|
The impact of
chronic pain on the patient and their family is significant. Often
the patient enters into a vicious pain cycle between the mind and
body where the perceptions of the pain contribute to increased
stress, leading to increased tension, frustration and fear which can
influence an increase in the experience of the pain, which leads to
more agony and so on. The goal in part then is to interrupt this
cycle and to optimize pain control and enhance psychological
well-being.
Learning to Cope
Understanding that pain is a complex interaction between your
physical and emotional reactions is one of the first steps toward
coping. Resistance and self-sabotage can occur in the face of pain
because of the tendency to blame the pain on the circumstances that
caused it. To effectively cope with pain, we need to be motivated
to recognize that we are responsible for what we tell
ourselves about the pain. A significant challenge for someone with
pain is to acknowledge the connection between their pain experience
and their thoughts and behaviors.
Chronic pain, therefore, has many dimensions: physical,
psychological and social. Treating the whole person increases the
chance of improvement. Managing pain from a psychological
perspective does not imply that the pain you experience is
all in your head. The reality is that when you have chronic
pain, your mind as well as your body is involved. In addition to
drug therapy, physical therapies and alternative treatments, there
are psychological techniques that you can learn from a psychologist
on how to manage the emotional impact and alter the subjective
experience of pain.
Learning these skills to manage stress and pain add value to the
medical interventions you are engaged in.
Knowing how to understand and control your pain can empower you to
return to a life of optimum functioning, with or without pain. Pain
management does not guarantee being pain free; rather it teaches you
to learn how to control your pain so that it no longer controls you.
Pain & Stress
Chronic
pain can be stressful. It is frequently associated with alterations
of sleep, strain in relationships, social withdrawal, fatigue,
decreased concentration and impaired occupational functioning. The
psychological impact on a person’s mood is highlighted by feelings
of depression, irritability, increased crying, outbursts of
frustration and a sense of hopelessness. The overall impact of
constant pain to the quality of life at every level can be
devastating. Decreased pain and improved
functioning can be facilitated by managing stress and tension.
Constantly tensing muscles make nerve endings more sensitive leading
to greater pain and increased muscle tension. As a protective
mechanism, you may hold your body in guarded positions that favor
the hurt areas but stress other muscles therefore spreading the
pain. Relaxation is crucial to breaking the link between pain and
tension. There are techniques designed to facilitate the relaxation
response which in turn can lead to more control over the pain.
Pain & Sleep Cycle
There is an interaction
between the pain and sleep cycle. Having chronic pain can have
troublesome consequences on an individual’s ability to sleep for
reasons that may appear obvious. Sleep disturbance comes in the
form of inability to fall asleep, inability to maintain sleep and
early awakening all due in part to the experience of pain. When
someone’s sleep is disrupted continuously because of pain it can
exacerbate daytime fatigue, irritability, anxiety, depression and
other somatic complaints which decrease ability to cope with
stresses of the day.
Another cycle ensues where pain affects sleep
which leads to increased tension and other emotional consequences
which exacerbate the pain, which then increase stress, lower pain
tolerance, and further disrupting sleep and so on. A variety of
behavioral and relaxation techniques can be helpful for conditions
such as chronic pain and insomnia. Many disturbances in sleep are
facilitated by the ongoing inner dialogue of despair and
negativity. One also needs therefore to address the accompanying obsessional thoughts that underlie many physical disorders and
contribute to sleeping difficulties.
Psychological Factors Influencing Chronic Pain
Pain is
not just a function of the mechanics of the body, it is also an
experience; that is, a function of the mind. How we perceive pain
and the degree of emotional impact varies from person to person.
There are additional factors that contribute to pain. Depression
and anxiety for example, can significantly intensify the experience
of pain and associated suffering. Individuals with pain undergo
many changes in lifestyle, finances, occupational and relationship
functioning. As a result the individual is grieving those
associated losses that have come as a result of the chronic pain.
Due to inactivity, individuals may gain weight, lose muscle
conditioning and this can impact self esteem. Increased frustration
can erode self-confidence in one’s sense of control over their
life. Individuals can feel overwhelmed with the chronicity of
their pain and the associated emotional factors which they feel to
some degree each day. You, your family and significant others
bring a unique blend of feelings, beliefs, expectations, coping
styles, support and skills to the overall management of your pain.
An obstacle to effective pain treatment can be the lack of
credibility that the patient feels at times with health care
professionals. Due to the huge psychological impact the pain
has on their life, the patient is sometimes treated as if their pain
is not real. For most individuals this is not the case; the
pain is a very real and a legitimate condition even if it cannot be
visibly seen. The challenge of the chronic pain sufferer is to
get appropriate treatment for the pain in addition to having the
psychological impact acknowledged and validated.
Treating Mind
& Body in Pain Management
It is
impossible to understand pain using physical concepts alone. There
are multiple elements comprising the pain experience; each of them
not working in isolation from the other. To effectively manage and
treat pain, one must take into account all of these elements and
their interaction with one another. These elements are:
Physical/Sensory:
This
includes the location, intensity, quality and times that factor into
the physical sensations and symptoms involved in the experience of
pain
Emotional:
Fear,
anxiety, anger, irritability, worry, depression, panic, despair,
hopelessness are examples of the emotional states that can accompany
both the experience and the effects of pain on your life overall.
It also involves the recognition of the multiple losses and changes
to your body and lifestyle.
Mental:
This includes your awareness of pain, focus of
attention, memories, attitudes about pain, self, others and life,
expectations, perceptions, decisions and other thought processes as
they relate to your experience of pain
Behavior:
This includes activities of daily living, diet,
exercise; things that you actually do in response to your pain. It
also includes behaviors of isolation and withdrawal in response to
the emotional consequences of pain on your life. As well, it
involves things like pacing, time management, sleep, self-care, and
pleasurable activities.
Social:
This includes your primary relationships, family,
friends, health care professionals, coworkers, insurance
representatives and anyone else involved who are affected by or can
affect your pain condition.
Environmental:
This
includes things in your surroundings that affect how you cope with
your pain like housing restrictions, weather conditions, physical
objects that assist with daily living (special bed, chairs,
appliances), and other practical things like transportation and
functional resources.
As an
individual challenged with pain, it is helpful to know that there
are things within each of these areas that you have the ability to
change and control. It can be empowering to know that there are
ways to approach each of these key elements and learn skills that
can help assist you in the overall management of your pain. The
goal is to learn how to live a better quality of life, with less
pain and less suffering by respecting the significance of each of
the elements involved in your pain experience.
Factors
Influencing Resilience and Pain Management
One of the biggest obstacles to pain management are
the beliefs we have about the pain; that is, how we interpret the
pain and the significance it will have on one’s life. Individuals,
who have learned to manage their ongoing pain in a way that allows
them improved quality of life, tend to possess the following
attitudes:
Determined
versus Helpless:
The
ability to re-evaluate beliefs, re-assess what one can do and not
do, take responsibility, and setting limits and boundaries based on
an altered definition of self and situations will all contribute to
an increased sense of “control” over the pain
Involved
versus Alienated:
Having a
sense of purpose facilitates ongoing involvement and commitment to
one’s self and one’s life in spite of the pain. It may be that the
approach to life may need to be redefined, however, remaining
engaged in life offers hope beyond the pain.
Face
Change versus Immobilized by Fear:
Making
decisions and setting goals empowers one to face things a step at a
time. Allowing yourself to see the positives can lead to
opportunities for growth and self-examination.
Psychological
Techniques for Managing Pain
The
personal meaning that someone assigns to their pain is a
significant determinant of how they will experience their
pain. A widely used tool for assisting people in managing their
pain is from Cognitive Theory. Essentially this theory proposes
that people are emotionally distressed not as much by the events
that happen as by the interpretation of those events. A
person’s subjective experience of suffering therefore is
impacted by their perception of the pain. When you think
about the major impact chronic pain has on an individual’s
everyday life, it is not difficult to imagine that most people
with pain think negatively about it. When negative thoughts
persist and go unchallenged, pain related emotional distress and
suffering is intensified. Therapy that aims at disputing these
beliefs and negative patterns of thought has the potential to
alleviate the emotional distress associated with pain syndromes.
Developing healthier, adaptive thoughts, emotions and behaviors is
facilitated by learning the tools that help identify, challenge
and restructure underlying beliefs about oneself, the world and
the future as it relates to pain.
The
components of a cognitive-behavioral approach to the management of
pain include:
Cognitive Restructuring:
Assist
the person with pain in seeing the connection between their pain
experience, thoughts, emotions and behaviors. Altering
perceptions of pain can reduce the level of depression and anxiety
experienced therefore influencing more adaptive coping behavior
Relaxation Training:
Learning
a skill called progressive muscle relaxation is useful in reducing
many chronic pain conditions in addition to the management of
stress and tension.
Imagery
Replacement:
Learning various techniques to alter images of pain to more
pleasant experiences can be effective for pain control.
Attention-Control:
Learning
ways to deliberately redirect and divert attention away from the
pain
Behavioral Coping Skills:
Learning
the importance of pacing, shaping and goal-setting
Interpersonal Coping Skills:
Learning
to set healthy boundaries and limits as well as assertiveness
skills
Effective pain management and relief are possible with patience
and persistent practicing of the above techniques.
Click here to email SoulSpring Counselling for information on how
counselling can assist you in learning skills for pain management.
|
