March
20

Coping With Chronic Pain

Posted on Friday 20th March, 2015

With thanks to the Thalidomide Trust and Dr Mark C Chorlton for this information


Mark C ChorltonThere has been a great deal of research conducted into the role psychological processes play in dealing with chronic pain.  It has become quite evident that these processes have a significant role in the management of chronic pain.  Lifestyle changes - such as those to diet and adoption of simple exercises - can also be beneficial. 

It is well known that people who are able to adjust their lifestyle are more likely to improve their quality of life and wellbeing.  From a psychological perspective, self-awareness is also an important skill to develop.  What are you saying to yourself? Are you encouraging yourself or are you defeating yourself? Why are you behaving the way you are in a particular situation? Insight in these areas put you in a better position to deal with your pain. 

Thoughts about ourselves, pain, our physicality, the past, present and future can influence the way in which we cope with life.  Negative thoughts are often the precursor to negative behaviours.  Therefore, change the thoughts, change the behaviour. 

Psychological approaches are not rocket science.  They are often simple and almost self- evident.  The major part is to understand what they are trying to achieve and being consistent in their application.  One of the nice things in the area of psychology is knowing that inappropriate behaviours have often been learnt.  Anything that has been learnt can be unlearnt and replaced by a more appropriate learnt behaviour.  This gives us hope that things can get better. 

Here is some advice about how aspects of your lifestyle relate to chronic pain. 

Nutrition and Pain Management


Nutrition
The average western diet can result in low grade systemic inflammation known as "metainflammation".  Therefore diet can have an influence on chronic pain by sensitising the nervous system in addition to other medical problems.  It is advisable to eat smaller portions at meal times ensuring you have a good mixture of vegetables, fruits and protein. 

Try to eat at least 2 servings of fruit and 5 serves of vegetables a day.  An easy way to do this is to juice fruits and vegetables and drink your daily requirements.  Supplements such as Omega-3 fish oil and antioxidants contained in a daily multivitamin may also be helpful. 

It is also advisable to reduce your intake of caffeine and alcohol and to try and quit smoking.  Altering these behaviours can be difficult but they are beneficial in reducing your pain and the development of other major medical disorders. 

Interpersonal Relationships


Interpersonal relationships can suffer due to chronic pain.  One of the emotional states that often accompanies disability and chronic pain is that of anger. 

An angry person can be unpleasant to be around.  Whilst it is understandable why we would feel angry, excessive displays and outbursts of anger are not helpful in relationships.  On the positive side we can gain social support through our interpersonal relationships.  Be willing to recognise those times when you need assistance.  Don't be afraid to ask for help. 

Social support is key, and many studies have shown that it has many positive health benefits.  Sometimes all that is needed is someone to talk to who understands what you are experiencing. 

Mental Wellbeing

Visual imagery can help relax muscles
Visual imagery can help relax muscles

Poor mental wellbeing is a common occurrence and is not restricted to only those with physical disabilities.  Most "normal" people will also experience psychological problems throughout their lifetime.  Do NOT feel that you are "weak" if you experience these psychological states.  It is normal.  How you deal with them is the important thing.  They should also not be considered psychological disorders unless they significantly impact on your ability to function appropriately within your environment. 

What types of psychological states may you experience? They may include the following:

  • Stress
  • Anxiety
  • Depression
  • Anger
  • Low self-esteem
  • Low self-efficacy (your own perceived ability to complete tasks and achieve goals)
  • Disrupted sleep
  • Relationship difficulties
  • Poor body image

  • If you experience these problems to this extent then it is appropriate to seek professional advice and assistance. 

    Understanding Why Pain Persists


    Understanding why pain can persist long after an injury has healed can aid you in managing your pain.  Chronic pain can develop from ongoing patterns of increased neural excitability that contribute to ongoing pain.  That is, these neural patterns become maladaptive and continue despite the removal of the stimulus that first caused the neurons to signal pain.  The good news is that with care, patience and perseverance these patterns can be reprogrammed. 

    The experience of chronic pain can be described as a pain cycle.  Firstly there are changes to the nervous system, Secondly this can result in muscle tension.  Next, psychological stress can develop in response to the preceding two occurrences.  Fourth, depression may develop.  Fifth, the stress and depression can lead to disturbed sleep which leads to increased nerve changes leading to increased muscle tension and pain and so on. 

    In order to reduce pain we need to break this "Pain Cycle".  Given the various processes involved in the cycle we can break the cycle at a number of points using various techniques.  For example we can reduce muscle tension by actively exercising or engaging in a relaxation process.  We can seek professional assistance for our depression, either through a psychologist or a psychiatrist.  The one thing to keep in mind is that using a variety of techniques is the best way to manage chronic pain.  We need to use a multidimensional approach. 

    Balancing Activity with Rest


    With chronic pain it is important to balance rest and physical activity.  Physical exercise is important but can be difficult where chronic pain is present:begin slowly to avoid injury or aggravating your pain, as this will only lead to avoidance of exercise in the future. 
    Exercise
    Pace yourself when undertaking an activity.  Do not go at it like a "bull at a gate", rather ensure that you complete the task in such a way that you do not increase your pain levels dramatically.  This may mean that you don't complete the task in one day or as quickly as you like.  Take breaks as you undertake the task. 

    Take timed breaks.  Every 15-20 minutes stop for 5 minutes.  Initially you may find that the time between breaks needs to be shorter.  When determining when to have a break, time yourself from the beginning of the task till you begin to notice an increase in your pain levels.  Take 3-5 minutes off this time and make this duration your break time. 

    Other techniques for exercising successfully may include:

  • Start slowly and allow your body time to warm up. Increase your activity level gradually over weeks and months (not days!).  Do some stretching exercises after your activity to help avoid muscle soreness and injury. 

  • Wear comfortable clothes and supportive shoes. This will make your activity safer and more enjoyable.

  • Drink sufficient water before, during and after your activity and do not wait until you are thirsty!

  • Set an appropriate pace. The saying 'no pain, no gain' is not true.  If you feel any increased pain, slow down or modify your exercise.  Keep comfortable.

  • Increase your exercises gradually. If you have stopped physical activity or are starting a new physical activity, start at a level that you can manage easily and gradually build up.  If you stopped exercising because of a new health problem, you may need to discuss starting again with your doctor or a health professional.

  • Exercises to Manage Pain


    When undertaking these exercises, remember to keep your pain at the same level throughout the exercise.  Be pain neutral.  Be aware of your pain and if it is increasing either reduce the intensity of the exercise or stop altogether.  The intention is not to increase your pain but rather release muscle tension. 

    There are a number of simple exercises that you can do that are not taxing on body yet allow you to stretch and relieve muscle tension.  There are even a number of exercises you can do whilst waiting for the kettle to boil or whilst watching TV. 

  • Front leg and ankle stretch: Remove your shoes and sit on the edge of a chair.  Keeping your back comfortable, stretch your legs out in front of you.  Keep your heels on the floor and stretch your ankles so that your toes point towards the floor.  If you don't feel the stretch in your ankles, lift your heels off the floor.  Hold this position for as long as comfortable.  Repeat twice for one session

  • Hamstring stretch: Sit on the sofa with your right leg up.  Try to keep this leg straight.  Keeping your back straight, lean forward until you feel a gentle stretch in the back of your right leg.  Hold this position for between 10 and20 seconds.  Repeat when you can do this again today, then turn around and do this stretch with your left leg.  Try doing this stretch using your breath out to ease tension. 

  • Arm stretch: Try lifting both arms above your shoulders - bring both arms straight out in front and lift as high as comfortable without increasing pain.  Keep palms facing towards each other.  Use your breath awareness as you stretch and gradually increase the time you can hold the position for between 10 and 20 seconds. 

  • Stand up and sit down: Sit on a chair with your feet flat on the floor and slightly apart.  Try to keep your back and shoulders straight throughout this exercise.  Slowly stand up, trying not to use your hands (or as little as possible).  Slowly sit back down and pause. 

  • Shoulder roll: Using a gentle circular motion, hunch your shoulders upwards, backwards, downwards and forwards.  Do this slowly for a few breaths in and out then reverse the direction. 

  • Stress

    Psychological Approaches to Pain Management


    There are a number of simple psychological methods you can use to manage chronic pain.  Dealing with stress and anxiety is a good place to start.  Why? There are many things we can do ourselves to reduce our levels of stress and anxiety.  There are many situations in life that make stress and anxiety a common occurrence.  One of the first things to learn is to recognise when we are beginning to become stressed.  Be on the lookout for the symptoms of stress and anxiety.  What are these symptoms?

  • Increased heart rate
  • Increased muscle tension
  • Increased perspiration
  • Increased breathing rate

  • One of the easiest skills to use to reduce your stress and anxiety is relaxation.  Relaxation is the ability to calm your body and mind (i.e.  your sensitive nervous system).  This can be done through breathing, muscle relaxation, imagery or mindfulness (noticing and being rather than doing) or using relaxation scripts. 

    Using Relaxation Scripts


    Why is relaxation a useful skill? As stated above, the main purpose of relaxation is to reduce the stress and tension of your mind and body.  Concentrating on your rate of breathing is a good place to start.  When we are stressed, our breathing rate increases and can remain fast.  It is important when trying to relax that you reduce your rate of breathing.  Concentrate on your breathing and make sure you take slow and deep breaths in and let them out slowly.  Breathe in through the nose and out through the mouth. 

    Relaxation scripts are useful as they provide a template that people can use to begin understanding the relaxation process.  It allows you to learn the skill and more importantly allows you to practice the process until it becomes second nature.  When you reach this stage you can engage in the relaxation process in any setting. 
    Peace
    A good idea is to start on a short script first.  This way you can get a feel for how you will respond without putting yourself under too much pressure to succeed.  You can also use the relaxation script to make a recording and listen to this if you wish.  Make sure that you read the script out in a slow and measured way using a calm voice.  You may need to do this several times before you determine the correct pace. 

    When playing back the script make sure the volume is not too high.  Make sure you can just hear the words without them being loud and jarring.  You want the words to relax, not startle.  You can also play soft music without vocals as a means of enhancing the relaxation process. 

    The space available here is too small to include a script for you to use.  However I have included a list of websites below that provide you with a number of relaxation scripts for you to use.  It may also be worthwhile reading up on Mindfulness Approaches and Acceptance and Commitment Therapy (ACT) as these techniques focus on self awareness and avoiding being caught up in thoughts. 

    REFERENCES


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    • Lifestyle and Pain: Changing Life, Changing Pain, Hunter Integrated Pain Service (HIPS), 2012. 
    • Psychological Aspects of Disability, Chorlton, Mark C., Unpublished, 2012. 
    • Harris, Russ (2009).  Mindfulness without meditation, HCP Journal. 


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