Chronic Pain Cycle
Pain can be the result of an injury, illness, or disease process. It is important to distinguish between acute and chronic pain. Acute pain is usually temporary, although it may be sharp or severe. Generally, this type of pain disappears for good once the injury or illness is resolved. However, there are times when this does not occur. When the pain persists for more than three months, it is usually classified as chronic pain and it therefore requires a different therapeutic approach.
The pain system is interconnected with other systems in the brain that underlie emotions, cognitions (thought) and behavior. Therefore a person with a pain problem needs to be open to looking at all aspects of his/her life, emotional state and personality in combination with medical treatment of the pain in order to manage it most effectively. Factors such as stress, pain behaviors, emotions, attitudes and physical activity all contribute to the triggering and maintenance of a chronic pain condition. Sleep disturbance, fatigue, muscle tension, arousal, medication abuse, memory and learning are other factors in the pain system.
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.