“The Four Agreements”: why a small book about ancient Toltec wisdom is one of the best tools for Chronic Pain
A Book I Read Years Ago Just Clicked in a Whole New Way
I read “The Four Agreements” by Don Miguel Ruiz years ago. It’s this little book—barely 150 pages—based on ancient Toltec wisdom. At the time, it helped me with my own life stuff. You know, the usual: being too hard on myself, taking things personally at work or during family diners, overthinking everything…
The agreements are ridiculously simple. So simple you almost dismiss them at first. But, if you start thinking about them, they stick with you.
Recently, I was thinking about chronic pain management and something just clicked. These four agreements—the same ones that helped me stop spiraling over everyday life drama—could be incredibly powerful for people dealing with chronic pain.
Not because the book is about pain. It’s not. But because chronic pain isn’t just a physical experience. It’s also the stories we tell ourselves about that pain, the shame we carry, the assumptions we make, the impossible standards we hold ourselves to.
And those mental and emotional layers? They can amplify suffering in huge ways.
So let me share what I’ve been thinking about. How these four simple agreements could create powerful, practical strategies for living with chronic pain more efficiently.
The agreements (and why they matter when you’re hurting)
Here’s Ruiz’s basic idea: From childhood, we’re “domesticated”—programmed with beliefs we never consciously chose. These beliefs become agreements we live by, and a lot of them create unnecessary suffering.
When you add chronic pain to the mix, these unconscious agreements get brutal:
- “If I’m in pain, I must be broken”
- “I should be able to push through this”
- “My worth depends on what I accomplish”
- “If I can’t do what I used to, I’m failing”
Sound familiar to anyone?
Here’s what’s wild: there’s actual neuroscience showing that changing these thought patterns can change pain perception. Brain imaging studies show people can reduce pain intensity by 40% and how unpleasant it feels by 57%—not by changing the injury, but by changing their relationship with the pain signals.
Same nerves. Different experience.
So let’s look at each agreement and how it could transform life with chronic pain.
~
Agreement #1: Be impeccable with your word
The words you use shape your pain experience
“Impeccable” sounds fancy, but really it means: pay attention to your words, especially the ones you say to yourself.
Your brain is literal. When you say “my back is killing me,” your nervous system doesn’t go “oh, just an expression.” It hears “killing” and amps up the danger response.
When you tell yourself “I’m broken,” your brain believes you.
When you say “this will never get better,” that becomes your reality.
When you’re hurting, in a lot of pain, you’re not thinking about being poetic. But the cumulative effect for yourself? It actually makes everything worse.
Just try tracking your pain self-talk for a few days. Don’t judge it, just notice it. How often are you catastrophizing? How often are you using violent language? How often are you attacking yourself?
Then experiment with shifting just one phrase at a time:
- **Instead of:** “My back is killing me” → **Try:** “My back is really loud right now”
- **Instead of:** “I can’t do anything” → **Try:** “I’m figuring out what’s possible today”
- **Instead of:** “I’m such an idiot for overdoing it” → **Try:** “Okay, I found my edge today”
It feels weird at first. But words matter. They literally shape how your nervous system interprets the signals it’s getting.
~
Agreement #2: don’t take anything personally
Your nervous system isn’t attacking you
This agreement says that what other people do or say isn’t about you—it’s about them, their beliefs, their stuff, their vision. What I mean is : what they say is their problem. You can choose how this will impact your life. If it’s positive, then use it for yourself. If it makes you feel bad, if it’s not constructive, then forget about it, it’s not your business!
But here’s the insight that hit me: **this applies to your own body too.**
Your nervous system firing off pain signals? That’s not personal. That’s not your body betraying you or you failing at healing. It’s neurobiology.
Central sensitization is real—sometimes your nervous system gets stuck in overprotective mode, yelling “DANGER!” even when there’s no tissue damage. Like a car alarm going off from a leaf touching it.
When that happens, it’s not because you’re weak. It’s not because you’re doing something wrong. It’s just how sensitized nervous systems work.
The freedom in this shift. Instead of “Why is my body doing this to me?” try “My nervous system is being protective right now.”
Same pain. Completely different meaning.
And when someone says something insensitive—“you don’t look sick,” “have you tried yoga, maybe you’re too stressed?”—that’s about their limited understanding. Not about you. Not about the validity of your experience.
Don’t take it personally. Their ignorance isn’t your burden.
~
Agreement #3: Don’t make assumptions
Your Brain Writes Disaster Stories (And Calls Them Facts)
Brains hate uncertainty. So they fill in gaps with assumptions. Usually the worst-case ones.
With chronic pain:
- Wake up with pain → “This will ruin my whole day”
- Get invited somewhere → “I’ll definitely have a flare and ruin it”
- Have a good day → “Better not get comfortable, it won’t last”
- Try something new → “Why bother, nothing works”
These assumptions trigger stress responses that literally amplify pain. There’s research on “pain catastrophizing” showing it’s one of the biggest predictors of suffering—bigger than the actual injury severity.
What I would recommend here is to switch your perception : get curious instead of certain.
So, what if instead of assuming, you asked questions?
Before deciding “I can’t go to that event,” ask:
- What would I need to make this work?
- What modifications could help?
- What’s the worst that actually happens if I try?
Before assuming “this treatment won’t work,” ask:
- What am I basing this on?
- What would success look like?
- What questions do I need to ask before starting?
Assumptions close doors 🚪 . Questions open them.
~
Agreement #4: Always do your best (and your best changes every day)
This is your permission to be human.
This one is huge. Your “best” isn’t a fixed standard. Your best on a good day looks totally different from your best on a hard day.
**Both are equally valid.**
This isn’t about pushing through or being tough. It’s about accepting that you’re doing the best you can with what you have right now.
This is what it looks like practically:
1) Try a simple morning check-in:
- What’s my pain level today?
- What’s my energy?
- What’s my realistic capacity: High/Medium/Low?
2) Then adjust expectations:
- **High capacity:** You can tackle most of your list
- **Medium capacity:** Maybe 50-70% of what you planned
- **Low capacity:** Essentials only, plus rest
On a low day, “doing your best” might look like: shower, one task, rest.
On a high day, it might look like: exercise, errands, social time, projects.
Same person. Different capacity. Both are your best for that day.
The research on pacing shows that matching your activity to your capacity (instead of boom-bust cycles) leads to better long-term outcomes.
~
Now, we need to make this actually work : here is a simple framework.
Look, I know you’re probably thinking “this sounds nice but I’m already overwhelmed.”
So let’s make this ridiculously simple.
### Week 1: Just notice
Don’t try to change anything. Just observe:
- Your pain self-talk
- When you feel shame about your pain
- Your automatic worst-case assumptions
- How your capacity fluctuates
Just notice. That’s it.
### Weeks 2-5: One agreement at a ttime
Pick ONE to focus on each week:
- **Week 2:** Shift one negative phrase daily (Agreement #1)
- **Week 3:** Remind yourself pain isn’t personal (Agreement #2)
- **Week 4:** Ask questions instead of assuming (Agreement #3)
- **Week 5:** Check your capacity each morning (Agreement #4)
### Week 6+: Keep What Works
Some will help more than others. Some will fit certain situations better. Use what works. Drop what doesn’t. You’re not being graded.
~
There is actually science behind this (for those who want it)
Research on mindfulness-based approaches (which share these principles) shows:
- Measurable improvements in pain intensity
- Even bigger improvements in quality of life and mood
- Less catastrophizing and fear around pain
- Better daily function, even when pain is still present
- Some people reduce medication needs over time
The Four Agreements just gives you a memorable, practical framework for these evidence-based concepts.
And here’s what’s interesting: the benefits often outlast the pain reduction. Your pain might still be there, but you suffer less because you’re not layering shame, catastrophizing, and impossible standards on top of it.
-----
## Start With One Thing
Don’t overcomplicate this. Pick ONE agreement that resonated:
- **Agreement #1:** Replace one harsh phrase each day
- **Agreement #2:** When pain flares, say “this isn’t personal”
- **Agreement #3:** Before assuming the worst, ask one question
- **Agreement #4:** Start each day with a capacity check
Try it for 30 days. Track it if you want. Or don’t. Just try it.
Forget for a few days? So what. Start again.
-----
Finally, what this can (and can’t) do
Real talk:
**Will this make chronic pain disappear?**
No. That’s not what this is.
**Will it reduce the suffering that pain creates?**
Based on the research and what I’ve seen—yes, if you actually practice it.
Because there’s a difference between:
- Having pain vs. believing you ARE pain
- Hurting vs. believing you’re broken
- Struggling vs. believing you’re failing
- Living with limitations vs. believing you have no life
The Four Agreements help you find and live in that difference.
~
Conclusion : Why I’m sharing this
I read this book years ago for my own stuff. It was simple but powerful. It helped me stop being so hard on myself, stop taking everything personally, stop overthinking.
Recently it hit me: these same simple principles could be transformative for chronic pain management. Not as some fluffy add-on, but as real, practical strategies.
Because chronic pain is complicated. But maybe some of the solutions don’t have to be.
Your pain is real. Your struggle matters. And you deserve approaches that actually help you live better, not just “manage symptoms.”
These four agreements might just give you some of that. Not because they’re magic, but because they’re practical wisdom that works and will help you reshape your thoughts and your brain.
~~
Where to Learn More
**The Book:**
- Ruiz, Don Miguel. *The Four Agreements: A Practical Guide to Personal Freedom* (1997)
- Quick read, under 150 pages ( I usually buy my books second hands)
- TheFourAgreements.com has an online course
- YouTube has tons of summaries if you want to preview
**The Science:**
- Hilton L, et al. (2017). “Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis.” *Annals of Behavioral Medicine*
- Zeidan F, et al. (2015). “Brain Mechanisms Supporting Modulation of Pain by Mindfulness Meditation.” *Journal of Neuroscience*
~~~
*If this resonated with you, share it. Sometimes the simplest insights are the ones we need most.*
Tell me in the comments if you liked this book review/read it before! Also don’t hesitate to give suggestions of books you would like me to discuss with a chronic pain approach! 📕
See you in the next article! Also check other books review and my blog section for more ❤️
