What Is Chronic Pain and How to Manage It?
At one time or another, we have all suffered some form of physical pain, injury or illness. This kind of “acute pain” is your body’s way of telling you that something is wrong with it and that you need to do something about it.
A lot of times, the pain goes away on its own or with medications or other techniques. This type of pain resolves in most cases when the underlying cause no longer exists.
What Is Chronic Pain?
As you know, even short-lived pain can put a damper on your life’s activities. Fortunately, once it goes away, you can resume your normal daily life.
However, for some people, the pain never goes away, even after the initial injury or illness. Pain that lasts more than three to six months is classified as “chronic pain.” This kind of pain is not as straightforward. It is estimated that there are at least 100 million adults with chronic pain in the United States!
Not so many years ago, chronic pain wasn’t identified for what it was, but fortunately, physicians and other healthcare providers now accept that it is a real entity.
So although pain may begin after an injury, such as whiplash or a pulled back muscle, chronic pain continues long beyond the injury and treatment for that initial event. Sometimes, the pain may come from an unknown cause (i.e. there is no known past injury to the body). Other times, the pain constitutes the main issue, as can be the case with migraines, fibromyalgia, and neuropathic pain (nerve pain which can occur after a stroke, for example). (Source)
What Issues Accompany Chronic Pain?
Normally, people think of pain as completely a physical problem. However, pain is so much more than that. It includes biological, psychological and emotional components. These other components include mood changes such as depression, anxiety, fatigue, anger, and frustration. After all, the pain affects your day-to-day functioning, making it difficult to enjoy and participate in all kinds of activities . Activities that people without pain can do and take for granted each and every day.
Poor sleep is also a complication of chronic pain, lowering your patience levels and ability to cope with minor stresses. And if you do not leave your home due to the pain, fatigue, depression, and so forth, your isolation increases. It is a vicious cycle. Well-meaning family and friends don’t understand what you are going through. They may tell you to push through the pain, causing you even more anger, frustration, and depression. (Source)
Chronic pain can also make it difficult to stay employed in some cases, which can result in financial difficulties as well. This additional stress intensifies the perception of pain.
Furthermore, the pain may interfere with your ability to be involved fully in your children’s lives or that of your friends and family, often resulting in missing important events and occasions. You may even lose friends who don’t understand why you have to cancel plans unexpectedly.
So as you can see, chronic pain results in stressful situations in life as well as stress inside your body, and then the result of this stress is worsened pain. It is never-ending. (Source)
What Is Pain Perception?
The basic goals of chronic pain treatment and management include:
- To reduce pain
- To promote self-efficacy
- To improve function and the participation in daily activities
Another thing to consider, when treating chronic pain, is that no two people’s perception of pain is the same. Pain is subjective, and the only ways to describe it are stating if it is dull or sharp, constant or not, and so forth. Two people could have the same amount of pain, yet one may be completely disabled by it while another is still able to function to some degree. (Source)
The only way pain can be measured with a subjective evaluation by the client using a rating scale. 10 being the worst kind of pain, and 0 being no pain at all, as well as assessment for improvement in function and activity participation after treatment.
So why is it possible for two people with the same levels of pain or the same kind of injury to experience varying responses in pain intensity?
In 2015, the University of Colorado at Boulder released their results from a study that showed there were two separate brain pathways involved in pain. One pathway sent the signal of physical pain to your brain. The other pathway involved using another part of the brain (that is involved with emotion and motivation) to modify the perception of the brain. It appears that pain will differ depending on a person’s outlook on things and their attitudes in life. (Source)
This is important to remember, because some of the most effective ways of treating pain involve changing your emotions and thoughts.
Can Anxiety Cause Physical Pain Symptoms?
Research into chronic pain shows that genetics has a role in whether you are at increased risk of developing chronic pain.
And similar to what was just mentioned about your outlook and attitude on things, the research shows that how you perceive stress and how your body reacts to it, can also affect your pain levels. This points to the general acceptance in the medical community that chronic pain is not only sensory, but also emotional. (Source)
Studies also show that people with chronic pain have changes in the emotional and cognitive areas of their brains that modulate the pain. This provides some insight into what is already known – that people with chronic pain can go on to become anxious or depressed.
On the other hand, it may also explain why those people who have anxiety and depression, are also at increased risk of developing chronic pain. In either case, chronic pain studies are continuing and will be helpful in the future treatment of people with this debilitating condition.
How Is Chronic Pain Treated?
Although your treatment plan may include medications, non-pharmacological approaches to chronic pain management are very important. In other words, medication is not the only answer, and sometimes it can make things worse and addiction to some pain medications is a real concern.
That is why it is important to see a team of pain management specialists.
In addition to physicians, this team may also include rehabilitation specialists such as physical therapists, occupational therapists, psychologists, nurses, and more. If chronic pain is to be treated, it requires a whole-body approach to treat not only the physical pain, but also the cognitive, emotional, and psychological aspects.
So, if it isn’t entirely clear yet, treatment takes into account the recognition that pain involves:
- The physical sensation
- Your emotions and thoughts about pain – sadness, anger, frustration, or worry that the pain is not going to get better, which can further amplify your perception of it.
Cognitive, Emotional and Psychological Approaches to Chronic Pain
Using Mindfulness to Approach Chronic Pain
This method teaches you how to cope with pain by relaxing and calming your mind. It involves being aware of and focusing on what is occurring in the present.
- Being mindful involves focusing on only one thing at a time.
- Stop what you are doing for a second.
- Sit or lie in a quiet spot.
- Close your eyes.
- Be aware of each breath you take, and focus on it.
When you practice mindfulness, it takes your mind off the past and the future and reduces the chatterbox in your mind which is often reminding you of the pain you’re in. This helps to relax your mind and body by taking your focus off the pain. A trained healthcare professional can teach you how to use this method effectively.
This method can decrease anxiety, depression, and pain in people suffering from chronic pain, particularly those with back pain. (Source)
What Is Cognitive Behavioral Therapy for Pain?
CBT is known to help people with many types of disorders including eating disorders, depression, obsessive-compulsive disorder, but also chronic pain. In particular, a study published in the October 2016 Pain Medicine journal concluded that CBT reduced the level of pain in people being treated with opioids for chronic low back pain. (Source)
The premise behind CBT is that you create your own experience by how you think about situations, including your perception of pain. It is known that if you always choose to see things in a negative light and expect bad things to happen, that this intensifies your pain. This is partly because your brain interprets the perception of pain. Pain is also reported to be able to rewire your brain and negatively affect your emotions.
Cognitive-behavioral therapy is a form of psychotherapy or talks therapy that treats how your thoughts and perception of things (including pain), affect you.
- Identifying and controlling your negative thoughts, emotions, and behaviors about the pain
- You can implement effective coping strategies that help you manage the pain.
- When you develop these coping strategies, you can change your perception and awareness of the pain, even if the pain is still there or has not lessened.
This is because when you treat the psychological and emotional aspects of chronic pain, you are also changing how your brain processes pain.
Cognitive-behavioral therapy teaches you:
- How to challenge your negative thoughts and inaccurate beliefs
- How to think differently about situations, including the pain
- How to be in control of your thoughts and actions (Source)
CBT is most effective when you:
- Go in with the belief that CBT works
- Have a cognitive-behavioral therapist that you like and trust
- Are willing to change the way you think to get results
- Take an active role in your therapy and practice what you learn
Can Hypnosis Help with Chronic Pain?
Hypnosis consistently shows significant results in the reduction of chronic pain and can be used in conjunction with other techniques of pain management such as cognitive-behavioral therapy. Some studies have shown that hypnosis is even more effective than physical therapy. However, further research needs to be conducted. (Source)
Hypnosis provides suggestions for relaxation and the production of a comfortable atmosphere. It also teaches you how to use hypnosis outside of hypnosis sessions by using a cue such as taking a deep breath. This cue then helps you create relaxation and comfort. It is helpful to learn self-hypnosis and to listen to hypnosis recordings at home so that you can practice hypnosis every day to manage your pain.
You may find a decrease in your pain immediately following a hypnosis session, or it may take several sessions and continual practice. The results are worth following through with it though. Literature indicates that people can achieve reductions in chronic pain that last for many months. While hypnosis can be used to manage your pain, it may also include the benefits of reduction in your anxiety levels and improvement in your sleep.
What Is Biofeedback for Chronic Pain?
The standard definition of biofeedback, according to the Biofeedback Certification International Alliance (BCIA) and two other related associations (AAPB and ISNR), is this:
“Biofeedback is a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance. Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. These instruments rapidly and accurately “feed back” information to the user. The presentation of this information — often in conjunction with changes in thinking, emotions, and behavior — supports desired physiological changes. Over time, these changes can endure without continued use of an instrument.” (Source)
In other words, sensors are placed on your body, and then you view the physiological activity on a monitor in real time. By becoming aware of what your body does under certain conditions, you can learn to make changes that result in reduced pain. For example, you can watch and learn how slow, deep breathing results in relaxation and a change in your body’s physiological responses.
The goal of biofeedback therapy is to replace the body’s fight or flight response (which is controlled by your sympathetic nervous system) that occurs with pain or stressful situations with the relaxation response (parasympathetic nervous system).
It is best to find someone – a psychologist, occupational therapist, nurse, et cetera – who is certified in biofeedback, and can teach you how to use it effectively. Biofeedback can be used in conjunction with other pain management techniques already described above.
How to Use Visualization to Manage Chronic Pain
Science points to the positive effects of visualization for pain control. Similar to other techniques already described, guided imagery allows you to use your mind to exert control over the pain. Guided imagery can be used in combination with meditation and biofeedback. (Source)
Sessions as short as ten minutes can result in significant pain reduction. Like other techniques, such as biofeedback, imagery turns off the sympathetic nervous system (the body’s fight or flight response that is activated during times of stress or pain).
The use of imagery involves sitting in a comfortable, quiet location, close your eyes, and imagining a scene or a memory that evokes relaxation. While in this state of relaxation, you imagine your body the way you want it to be.
An example of chronic pain might involve imagining a day at the beach with no pain, running and playing in the sand with your children or grandchildren. You imagine the feel of the warm sun on your skin, the sensation of sand sticking to your body, and how happy you feel.
By inducing this relaxation, your body’s stress hormones go down, and your experience of pain is reduced. You can find imagery specialists at Imagery International (Source). You can also find numerous recorded imagery guidance sessions online. Ohio State University has an MP3 that you can use for easing the pain. (Source)
Breaking the Cycle of Chronic Pain and Insomnia
Pain is one of the most common causes of insomnia. Two-thirds of people with chronic pain suffer from sleep issues ranging from trouble with falling asleep to staying asleep. And when you suffer from poor sleep, it makes it harder to function and deal with even the smallest of daily stresses, and this intensifies the pain. However, by determining what sleep issues exist and treating them appropriately, this pain can be decreased.
Before your doctor treats your insomnia, he must rule out another potential physical (sleep apnea) or psychological issues (depression, anxiety) that may be the problem.
Some pain medications can be used that also help you sleep better. However, opioid pain medications can wreak havoc on your sleep, preventing you from entering the deep restorative stages of sleep.
Of course, the normal “sleep hygiene” techniques of going to bed and waking at a regular time and giving your body time to wind down before settling down, are important things to do. If you have chronic pain, you want to find something to do before bed that is not too stimulating, but yet helps to distract you from the pain. You may want to use imagery/visualization to help you relax at bedtime. A sleep app that plays a constant relaxing sound such as light rain can also help distract you from thoughts of pain when it is time to go to sleep.
In addition, you may want to ask your doctor if a melatonin supplement would be helpful.
A big part of treating insomnia also involves the psychological and emotional components, including learning how to manage your thoughts and emotions. Not surprising, cognitive-behavioral therapy can be used to treat insomnia. By learning how to shut your thoughts and worries down at bedtime, you can also learn how to fall asleep more easily.
What is the Pain-Anxiety-Depression Connection?
Pain can result in anxiety and depression. However, anxiety and depression can also make pain worse. It is not always to know which came first – kind of like the chicken and the egg scenario. Chronic back pain is actually more common in people with anxiety and depression. (Source)
Once again, cognitive-behavioral therapy, imagery, and meditation are all effective techniques that help treat both chronic pain and co-existing anxiety or depression.
Chronic Pain Relief Techniques (Conclusion)
The medical community accepts that chronic pain is a real entity requiring treatment. Because chronic pain has psychological, social, and emotional components, pain medications are not the only answer. In fact, pain medications may not be the answer at all.
Chronic pain responds well to psycho-social treatments that involve learning ways of changing your thoughts and controlling your mind. There is a lot of research supporting these techniques, and it continues to grow.
Whether you choose to use cognitive-behavioral therapy, visualization, biofeedback, or mindfulness techniques, remember that the goal is to reduce and manage your pain.
It can be done! It is working for others, so it can also work for you. What have you got to lose?
You will probably find it most helpful to find a professional who can teach you these techniques, but getting better requires that you take an active and positive role in your care.
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