“I will do anything to get out of pain”
How do we help people get out of this pain state and back into a meaningful life? Is there a “cure” for chronic pain in our society? Pain is a complex phenomenon and there are no easy solutions at this point. However, I think there are two things that we can do that will make a difference.
#1 Change Our Language
“You don’t get it, something is wrong”
Our healthcare professionals must keep up to date on current pain theories and be able to communicate this information clearly to patients. It is no longer acceptable to fall back on the anachronistic belief that pain equates to tissue damage in all cases. This is simply not true. A more progressive understanding of chronic pain must include discussions of central nervous system sensitization and other neural changes and we must use this knowledge to guide treatment. Chronic pain patients need guidance from these professionals in order to help them make sense of their symptoms and take a more proactive role in their own treatment.
“You’re just going to have to learn to live with it”
Whether because of a distrust of patients or because of an inability to address pain effectively, clinicians often dismiss chronic pain patients. This can be increasingly frustrating to patients, who feel “misdiagnosed, misunderstood, and miserable.”6 Trust your patients. When they say it hurts, it is best to assume they are telling you the truth. The fancy word in medicine for faking is “malingering.” Even though people may think that they are great at telling fake pain from real pain, they are not very good at all (in one study, clinicians were only 51% accurate in distinguishing fake pain from real pain).7 Your best bet as a listener is that the person’s pain is real until proven otherwise.
One of the hardest struggles about living with pain is the mental toll that it takes trying to maintain positivity and hope each day. Those in chronic pain need support from family, friends, and healthcare professionals to maintain an optimistic, albeit realistic outlook (see how this idea affected me personally: your pain is NOT your fault).
One way to practice optimism (and it is a practice!) is by returning to those things that you are able to do and that you are grateful for in your life. I like the words of Dr. Jon Kabat-Zinn, who says, “…as long as you are breathing, there is more right with you than wrong, no matter what is wrong.”8
There are many things that factor in to recovering from chronic pain, but as Moseley et al., say it is usually a long road to recovery and it takes some dogged persistence and hard work.4 Sufferers of chronic pain need your support! Sometimes all it takes is one person that believes in your ability to get better. You can be that person for someone in pain.
#2 Treatments Need to be Integrative and Collaborative
Drug treatments may be helpful for some chronic pain sufferers, but others may benefit more from non-pharmacologic treatments like physical therapy.10 It is important to realize that your mental and emotional state can severely impact pain and your experience of pain (i.e., suffering, which has been called the “second arrow”). For example, one study found that catastrophizing thoughts were the most associated with increased pain.11 So, it is no surprise that there is a high incidence of comorbidity between chronic pain and mental illness. Some research suggests that anxiety and chronic pain may “facilitate” each other12 and some experience depression, which can in turn increase pain.6
As I’ve experienced personally, dealing with a chronic pain condition “successfully” forces you to come up with adaptive coping strategies so as not to compound the problems that you are already facing. Writing can be a helpful strategy to reduce stress and process traumatic events.13 Also, meditation/stress reduction techniques can be effective for chronic pain. One of the most widely researched and applied programs is Dr. Kabat-Zinn’s brainchild: Mindfulness Based Stress Reduction course (MBSR) [From Seth: Check out Kabat-Zinn’s book Full Catastrophe Living on my Recommended Reading List]. In one of the worst periods of my pain, I started a formal meditation practice with the help of this free online MBSR course. It completely changed the way I related to my pain and significantly increased my ability to cope with it and make proactive decisions. [From Seth: as we learn more about the neuroscience behind persistent pain, interventions like meditation and expressive writing are more than just coping strategies, they are treating the pain.]
About the author:
Leda is in her first year of physical therapy school at Ohio University. She was inspired to go back to school for physical therapy because of her personal experiences with a knee injury and subsequent surgeries, which have left her dealing with chronic knee pain for the past three years. Currently, she is writing an e-book about her experience with chronic pain, as well as blogging at: https://farmerleda.wordpress.com/. Feel free to get in touch with comments or questions: firstname.lastname@example.org
- Tsang et al. (2008). Common chronic pain conditions in developed and developing countries: Gender and age differences and comorbidity with depression-anxiety disorders. Journal of Pain, 9 (10) pgs. 883-891.
- NIH fact sheet (2010): https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=57
- Butler, D.S. & Moseley, G. L. (2003). Explain pain. Adelaide, Australia: Noigroup Publications.
- Moseley, G.L., Butler, D.S., Beames, T.B., and Giles, T.J. (2012). The graded motor imagery handbook. Adelaide, Australia: NoiGroup Publications.
- Vagg, M. (2015): http://www.bodyinmind.org/talking-about-pain/
- Benner, R.N. (2015): https://www.washingtonpost.com/national/health-science/chronic-pain-not-only-hurts-it-also-causes-isolation-and-depression-but-theres-hope/2015/01/12/db576178-7fe7-11e4-81fd-8c4814dfa9d7_story.html
- Wiech, K. (2015): http://www.bodyinmind.org/decoding-fake-pain/
- Kabat-Zinn, J. (2013). Full catastrophe living (revised edition): Using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Bantam Books.
- Gifford, L.S. (1998). Pain, the tissues and the nervous system: A conceptual model. Physiotherapy, 84(1), pgs. 27-36.
- PT in Motion (2015): http://www.apta.org/PTinMotion/News/2015/1/14/ChronicPainNIH/
- Jensen, M. P. (2015): http://www.bodyinmind.org/pain-catastrophizing-brain/
- Soleiman, M. (2015): http://www.painresearchforum.org/news/57740-prelimbic-circuitry-links-chronic-pain-and-anxiety
- Pennebaker: https://www.utexas.edu/features/archive/2005/writing.html