Conventional medicine is not always the answer to treating chronic pain, especially in this age of concern about the effects of narcotic and even nonsteroidal anti-inflammatory medications. Certain conditions such as fibromyalgia and rheumatoid arthritis do not respond well to conventional medicine.
Because of this, Complimentary Alternative Medicine (CAM) as well as Mental and Emotional treatments have become more popular. CAM includes treatments such as yoga, massage therapy, minerals and natural supplements, acupuncture. Not all CAM techniques will be helpful for everyone and several may need to be attempted. Most chronic pain patients will find that a combination of conventional medicine and various CAM techniques are needed.
This article will focus on addressing the mental and emotional components of chronic pain. Those affected by chronic pain soon find that chronic pain, depression and anxiety are often intertwined within the central nervous system. Nerves affected within the central nervous system amplify pain sensations along with the intensity of depression and anxiety. Behavioral and mental changes such as decreased accomplishments and work performance, negative perceptions of life and social withdrawal also affect the mood, increasing pain sensations and further affecting the vicious cycle. Listed below are areas where a mental health professional can help you gain some control and combat chronic pain.
Consulting a psychiatrist or your primary care physician regarding antidepressants, antianxiety medications and mood stabilizers can be helpful. These medications may block the pain-mood vicious cycle and may need to be considered.
Internal Locus of Control
Mental Health professionals help individuals develop an attitude of internal locus of control. This means taking charge of one’s life. This is in opposition to an external locus of control, which involves the expectation that something outside of the self- such as medications, drugs, alcohol or geographical cures will make things better. Individuals who develop an internal locus of control gain power over their lives and physical distress, resulting in increased quality of life.
Individuals are taught several meditation and visual imagery techniques which reduce baseline levels of anxiety and muscle tension, increase blood flow through the muscles, elevate the mood and reduce pain sensations.
Mindfulness requires learning to keep one’s mind focused in the moment, in the here and now. Allowing the mind to dwell on negative things from the past increases depression and dwelling on the future increases worry, tension and anxiety.
Reframing helps one to turn things around and look at a situation from a different angle, looking at the positive side of things or even viewing it as an opportunity for growth. Those who engage in this technique reframe pain as physical distress. They do not even use the word “pain” and remind themselves that they can deal with distress in their lives using skills/tools learned in therapy.
Tolerating distress, including pain, involves using various techniques. These include accomplishing what one can on a daily basis yet pacing and not overdoing. It also involves contributing to others. Contributing distracts one’s mind from the self and physical distress and also leaves one with the good feelings that comes from helping others. Comparisons are sometimes used to remind the self that things could always be worse. Distress tolerance also emphasizes the role of prayer and belief in a higher power in reducing physical and emotional distress.
Meditation involves silently calming oneself and focusing the mind either for relaxation or spiritual reasons. It has been known to stop racing thoughts, reprogram the brain, and decrease distracted thinking. It has been known to help manage chronic pain, improve mood and to reduce baseline levels of stress and anxiety.
Since shallow and rapid breathing is associated with physical and emotional anxiety as well as distress, one is taught deep breathing from the diaphragm. Deep breathing helps one relax, reduces muscle tension and thus also pain.
Using the mind to distract oneself from physical distress involves interrupting the pain signal from reaching the conscious parts of the thinking brain and thus helps one to escape the awareness of pain. Pushing away by engaging in alternative thoughts such as brain games, watching a movie or engaging in any mindfulness activity may assist in accomplishing this.
Since certain interactions with others can involve much distress, learning to be more effective interpersonally can be very helpful in decreasing physical distress. Techniques such as asserting oneself by sharing thoughts, feelings, needs and what one wishes was different may help in accomplishing this goal. It is often helpful to disarm others by agreeing with a grain of truth in what they are saying or even using the repeating technique to state one’s position over and over in a calm manner to prevent the other from taking one down blind alleys or escalating the situation more.
Stress intensifies chronic pain and vise-versa. Managing stress in one’s life by focusing on the techniques in this article will help to provide relief from chronic pain. In addition to the techniques mentioned elsewhere in this article, stress management also involves having balance in life, pacing oneself in terms of physical and emotional activities and learning to develop a positive mindset and an attitude of gratitude. It also involves eating healthy and moving your body on a regular basis.
Given that emotions play a huge role in chronic pain, it is imperative that one learn to keep their emotional responses to external stressors in proportion to the situation. Individuals learn to stop and think, asking themselves where a given situation would fall on a scale of 1-100 out of all of the things that could happen in a lifetime. This requires responding with thought versus reacting emotionally. Regulating one’s emotions decreases the intensity of emotional and thus physical distress experienced.
Being one’s best cheerleader goes a long way in developing the internal locus of control mentioned above and taking charge of one’s life. Although things are distressing, learning coping skills to manage one’s life and physical pain goes a long way in believing in oneself and the fact that anything that comes along can be dealt with by using a multitude of coping skills and tools.
Finding a support group with others who experience similar symptoms can be very helpful. Not only can thoughts, feelings and experiences be understood within that context, but one can be given hope and encouragement regarding taking charge of one’s life. Be careful, as some of the support groups only involve venting and sometimes in a very negative manner. Although it is very helpful to express oneself and feel understood, quality support groups should involve positive coping suggestions and encouragement as well.
In conclusion, dealing with chronic pain can be extremely daunting. Physical and emotional distress are intertwined on many levels and how one deals with this complex illness creates vicious cycles, either in a positive or a negative manner. It is up to you. Taking control often results in relief regardless of the root cause. If you are contemplating alternative treatments to include behavioral and emotional health, have a conversation with your primary care physician to determine which ones may be helpful for you. A combination of these treatments is what is needed to be effective.
There is hope. Reach out for help. Work with an experienced psychiatrist, psychologist, and counselor to manage your illness, reduce your pain, and rebuild your life. You may want to consider the Health and Wellness Intensive Outpatient Program at The Behavioral Wellness Group. This Program includes individuals who struggle with depression, anxiety and chronic pain. It focuses on teaching many of the above skills and tools to help individuals decrease levels of pain and improve quality of life, mood, anxiety, sleep and relationships with others.
John A. Glovan, Psy.D.
Director, Health and Wellness Program