Chronic Pain – All In The Mind?




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Coping with chronic pain is not easy. Ask anyone who has been diagnosed with it and you will quickly understand that everyday living can be a time consuming, energy draining, and frustrating experience. Despite the challenges inherent in living with chronic pain, there are several approaches that can help an individual cope more effectively.

Let’s first define chronic pain. In contrast to acute pain, a diagnosis of chronic pain is usually given when there is any bodily pain that lasts for more than three months. The pain is often debilitating in that it compromises one’s functioning in the area of work, relationships, emotional health, and/or activities of daily living. The causes and types of chronic pain are many. An exhaustive list of causes goes beyond the scope of this article.

Whatever the cause or type of chronic pain condition one may have, we know that the measurement of the quality and intensity of the pain experience is subjective and therefore, the perception of pain varies across individuals. Moreover, chronic pain is often influenced by factors that go beyond the physical plane. This in no way suggests that the pain a person experiences is “not real” or “all in their head” which unfortunately, may be erroneously attributed to someone suffering with this condition. In contrast, consideration of these additional factors give the chronic pain sufferer a launching point to cope more effectively by focusing on potential areas of influence that lie beyond the physical realm alone.

Here are four factors that influence the experience of chronic pain:

  1. Physical factors: Examples include injury, repetitive use, structural changes to the body, accidents, physical trauma, muscle tension.
  2. Biological factors: Processes such as infections, neuropathic pain, auto-immune disease, and sympathetic nervous system over-responding may contribute to the pain experience.
  3. Psychosocial factors: Phenomena such as attention, negative thinking, expectations, beliefs, memories of past pain experiences, social support systems (or lack, thereof), interpersonal relationships, and factors such as age, culture, subculture, gender and status are all examples of psychosocial factors impacting the pain experience.
  4. Emotional factors: Emotions mediate the pain experience through direct pathway connections in the brain. Emotional distress in the form of guilt, depression, anxiety, anger, frustration or fear can all impact the pain experience.

Now that we have considered some of the factors that contribute to the experience of chronic pain, let’s take a look at practices and strategies to address it. In addition to receiving allopathic medical treatment for chronic pain, which may include trigger point injections, cortisone injections, medications (i.e. pain medicines, steroids,) and/or surgery (if indicated) there are several complementary, evidence-based treatments and practices that contribute to more effectively coping with chronic pain.

Psychosocial Pain DiagramIn our book, From Stressed To Centered: A Practical Guide to a Healthier and Happier You, we offer several of these complimentary stress management and self care practices that can help directly to cope more effectively with a chronic pain condition. Let’s take a look at a few here.

  1. Progressive Muscle Relaxation (page 54): This evidence-based relaxation technique, when used discerningly with specific pain conditions, can provide relief to an overactive mind and to tense muscles. This practice teaches the participant to tense and release muscle groups from head to toe, in accordance with the breath, providing full body and mind relaxation.
  2. Mindfulness Meditation (page 64): Mindfulness-based practices such as mindfulness meditation, teach us how to harness our awareness in such a way that often benefits our health and well-being. Becoming well-trained in the area of awareness and focus can contribute to calm mood, decreased anxiety, a better sense of control over chronic pain, less impulsivity and “flying off the handle”, and more self-management of emotions. It may be a surprise to learn that you do not have to spend hours a day sitting on a cushion to benefit from this practice. Several mindfulness approaches allow the practitioner to learn brief and integrated practices that are very effective.
  3. Thought Stopping/Thought Replacement (page 61): This practice teaches us that we do not have to be slaves to our thinking. Many of us go through the day with intense and worried thoughts that we believe we have no control over. The first part of this practice will help you to identify thoughts that contribute to the experience of chronic pain. The second part of the practice teaches you to replace those negative (or catastrophic) thoughts with something more positive and realistic. When practiced over time, awareness of unhealthy thought patterns is raised, giving practitioners a greater sense of control and efficacy over their thought life, and therefore, their high stress levels which can contribute to the pain experience.

Self-Care and Chronic Pain

We have established that a key factor contributing to a person’s pain experience is the level of stress they are experiencing. Another great strategy to pro-actively manage stress is practicing good self-care on a regular basis. A program of self-care is both pro-active and preventive, in that practiced consistently, in can help inoculate one from the adverse effects of stress. This is especially important for individuals coping with chronic pain.

Good self-care begins with the three pillars: nutrition, exercise and sleep.

However, self-care is much broader than these fundamental components. In our book, we highlight the key components of good self-care, several of which are:

  1. Setting boundaries: Boundaries serve several key functions, which are fundamental to our well being. Boundaries help to protect us, to clarify what is and isn’t our responsibility, to preserve our physical and emotional energy, and to identify and honor our needs and limits. Failure to set or maintaining boundaries often leads to increased stress, inner conflict, anxiety and feeling overwhelmed and over-extended.
  2. Renewal: Making time regularly to rest – mentally, physically  emotionally and spiritually helps us to preserve our resources (i.e. energy), and reduce the effects and build up of continual stress. By giving ourselves permission to take renewal breaks (5-20 minute duration) throughout each day, we are pro-actively engaging our parasympathetic nervous system, and eliciting a relaxation response in our bodies.
  3. Laughter and fun: There are many health benefits to laughter and fun. Research indicates that laughter releases endorphins (often known as “feel good” hormones) and reduces our stress levels. When we are laughing, we are very much in the present moment, not worrying about the past or anxiously anticipating the future. This both helps decrease muscle tension and also serves as a good distraction from one’s pain. Laughter also has been shown to increase an individual’s pain tolerance. All of the benefits of laughter contribute to making coping with chronic pain more manageable. A helpful tip is to make a list of 5-7 items of things (e.g. a sitcom or movie), experiences (e.g. comedy show, playing a game) or people which consistently make you laugh. When experiencing pain, stress or emotions such as sadness, you can take this list out and choose one to lift your spirits and increase your pain tolerance. This helps you avoid having to problem-solve what to do in the moment

References

Davis, M., Eshelman, E. R., and McKay, M. (2008). The Relaxation and Stress Reduction Workbook, 6th Ed. Oakland, CA. New Harbinger Publications.

Gionta, D. A. & Guerra, D. (2015) From Stressed to Centered: A Practical Guide to a Healthier and Happier You, Santa Barbara, CA. Sea Hill Press.

Innes SI (2005). Psychosocial factors and their role in chronic pain: A brief review of development and current status. Chiropractic & osteopathy, 13 (1) PMID: 15967055

Kabat-Zinn, Jon. (1990). Full Catastrophe Living: Using the wisdom of your body and mind to face stress, pain, and illness. McHenry, IL. Delta Publishing Company.

Linton, S., & Shaw, W. (2011). Impact of Psychological Factors in the Experience of Pain Physical Therapy, 91 (5), 700-711 DOI: 10.2522/ptj.20100330

Mahony DL, Burroughs WJ, & Hieatt AC (2001). The effects of laughter on discomfort thresholds: does expectation become reality? The Journal of general psychology, 128 (2), 217-26 PMID: 11506050

Turk, D. (1999). The role of psychological factors in chronic pain Acta Anaesthesiologica Scandinavica, 43 (9), 885-888 DOI: 10.1034/j.1399-6576.1999.430904.x

Weisenberg M, Tepper I, & Schwarzwald J (1995). Humor as a cognitive technique for increasing pain tolerance. Pain, 63 (2), 207-12 PMID: 8628586

Image via Bartek Zyczynski / Shutterstock.

Dan Guerra, PsyD and Dana Gionta, PhD

Dan Guerra, PsyD, is a licensed clinical psychologist and an executive coach with expertise in stress management and behavioral change. He is also an author and international public speaker. Dana Gionta, PhD, is a clinical psychologist, executive coach and organizational consultant with a diverse professional background in business, psychology, coaching and health. She received her BA in Business from New York University and her PhD in Clinical Psychology from the University of Rhode Island.
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