Managing Chronic Pain

Chronic pain can be a devastating problem, rendering its sufferer unable to work, perform routine tasks or enjoy previously pleasurable activities. Relationships with families and friends often are adversely affected. The chronic pain sufferer often goes to a wide variety of medical specialists with little or no alleviation of pain. The chronic pain sufferer often looks normal and other people often think the person is “faking it” to get out of unwanted responsibilities. It is not uncommon for individuals in severe chronic pain to experience suicidal thoughts because so little hope or support is offered and life has become so intolerable.

As the survivor of a chronic, disabling back condition, I know this experience firsthand. I also know there is hope and help from a wide variety of approaches you will not usually find out about from your doctor. The most important of these approaches is a mind/body approach.

The National Institutes of Health (NIH) recently held a technology assessment conference on chronic pain which brought together experts in behavioral medicine, pain medicine, psychiatry, psychology and the neurosciences. This expert panel concluded that drugs and surgery have had limited success in managing chronic pain, and “integrating behavioral and relaxation therapies with conventional medical treatment is imperative for managing these conditions”. Among the therapies the panel found effective were relaxation techniques, hypnosis, biofeedback and cognitive therapy.

These mind/body techniques go to the source of much of chronic pain: muscle pain related to overuse of muscles and resulting fatigue. When a person is in emotional distress, they unconsciously tense their muscles, even while at rest, so that their muscles are always working and become fatigued. This emotional distress may have preceded the injury, or may be a result of the injury itself and its consequences. Once a muscle has been injured, such as from overuse or an overextension injury such as a sprain or whiplash, it is more prone to pain from emotional distress. Learning to relax and to rest the muscles can alleviate much of the chronic pain. Other reasons for chronic muscle fatigue and its resulting pain are bracing and guarding. Bracing refers to an instinctive reaction to pain where the sufferer responds to the pain by tensing the muscles, thereby increasing pain. Guarding results from the person’s attempt to protect the injured area by overcompensating with other muscles, thus creating chronic tension and pain in areas adjacent to the original injury. The pattern of guarding often becomes habitual, creating pain long after the original injury has healed.

Specialized techniques with EMG (muscle) biofeedback are extremely useful in identifying muscle overuse patterns and teaching the chronic pain sufferer to use the muscles more functionally.Another common source of pain is reduced circulation to an area of the body, which can result in chronic inflammation or tissue damage. Relaxation, biofeedback and hypnosis can all be used to alter blood flow and promote healing in such situations. Hypnotic techniques can also be used to direct the body’s attention to healan area or to distract attention from the pain.

Cognitive techniques, which involve teaching the individual to become more conscious of thoughts and how they affect mood and physiology and how to think more positively, are very helpful in reducing the level of emotional distress, and as a result improving the level of functioning. Learning, for instance, how not to worry today about how much pain you will have tomorrow can allow you to start the new day more rested and relaxed.

Other modalities which can complement the use of mind/body techniques work on the physical level to promote relaxation and healing. These include acupuncture, massage, chiropractic, physical therapy and movement therapy. Dietary changes such as eliminating caffeine and alcohol use, obtaining adequate nutrients to support healing and avoiding allergens are also frequently helpful. An exercise program which includes attention to both strength and flexibility is also an important part of a pain management program.

~ Cindy Perlin, LCSW

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