we were once trying to push the falling water of Niagara Falls and make it stop, we let go of that fight – and in doing so, we enter the flow of the water and become one with it. We no longer fight. We flow. It is here that we get out of the way and empower the body to assert its awesome healing powers.


The Miracle of Surrender

In active addiction, I knew surrender was inevitable. It was only a question of time and under what circumstances. The possibility of redemption was highly questionable to me, and any shot at my resurrection had all but faded to the barest glow on the edge of my inner horizon. I was so lost in the chaos of chronic pain and addiction that I could not even conceive recovery was possible. The gifts of recovery are in many ways completely unexplainable to those who have not experienced such spiritual metamorphosis themselves.

I experienced my recovery as a surrender on so many levels. I surrendered my willfulness to exert control at all costs. I surrendered my conviction that I was right. I surrendered my perspective. I surrendered my hopelessness. I surrendered my insanity. I surrendered to the pain. I bowed such a bow I will never forget. I laid it all down at the feet of whatever that unknowable but ever-present Higher Power was.

I bring you my view on The Twelve Steps of Chronic Pain or The Steps As A Bow, surrendering all and gaining everything, all the gifts of recovery, in return.


The Twelve Steps of Chronic Pain – The Steps as a Bow

I bow to how unmanageable my life has become.

I bow to the idea that there is a power greater than me.

I bow to the concept that such a Power can help me find my way out of the chaos.

I bow to this Higher Power…

and I keep bowing.

I bow to all the different and seemingly disparate parts of myself.

I bow to my Higher Power, find faith in another person and myself, and together this helps me embrace all of who I am.

I bow and open myself to my Higher Power and ask to change and grow.

I bow to all those I have harmed in any way and become willing to make amends.

I bow to my trespasses and made amends where I can.

I bow to the truth in my daily actions and course-correct every night, admitting my mistakes.

I bow and bow again to my Higher Power and ask for guidance and the power to act on such guidance.

I bow and in the light of the bow, hold it for those seeking a way out of the darkness.

I bow and pray that I will find the power and the wisdom to keep bowing.


The Twelves Steps used for Alcoholics Anonymous, Narcotics Anonymous, Codependency Anonymous, and so many other 12 Step programs, including Chronic Pain Anonymous, are useful as part of the healing process. Here are a few notes about how to apply the principles outlined in this book into The Twelve Steps if you choose to.

The main issue with someone dealing with chronic pain is one of control. Because we perceive chronic pain as pervasive and overwhelming, we try desperately to control our lives wherever we can. Part of healing this destructive pattern is to learn to renounce our insistence of having control. We find that our perspective on the power structure readjusts. We realize who is really in charge: our Higher Power – not us. Knowing this, we can finally relax that tension we have been holding for so long. These actions help us to unleash our healing power. These Steps underline the action of bowing, of relinquishing our power to a power greater and more loving than ourselves.

Take note that the word “we” is in all these Steps. We are no longer isolated. We seek out others who are working to recover and enlist their help. We do this work in a group setting, minimally with a sponsor who can help guide us through this process.

You can see as well that these Steps are written in the first person present tense. This is because I am emphasizing these as personal action steps and it keeps us in the present moment.

Here is a last note to remind the reader that the terms ‘chronic pain sufferer’ and ‘addict’ are interchangeable from my viewpoint.


Step 1: We admitted we were powerless over our addiction – that our lives had become unmanageable.

In this Step, we embrace a sacred moment. We realize we have come to the brink. We can take no more. We realize we have ceded our power to the pain, to our habit of engaging it, to our addiction to it, to our desire to control. In these realizations, we admit our lives have become unmanageable. Step One is a place of the bow, the sweet relief of humility. It is the first step in gaining our power back.

We get honest with ourselves. The bow I see in this Step is one to our situation, and ultimately a bow to ourselves. We finally turn and face ourselves. We shift from hiding from ourselves to facing ourselves with the truth about our situation.

In Step 1, we bow in surrender and accept where we are.


Step 2: We came to believe that a power greater than ourselves could restore us to sanity.

In Step Two, we finally realize that our way of thinking has brought us to this point. We can see that our way of doing things has not led to health. The root word for sanity is sanus, meaning healthy. We see that our behaviors have fed our suffering. In this way, we are insane. Clearly, we were unable to find a healthy way to live by ourselves.

We know from our honest look at ourselves in Step 1 that we are utterly overwhelmed. In Step 2 we look to a power that is even greater than our addiction and our suffering.

In Step 1, we came to the brink. We came to the pause.

Now in Step 2, we take a leap. And as we leap, we are bowing once again in humility. We change the direction of our previous momentum.


Step 3: We made a decision to turn our will and our lives over to the care of God as we understood God.

In Step 3, we bow once more to a Higher Power of our understanding Who is greater and more loving than ourselves. Before, we tried to control our pain and our lives only to find that the more we tried to control things, the more uncontrollable things became. We felt the grip of chronic pain tighten and intensify. We tried this strategy over and over, never to succeed, and all the while we sank deeper into the abyss.

We had lived in isolation before and tried to work everything out by ourselves. We became so isolated from friends and family members. We were so overwhelmed by our pain that we turned away from ourselves. Our sense of disconnection from the world was complete and terrifying, and the way we coped with all of this was to try and control anything and everything we could.

In Step 3 we shift trying to control everything to turning it over to our Higher Power. This is a place of humility and great relief for us as we realize we do not have to carry all the burdens of life by ourselves. We enlist a Higher Power to act as our guide.

In Step 3, we turn willfulness into willingness.


Step 4: We made a fearless and moral inventory of ourselves.

Step 4 invites us to look at the underpinnings of our pain. We do not have to relive old traumas. This Step is a place of deep listening. This step is a further dive into Step 1 when we immerse ourselves even more deeply into the truth of our past. We are not dwelling here, but we remain here long enough to give voice to those parts of ourselves we have ignored or tried so desperately to silence for so long.

We look at both our liabilities and our assets with regards to our character and our actions. For some of us, this may be the first time we have attempted such an assignment.

In our honesty, we also bring self-compassion. Let me say here that before doing any Step work, I and my sponsors have always started with a prayer to our Higher Power. This is one more place to bow and turn our will over to willingness. In the prayer, we ask for courage and compassion as we work this Step.

As chronic pain sufferers, we have been filled with fear of our pain. With the help of our Higher Power, we step toward taking the reins of power back. In our honest assessment, by listing what we are so upset about, we realize how much resentment and anger we have built up about our pain and whatever we believe caused it. We may be angry at the body. We may be angry at God. We may be angry at ourselves for letting our whole situation come to such a point of chaos.

We examine the fear that lays beneath the surface of our anger. The more we fought our pain, the harder we tried to get rid of it, and the bigger it grew. As the pain grew bigger, so did our fear of it. We see this conundrum and the prison we made for ourselves.

Please note that Step 4 is a key place to practice self-compassion. We can look back at what happened and marvel that we stuck with things and survived to this moment. We can thank ourselves and thank our Higher Power. This is another Step where we bow.

In Step 4, we shift from fearful to fearless. I am not saying that we are no longer afraid of pain. I am saying that we are no longer afraid of facing ourselves, our secrets, and our shame.

We keep secrets out of fear of others’ reactions, fear of being the object of ridicule, fear of being rejected, punished, and even persecuted. We keep secrets out of shame. We close to others and in doing so, we close down to ourselves. We close our hearts. We hide things so deeply sometimes we even forget they are there. Yet we feel them. Their impact never goes away. They begin to fester and grow.


Shame is the food of addiction. So, as recovering addicts, we become brave shame hunters. We do what we can to seek it out and shine a bright disinfecting light on it. No longer will it hide and eat away at our very foundation. When we go after our shame, we get a good handle on preventing relapse.

I was challenged to look where shame was hiding inside of me. I thought about it. I was so filled with fear at the mere thought of looking that deeply into myself that I dreaded this challenge. I promptly forgot all about it until one day in morning meditation, this question popped up in my head: “Where is your shame hiding?”

And there it was – my shame.

Front and center.

Somehow after trying much of what had been suggested to me by old timers in recovery – and after many sadhana mornings, after hours of meditation, and finally being able to have moments when my mind gently, blessedly quieted – the noise died down long enough for me to hear the voice of my deepest secret.

I always thought I would be consumed by the intense fear I would feel if I ever faced my deepest secret.

No wonder I had hidden this shame so deeply inside of me in the first place.

But, in this moment, I was not afraid.

Instead, I was grateful.

I sat and listened to the story my shame told me.

All those chants for compassion I had sung in sadhana merged into this moment and poured compassion into this part of me.

And I healed.

I was no longer haunted by a part of myself I had hidden away and had left alone to languish in a kind of twisted inner purgatory.

When I finally faced my shame, I felt a measure of relief I cannot even begin to describe.

I even felt the undercurrent of contentment enter my life.

It’s still with me today.

I became fearless to myself…

… of myself.

You can see how incredibly powerful and healing the work of being a shame seeker is.

And you can see that there is exquisite wisdom living within us. This shame I carried sat quietly hidden until I was ready to process and heal it. This is the power of these practices.

And for those of you in a 12 Step program, you can see the priceless value of working Step 4

In Step 4, we shift from living in fear to becoming fearless.


Step 5: We admitted to God, to ourselves, and another human being the exact nature of our wrongs.

Step 5 helps us to further solidify our work in Step 4 by sharing all the work we did in the prior Step with another person, our sponsor. The secrets we’ve hidden away for so long are not only out to ourselves, but now also to ‘the world’ through our sponsor. I feel that speaking these newly unearthed truths is like a kind of rich compost that helps our healing grow even further.

In the previous Steps, we brought ourselves out of isolation further and further with each Step. Step 5 cements our commitment to getting truthful with ourselves by declaring it to someone else. I see it as a Step where we declare, literally, our commitment to our healing.

It can be a moment of such power that our healing takes on a new dimension. We are more self-aware and we have decided to embrace who we have found in ourselves.

In Step 5, we become even more fearless.


Step 6: We were entirely ready to have God remove all these defects of character.

For me, this Step is one where the rubber meets the road. Let me explain.

The first time I read Step 6, I read it as if it said, “We were entirely ready and now God will remove all these defects of character.” That is not quite what it says. My sponsor lovingly pointed this out to me when I asked her this question: “How can God take away all of my character defects?” This Step states that we are now ready and willing to do the work on our unhealthy behaviors.

Our Higher Power is there for us, of course. However, the work is done by both of us. It is a co-creative process.

After writing out our personal inventory and sharing it with our Higher Power and another person, in Step 6 we get down to work of a different kind. We are ready to release the burdens we have been carrying for so long. The action here is in bowing and asking our Higher Power to help us let go and then to pray in stillness, showing that we are ready to purge and purify ourselves.

In Step 6, we double down on our willingness from Step 3. We bow to our Higher Power, open ourselves, and ask to change and grow.


Step 7: We humbly asked God to remove our shortcomings.

When I read Step 7 the first time, I thought God was going to remove my shortcomings. That’s not the way it works.

In this Step, we are now ready for our assignment.

So, we ask our Higher Power to remove all these defects of character. I’ll start with the incredible challenge I have had with patience. First, I realize my impatience is my character defect. Then, I humbly ask my Higher Power to help remove my impatience. The juice and the magic of Step 7 come next. I go on living my life, and the next thing I know, I am dealing with a situation that tries my patience. Whatever it is that irks me, that drives me bonkers, I find myself face to face with it. This is my Higher Power in action. I asked for help from The Boss, and lo and behold, I received it. Maybe not the way I wanted it, but my request was granted. My Higher Power has a sense of humor, too. I will continue to be presented with the lesson of patience until I learn it. Such is the power of Step 7.

In Step 7, We bow and open ourselves to our Higher Power and ask to change and grow. We get to work on ourselves, removing character defects, and building the character of integrity.


Step 8: We made a list of all persons we had harmed and became willing to make amends to them all.

In Step 8, once again, we bow. Our personal inventory from Step 4 lists the resentments we have and people whom we have harmed. In Step 8, we list those we harmed. We build our willingness once more. Bowing to our Higher Power for guidance, we open ourselves and become willing to make amends. We bow to those we have wronged in this act of willingness. We include ourselves in these amends. Self-compassion and self-forgiveness are at the core of Step 8. I remember feeling such a measure of peace as I did the work for this Step. It was a relief to know that it was possible for me to make such amends.

In Step 8, we bow to all those we had harmed in any way and become willing to make amends.


Step 9: We made direct amends to such people wherever possible, except when to do so would injure them or others.

In this Step, we further our work of purifying ourselves by literally coming clean to people we have wronged. With the help of our Higher Power and with all the preparatory work done in the previous Steps, we can now face those we injured in some way. We make an adjustment in our relationships here. This, of course, includes our relationship with ourselves. Amend means to adjust or rework. We are righting the ship, so to speak. We are clearing the decks. We come to these people we hurt and admit our wrongdoings. This Step is one of liberation, as we have been honest and cleaned up our past. Through our actions, we have released the pent-up energies of guilt and shame around our past behaviors and come clean with those against whom we trespassed. When we bow earnestly to our Higher Power, our transgressions and those we transgressed, we rise above our circumstances.

In Step 9, we bow to our trespasses and make amends where we can, and in the process, we are liberated.


Step 10: We continued to take personal inventory and when we were wrong, promptly admitted it.

Here in Step 10, once again, we take responsibility for our actions. We take the lessons we learned in the previous Steps and apply them in everyday life, in all our actions. Living in integrity becomes a lifestyle to which we aspire. We graduate here and work this Step on a regular basis so that is becomes part of our nature.

As people recovering from chronic pain, this Step helps us live in the moment and not allow ourselves to carry resentments. We own our mistakes. We take responsibility for our lives. We replace playing the victim with living a role of empowerment.

In Step 10, we bow to the truth in our daily actions and course-correct every night, admitting our mistakes. We stay in integrity with ourselves.


Step 11: We sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for God’s knowledge for us and the power to carry that out. 

In Step 11, because of the previous Steps, we now strive towards including our conscious contact with the Higher Power of our understanding in everything we do. This is an important Step because we are no longer living our life from a place of trying to control everything. We look to our Higher Power for guidance. Thy will, not my will, be done. This Step is where the rubber meets the road once more. The action here is to bow, ask, listen, and act once we hear Divine Guidance.

In Step 11, we bow and bow again to our Higher Power and ask for guidance and the power to act on such guidance.


Step 12: Having had a spiritual awakening as a result of these Steps, we tried to carry this message to other addicts, and to practice these principles in all our affairs.

We have found our way through the darkness of chronic pain and addiction. Now we have the opportunity, honor, and responsibility to pass the torch forward. We now are the light in the darkness for those who still suffer.

We work this Step in a few ways:

We live by example. We build on all the other Steps, for they culminate here in Step 12. By living in humility with the guidance of our Higher Power, we live the example of what the Steps outline for us.

We live by being of service to others. We work in community, within a 12-Step fellowship, perhaps in an institutional setting, and carry the message of recovery. This is not an evangelistic pursuit, but one in which we are watchful for opportunity. Occasions will present themselves to us to help others find their way through the suffering of chronic and addiction.

In Step 12, we bow, and in the light of the bow, hold it for those seeking a way out of the darkness. We bow and pray that we will find the power and wisdom to keep bowing.

There is much discussion about “power” in recovery, in the literature, and in The Steps. I have wrestled with this myself. I have been in discussion with a few people about “powerlessness” vs. “getting our power back”. It was really been an ongoing conversation I have been having since 2013. These words get tossed around and can be so confusing.

For instance, if we admit we are powerless over our addiction, how can we even speak of “regaining our power”? And, if we are “turning it (read our power) over” to our Higher Power, then we have no power at all… because we just turned it over, right? See how confusing that sounds? (Leave it to an addict to make things convoluted and confusing. Certainly THIS addict can!)

Here’s what really makes sense to me, having turned the entire matter over to my Higher Power and quietly listened for a response:

“Calling back our power”, “regaining our power”, “empowering ourselves”
– to me, these are all words that speak to Nikki Myers’ concept of “the lost self”.

Please hear me out.

In our addiction, we have lost ourselves in that we live as this weird specter of a shadow of who we are. We are splintered into aberrant versions of ourselves. We have literally lost track of our wholeness, and our health on every level.

When we do the Steps and other work in recovery, we turn our power over to our Higher Power as the Ultimate Authority. With It’s help and our honesty, willingness, and openness, we reclaim or call back that/those part(s) of ourselves to which we had ceded our addiction.

We may be powerless over our addiction, but with the help of a Higher Power, we reconnect to those parts of us that splinted away. We incorporate that weird specter back into us, and through the transformational ability of Stepwork, we become whole and healthy again. The power, therefore, is in us becoming whole and healthy.

It is not so much about “power” vs. “powerlessness” as it is about integration of ourselves, literally, with the direction of our Higher Power. We get the Power Structure straight and reclaim our lost selves.

The 12 Steps create a structure for us to actively practice how to live beyond selfishness and victim-hood. They teach us how to release the fierce grip of control we felt we needed as addicts. We have found purchase in a place beyond hopelessness. We are caught by our Higher Power, and realize we are held and will not be dropped by It. When we bow, we rise out of the victim-hood of our circumstances and into empowerment. We find such sweet relief. We find an honesty we had hoped for, but didn’t realize was possible for us. We discover that we are not alone. We find joy and purpose in service to others. We find a new way to live. We find liberation and we find ourselves in the process.

Note: This work is an excerpt from the upcoming book “The Way Through: Crack the Code to Chronic Pain & Discover a Thriving Life”

For more on the elements of recovery for the chronic pain sufferer and addict, please visit here.

The Twelve Steps of Chronic Pain The Steps As A Bow



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6 Responses

  1. CPA does not treat addiction but offers Spiritual Principles and a way of life for folks dealing with chronic pain and/or illness. It is not referencing as an addiction in any way and many of its members are not addicts.

    1. Thank you, Surina. I have edited this post as follows: Please Note: “The Twelve Steps of Chronic Pain – The Steps As A Bow” is rooted in the work of Alcoholics Anonymous but is my own interpretation of how we can use The Twelve Steps to help chronic pain sufferers. These Steps are not referring to or in any way affiliated with Chronic Pain Anonymous (CPA).

  2. CPA does not say we are addicted to pain. It’s the only 12 step program that doesn’t address addiction that ai am aware of. The way this is written is not official CPA literature and is misleading.

    1. Thank you, Surina.i have edited this post as follows:Please Note: “The Twelve Steps of Chronic Pain – The Steps As A Bow” is rooted in the work of Alcoholics Anonymous but is my own interpretation of how we can use The Twelve Steps to help chronic pain sufferers. These Steps are not referring to or in any way affiliated with Chronic Pain Anonymous (CPA).

  3. I love your insight the beauty of the words you used to communicate so clearly
    I am a chronic pain suffer on my way to healing. And I think the 12 steps will be another tool that will help
    Thank you so much for all the time and the generosity of yourself!!

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