Having chronic pain affects self-image, relationships and interrupts life plans. It constricts physical and emotional abilities. It’s frequently not understood or accepted by many people.
Often, the person with chronic pain can be judged harshly. Many report feeling angry that the pain and fatigue hinders them from the things they love to do. Since the symptoms of chronic pain tends to change from day to day, family members and friends sometimes struggle with understanding how their loved one can be so impaired one day and are able to do things the next day. They may say, I thought you were better!
Understanding the issue of how chronic pain impacts your life will go a long way in managing your chronic conditions better. Management is the key word. This is hard when we live in a world that is surrounded by the latest cure for this or that. We can’t believe that health care providers are not able to figure out how to fix our problems. Medical science has come a long way in understanding, but there is still a long way to go to find cures for many common disorders.
We can help with the acceptance process and get you back to your life. We help provide support, a listening ear, and problem-solving. We can teach skills to manage physical and emotional symptoms, along with learning to pace activities appropriately. Being in pain can be very stressful and lonely, and understanding and treating the anxiety or depression that chronic pain creates is important. There is hope! Behavioral health counselors are an important piece of the puzzle with managing chronic pain and/or insomnia. Your first appointment will clarify your wants, needs, desires, and goals.
Chronic pain has varying causes, unpredictable triggers, accompanying exhaustion and an unrelenting weight that impacts every aspect of life. It can cause depression, exhaustion and anxiety.
Those that suffer from chronic pain often experience pain in different ways: Stabbing, exhausting, terrifying, unbearable, agonizing, intense, miserable, shooting, and suffocating are just a few of the words used to describe one’s pain. Some describe it as a feeling, others as an emotion, and often we end up using both. This experience makes it difficult to do things, and what we’re able to accomplish, we either can’t finish or end up doing rather poorly.
When we are hurt, our nerves send signals to our brain telling us that we are experiencing pain. This is a good thing when it’s working normally; we don’t want to accidentally touch a hot stove and neglect to remove our hand. When it backfires, our nerves send out the signals of pain (phantom pain) or an intensified version of our pain. When it goes out of control, the cause of the pain becomes a secondary concern; the pain itself actually becomes a disease in and of itself.
Major Chronic Pain Mistakes
There is no doubt that “entering the world of chronic pain” is a confusing and difficult process. Many times, patients do not understand some of the basics of pain management approaches to care. However, helping patients to become aware of various problems and mistakes, ahead of time, will allow them to respond differently and learn how to become part of the pain management team.
There is no question that for the person living in chronic pain, life is very difficult and exhausting. In fact, the Greek philosopher Aristotle is reported to have said “Pain upsets and destroys the person who feels it.” However, there are some very important factors that one has to think about relative to learning how to cope and manage one’s pain. Notice that some of these ideas are restated in different ways to help you think about them and how they help and hinder your progress in pain management treatment.
Using medications to “totally block” all of one’s pain
Many times, patients want to “chase their pain” with more and more pain medications only to find that the medications are no longer as effective even at higher dosages. Medications are helpful but it all depends on how we use them and what we “expect” from them.
Not understanding that medications will only help with about 50% of the pain
You have to employ other active self-care techniques to help you manage the pain over time. You should not just rely on your pain medications–or keep hoping that you can continue to increase it and “finally” block it. That won’t happen. So, you have to learn to live with a certain amount of pain and accept this fact of life.
Using medication to help us “do more”
All this will do is to ensure that you will crash and have more problems later. It is critical that you learn to pace yourself and your activities by accepting that you are limited and have to now make adjustments. This is particularly true of patients who have just had surgery, or physical therapy, or even biofeedback techniques. They tend to “rush too fast” back to doing more activities, chores at home, returning to work too soon, and feel they can be their “old selves” only to end up feeling even worse. In other words, they cause a flare -up in pain and then ‘panic feeling they have to try even harder.” It is a “new start” in life, not expected but one that is “forced upon” chronic pain patients.
Taking medications any time that pain is felt
Medications are best taken on a time-contingent basis–regular by the clock–if you are to have the best results. Take them as prescribed not just when you feel you need them.
Taking more pain medication at times of flare-ups of pain and then running out of medications later
After a while you will have more pain because your body will “depend” on the medications being there to handle the difficult times. A “Rebound Effect” will happen whereby you will have more pain if you don’t have the pain medications. It is the medication that will cause more and more flare-ups in pain over time if you keep increasing the medications to get through many “bad” times.
Waiting till the last moment to refill your prescription
It’s not uncommon to try to get your physician to fill your prescription in a rush and then getting upset because “it is not done right away or on time.” This pattern will only increase the tensions between you and your health care providers. Have a regular plan for how you handle getting refills. Don’t wait until Friday, the weekends, or the evenings, etc.
Wanting everything to be the way “it use to be” before the pain
Everything has changed now and you have to work on grieving your past abilities and finding ways of now living with where you are at in the moment, pacing activities and being more realistic about what you can and cannot do.
Overdoing things because “you know you will feel bad later”
This insures that you will have even more bad times and many “ups and downs” with your pain problems.
Forgetting to pace yourself
Take breaks every twenty minutes to change positions, do something different, or to just rest. It is easy for time to “get away” from you and then a few hours have passed since you have moved or slowed down.
Thinking that your physicians will always understand your pain and be available to you when you need them
You are the only one who will really understand your pain problem and your needs. You can communicate them to your health care providers, but it is up to you to work out a realistic plan that will work for you AND them. They are not the “all-knowing priests” of life!
Thinking that one thing will work to solve it all
In pain management, as in other types of care, it is usually many things that you have to do to manage problems over time. You have to learn active self-care pain management skills. This is also like learning a new language. It helps work with a pain management professional such as a pain management psychologist, who can teach your new active self-care skills as part of cognitive behavioral therapy techniques that focus on practical things that can work in everyday life.
Thinking that it will all get better “if I push hard enough and work to get me back to where I was before”
This is a major mistake. You can improve and be more functional, but now some things have changed and you have to learn an entirely new way of handling things.
Avoiding seeking help from pain management counselors
These professionals can help you in learning active pain management skills and techniques. There are many things one can learn that can help you to manage and reduce your pains by consulting such professionals. The more you think that relief only comes in the form of a pill, the more problems you are going to have over time.
Thinking that you can’t have a life if you continue in pain
Many people have pain and go on with their lives. You can too even though it may not be easy. It requires positive, and realistic, thinking. Those who do better have been found that they have “accepted” their pain and limitations but still have decided to refocus and live live even though one has limitations.
Allowing fear to rule your life
Fear results in more anxiety and avoiding doing anything for FEAR that you will have more pain. This has been found to lead to even more disability and even more limitations over time. The center of the brain that controls pain is also the same center where your moods (anxiety and depression) are also controlled. One can set off the other so you will need help dealing with this issue.
Not understanding that increasing medications may lead to more pain in the long run
It is important to know that pain medications can have a rebound effect. The body becomes dependent on them and when you “run low” you have more pain. Research with headache patients shows that stopping pain medications will result in a 75% reduction in pain after three months. At first, things might get worse but over time things will get better.
Not understanding your patterns
Once you start to become an active part of the process, learn “the patterns,” and explore different ways of helping yourself, then you will know you are on “the right journey.” Ask yourself what emotions or fears come up at times that may make things worse? Also ask what tasks caused the problems–maybe noting the pain is not evident until the day after doing an activity? Is there a time in the week or month when things are worse? Do setbacks happen when you push to do things–emotionally or physically? You will find, if you are honest with yourself that there are many more questions that you can ask yourself about “the patterns.”
How to Handle Chronic Pain
Remember that “Stress goes to the weakest identified part of the body.” If it is your blood pressure, it will go to that system. If it is your ‘gut” then it will go to that area. If you are injured, or had surgery, then it will go that area. Remember, your body is “an equal employment opportunity host.”
Also remember that in a crisis, we humans tend to regress to previous levels of emotional functioning and can feel “sicker” and more emotionally drained at the time than we had ever thought possible. It is important to not panic at these times. Research on crisis intervention theory points to the act that we will return to our previous level of stability, and reduced fear, with time. The goal is to help in achieving that functioning by becoming aware of how we think, our fears, and our panic.
It also helps to know that progress can take time—more time than you may expect. We can’t rush recovery. Let go of the “magical belief” that everything is solve and the patient can go home the next day without any problems.
These are just a few ideas to consider. There is no magical cure. That is dreaming the impossible dream. You have to be part of the team of specialists that help you. You will have to learn many new things and ways of helping yourself over time. Pain Medications can be helpful but they are not the full answer. You have to be part of the helping team.
The Best Way to Take Pain Medication
Over the years there has been a great deal of research and practical experience around the issue of how best to take one’s pain medication. Understanding a few issues might assist you with having the best response to your medications.
We live in a society that has mixed feelings about the use of medications. On the one hand we “expect” that physicians should be able to prescribe medications that will provide quick and effective “magical cures” that will solve all our problems. In fact, the media, through television and news, is always talking about “new discoveries” for medications and procedures that keep us excited in how we can overcome problems. At the same time, we also live in a society that seems to express a belief that taking medications is not helpful.
We believe in the idea that we should be able to overcome problems without having to rely on outside help, or pills. This is especially true for “Macho Males” who believe that they have to be “tough” and to handle it all on their own! Further, we feel that if someone takes something for a long period of time that they must be “addicted to it.” So we tend to see pain medications and addictions as something that goes together.
Pain-Contingent Medication Use
Most pain medications are taken “when we need them.” That is, they are “contingent” (or depend upon) our needs for them. The person, therefore, waits until they “need them” or are in “enough pain” before having to rely on them. Sometimes this works for acute pain problems where we have just had a problem and do not need to have the medication at other times. In fact, when having surgery, or following an injury, we will use medications at first, hoping to taper them off as one improves. The problem is that when one suffers a “chronic condition” this approach to medication usage does not work very well at all.
Time-Contingent Medication Use
With chronic pain problems, those lasting over 3-6 months, “chasing the pain with pills” does not work very well at all. What has been found to be the most helpful is “taking the medication on a regular schedule as prescribed” by your physician. In fact, waiting until one has “more pain” only seems to insure that the person will always have more pain as they “chase the pain away with another pill.”
So it is always better to take prescribed pain medication on a regular, specific, time-specific, basis. In this manner, the person does not get so tense and overwhelmed by the pain. So, most off the time, it is best to take medications on a regular basis as they will work better and you will have less pain.
There will also be a tendency for you to NOT over utilize medications in this manner. When you are using it on a “pain-contingent basis” you will, many times, need more medication to control the pain. With a “time-contingent basis” you will find that over time you should have better control and need less medication.
Exceptions to Pain Management
There are always exceptions to any rules. Sometimes, people who have taken pain medications, or even over-the-counter medications, will have more pain just because they are taking pain medications every day. They then have “rebound pain” that is caused by the body’s need to have the medication. The brain, and body, learns to become “dependent” on the medication. So some people are better off tapering off their medications and using the lower possible dose.
However, these are also the very people who many times tend to take regular medication, but on a “pain-related” basis rather than on a “time-related basis.” Since stress can influence the body, and increase pain issues, it is easy to “medicate ones moods” with pain medications rather than dealing with the real stressors in your life.
Addiction vs. Dependency
There is also the fear that if one takes medication on a regular basis that they will become addicted to it. In fact, research has shown that this does not happen. Many times, patients are under-medicated and so are always in pain and feel that they “have to have something” making them, and others, feel that they are addicted. In fact, taking medications on a regular basis does not create addiction. It may create a “dependency” on the medication in order to function better in life and on a daily basis. The body may come to depend on it, but this does not mean that one is addicted to it.
For this reason, it is important to not just stop medications abruptly. You need to work with your physician about how you take your medications and the schedule you are taking it on. Dependency is okay if you are working with your physician in positive ways to achieve the best and most appropriate pain control.
At the same time, it is important to remember that you will “never” be without some pain. Even with regular pain medications you cannot “knock out all the pain.” The goal is overall “management of the pain problem over time.” The goal also focuses on your being an active participant in the process, learning active self-care techniques, and working with your pain management specialists.
The Key Factors That Stop Progress in Chronic Pain Treatment
No one likes to experience pain, injury, limitations, or any chronic problem that interferes with our ability to be fully functional. Many things can stop one from becoming healthy and healing from injury and pain problems. Recovering from any type of chronic health problem requires understanding a number of factors.
Fear is a natural response. When we are in the midst of a crisis we tend to “regress” emotionally and feel vulnerable and dependent. Crises, traumas, or any change in the body causes the natural response of feeling overwhelmed, fearful, and highly anxious. Just because it is normal to be fearful and anxious does not mean that we should let it rule our lives and stop your progress toward being healthy and functioning.
Fear and Anxiety are a Blocking Response
The problem is that when we “let fear run through our lives and bodies,” we become “held hostage” by our fears. The more one fears a problem, the more helpless and overwhelmed the person will feel. Sometimes we fear moving or doing anything which causes us to “freeze up more” and become even more de-conditioned.
Catastrophizing Negative Thoughts Predicts Pain & Disability
A study in the journal of Pain, 77 (1998), 253-260, by Sullivan, M., et. al., “Catastrophizing, pain and disability in patients with soft-tissue injuries,” studied patients who had been injured and suffered persistent pain problems. The results suggested that patients with negative, overwhelming, “sky is falling,” catastrophizing thoughts (“Oh My God,” “I can’t take it anymore,” “I’ll never get better,” “Oh, My God,” etc.) reported more intense pain, felt they were more disabled, and could not work.
Catastrophizing contributed to the prediction of disability over and above the actual level of pain intensity. We ended up never getting better and staying. When this happens, you end up stuck, in more pain, and become disabled even further. Such patients never benefit from any help in treatment, due to their overwhelming fears. The issues of Catastrophizing throughts was also studied with similar findings for patients with osteoarthritic patients in the journal of Pain, 87 (2000), 325-334, by Keef, Francis J, et. al., “The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: the role of catastrophizing.” The results of this study suggested that catastrophizing makes the patient feel and act more disabled, overwhelmed, and having more problems ever overcoming their problems.
One’s fears were also connected with an increase in disability even separate from the levels of depression and anxiety. Obsessing, fearing, ruminating about pain (i.e., thinking about it all the time), and fearing that the pain was getting worse, were the strongest predictor of pain and long-term disability and the inability to improve and get healthy again.
Moving Toward What We Expect
The “psychology of growth and change” relies heavily on our expectations and fears. This is because we “tend to move toward what we expect and become what we fear.” As a result, our own health is based on our positive expectations. If we fear an outcome, we are actually setting it up to be achieved.
We have to see risks and problems as opportunities for growth and change. To change we have to start seeing the positive outcomes, let go of negative self-talk, and imagine how things are going to work out even though the situation may be difficult at the present time.
The Desire For a Total Cure
One of the problems faced by chronic pain patients is that they feel they must “be on the search for a cure” and a way to solve all their problems. There is a desire to “return to the way it use to be” so that the body can be used again without any restrictions. Accepting the reality of the situation, limitations, and that “something has made major changes in one’s life,” needs to be acknowledged. The most important thing to know in pain management techniques is that “management” is the magic word. Chronic pains are managed rather than cured! This requires knowledge and the development of active self-care skills.
Research by Michael Sullivan, Windy Rogers, and Irving Kirsch, entitled “Catastrophizing, Depression and Expectancies for Pain and Emotional Distress” in the 2001 issue of the Journal of Pain, 91:1-2, 147-154, suggests that the best way of decreasing pain and emotional distress is through interventions that specifically target catastrophic thinking/fear patterns and thoughts. In the 2002 Journal of Pain, Michael Sullivan, et.al, presents research findings in an article entitled “An experimental investigation of the relation between catastrophizing and activity intolerance,” 100:1-2, 47-53, found that catastrophizing predicted reductions in weight lifted even after controlling for pain and negative moods. Catastrophizing was associated with activity intolerance associated with pain.
However, if you let your fears get in the way, it is like having a panic attack in the middle of a lake. The result of any panic is that one quickly sinks to the bottom and loses their life. Fear, anxiety, negative thinking and panic responses causes the body to tighten up, increase muscle spasms, pain, exhaustion, fatigue and difficulties in sleeping. No professional can help you when you let fear, worry and feeling overwhelmed direct your life. To change you have to make major adjustments in your life to focus on whatever you need to do to get healthy. Other members of the family have to allow you to focus on what you need to do to get healthy.
Pain management is a “process” that happens over time. Progress will go up and down for a while as you “learn” new ways of dealing with the problems and find what works and what gets in the way of your progress. If you stay in fear you will “frighten away” professionals who will just start to “give up” on you because they know that you are “letting yourself sink deeper into helplessness!”
How to Talk with Friends and Family About Chronic Pain
Sometimes people with chronic pain give up trying to explain things because they feel misunderstood, saying things like, I don’t want to be a whiner, I’m afraid they’ll think I’m a hypochondriac, or no one can understand. So how do you tell someone what it feels like within your body?
It’s difficult to describe. Part of the challenge to communicating your situation with friends and family is that chronic pain is not well recognized. More people suffer from chronic pain than diabetes, heart disease and cancer combined, yet it gets very little media attention and the general public doesn’t realize how common – or valid – it is.
You can describe it like trying to put together a puzzle. Normally, it would take you fifteen minutes. But, how long would it take if you were hooked up to wires that gave you a painful amount of electricity every five seconds? Chances are, it would be almost impossible. The pain takes away your ability to focus and concentrate. That’s what living with chronic pain is like.
When talking with others about your chronic pain, it’s important to be honest. It’s okay to admit that life hasn’t been all that smooth lately, or that you are feeling pushed or depressed. Appreciate their interest. If you thank someone for asking how you’re doing, you encourage them to keep asking – and to continue to care. If you brush an inquiry aside, it’s unlikely to come again – the person who asked will assume you don’t want to talk. Be patient and share your feelings. Give those who love you time to understand your situation.
You can help by sharing what you are experiencing and how you are feeling. Accept help. You understand how important it is to maintain self-reliance and stay active, so it can be hard to accept help even when you really need it. When you are suffering it’s okay to let friends or family run to the grocery store for you, bring you a meal or clean your gutters. By accepting help, you are allowing them to express love in a way that’s truly meaningful. You would do the same for them.
Don’t feel obligated to maintain relationships with people who negate your feelings, or shrug off your experience with a buck up, buddy. Focus on those who believe in you and choose to help you without judgment.
Coping Skills for Chronic Pain
Life is full of stressors, from jobs or co-workers we don’t like, to cars that break down, from teenagers who act out to bills to pay. How anyone copes with stress is important but it is particularly important for people who also suffer from chronic pain. Here’s why.
Chronic pain disorders are not understood or accepted by many. Pain impacts self-image and interrupts life plans. It stops people from enjoying activities they used to do and creates stress and anxiety. Chronic pain may also disrupt relationships. Understanding and treating the impact chronic pain has on your life is an important part of healing.
Our experiences create neural pathways in our brains. Left to its own devices, the brain will focus on the pathways that are familiar. For people with chronic pain, this means the brain focuses on pain pathways, making them even deeper and stronger. But if you can train your brain to focus on pleasure instead, you can remap neural pathways in the brain and override the pain pathways. For this reason, coping mechanisms and self-soothing are important concepts in neuroplasticity.
We first begin learning coping mechanisms from our parents. Unfortunately, many of us learned unhealthy ways to self-soothe from our earliest role models: smoking, pouring a glass of wine or opening a beer at the end of a stressful day, overeating, or escaping reality by watching TV, playing video games or surfing the web for hours. Ask yourself, “How do I cope with stress?” If these soothing mechanisms sound familiar, it’s important to explore healthier ways of managing your stress.
Think back to when you were a child. Sucking your thumb, stroking a favorite toy… these are all common ways that children self-soothe. Unfortunately, as we grow up we are often conditioned and encouraged away from self-care. We are taught to be stoic, “tough it out,” or to “pull ourselves up by the boot-straps.” But denying yourself soothing activities isn’t healthy and it won’t help you cope with pain.
There is a lot of research about the role that one’s state of mind plays in a sense of well-being and physical functioning for all of us. In this context, we know that there is a great deal of variability in the emotional lives of people. Further, emotions have many different dimensions to them–some stronger than others. For example negative states of mind tend to make pain last longer and brings about more stress for the person.
During high pain periods, we seem to have an inability to sustain any positive sense of well being. This in turn results in our struggling with more stress, sadness, and negative emotions. At these times it is easy to forget that positive emotions helps to foster a quicker, compared to negative emotional states, recovery from pain. What this means is that it is important to become more aware of both our negative and positive emotional states when we are stressed by high pain and disability states.
How positive emotions can arise in the context of chronic pain and disability is critically important. Research has suggested that the ability to know the difference between positive and negative emotions when stressed and in pain is important and be of a benefit in helping one cope better over time.
We know that when a person has ‘mood clarity’, they have the ability to both identify and understand the specific emotions. This requires that learning the technique of ‘psychological mindfulness’ is central to being able to recover from difficult times. We know that the ability have a trait known as ‘psychological resilience’ can become more stability and allows for the ability to overcome and bounce back from difficult times.
This means that those with greater mood clarity (mindfulness-personal awareness of emotions) and trait resilience can (1) experience positive emotions even when facing problem situation, and (2) draw on the experience of such difficult situations to develop tools to rebound from stressful times quicker.
Mindfulness and Clarity
Practice makes perfect. We need to work on identifying both positive and negative emotions when we are not stressed by a situation. This requires working on it many times to make sure we have really learned it so our response becomes more automatic. We need to know what is called the ‘two dimensional view of pain patients’ emotional well being.’
Mindfulness is stopping and asking ourselves what emotions and feelings we are noting at a present moment before we start to act, or react, on them. Others may tell us that we should not pay attention to our emotions. Mindfulness requires we develop the ability to ‘stop denying’ and start paying attention to how we feel and are reacting to situations BEFORE we jump in and react.
Personal Intervention in Chronic Pain
A focus on positive emotions has many benefits in pain treatment over time. Mindfulness training broadens our awareness and helps maintain a positive emotional focus especially during periods of high pain What is known is that positive emotions serve to counteract catastrophizing negative thinking that frequently trigger, and prolong, pain episodes. For example, we know that those patients with Fibromyalgia pain syndromes tend have more negative emotions and seem to lack any positive emotions that could help one cope and function better in both difficult and good periods.
It is hard to not be negative in the face of problems, disability, and/or high pain periods. So having a ‘two dimensional’ view of experiencing pain can help one with a better sense of well-being over time. It is not how ones sense of well-being is defined by the experience of pain or disability but by also how well one pays attention to their personal goals and social relationships that give meaning and value to life even in the face of one’s ongoing limitations and problems.
Why Is This Happening to Me?
It is natural to want to ask why ‘this’ problem is happening at this point in time–especially when we have been ‘doing so well.’ Maybe a better way to asking such questions is to look to the manner in which we paced ourselves, or the stressors in our lives, that we faced before this problem developed. Many times, setbacks happen because we have pushed ourselves more when feeling good.
We have forgotten the importance of pacing ourselves or we feel that we have to push hard when feeling good to get things done before the bad happens again. Pushing ourselves only insures we will have more difficult times later on. We have to find a middle ground and now over do things.
We also have to know that stress–from work, family, friends, and other pressure, are very potent forces in bring about setbacks. It is also to point out that stress can be positive or negative with each one adding to our overall stress and physical-emotional endurance levels. Setbacks will happen and should not be a surprise to us. We need to use periods of setbacks to learn more about ourselves and functioning.
Remember, it is important that we work on how to keep a more positive emotional state even in the difficult times. This will take practice and time. It is about learning new skills that can help us with a better overall sense of well-being even when facing difficult times.