There is no doubt that living with chronic pain can be extraordinarily taxing for the person experiencing it and for their loved ones. It can be an all-consuming experience that infiltrates many aspects of life—sleep, appetite, moods and relationships. The sense of desperation and powerlessness that can accompany chronic pain can bring a person to their knees, evoking existential questions such as – ‘why me?’
To understand chronic pain, it is important to note that it’s not just about damage to a particular area in the body that, once repaired, simply goes away. Instead, it is influenced by several variables that can contribute to it, exacerbate it, or help to manage it; this speaks to its complexity. Relying solely on pharmaceutical drugs and medical doctors to treat it is insufficient.
A comprehensive treatment approach, known in the scientific spheres as the biopsychosocial model, explains the interconnectedness of physiological, psychological and social factors that influence health as well as one’s experience of pain (and other illnesses), Engel, (1977). The following will provide a description of this model and some general strategies to assist with pain management at each level.
Managing Chronic Pain
Biology of Chronic Pain: refers to the physiological elements of pain, such as the nature of the illness or injury and how it affects the body. This is the area that typically gets the most attention as our health care system is set up to treat people at this level.
Strategies that can help:
- Work closely and actively with a multidisciplinary team of health professionals to understand the nature of the illness or injury and the best possible treatment options.
- Knowledge is power. Be open and curious about better understanding your experience with pain. Seek out literature available on this topic. Peruse titles and topics that speak to you as a means of learning as much as you can about what you’re experiencing. This can facilitate an increased ownership over your health, while also helping you feel more connected with others who may face similar concerns.
Psychology: refers to how your thoughts, emotions and what you do and don’t do, influence your experience.
What is your relationship to the pain?
Creating space to listen to your body and start to notice the details of how the pain shows itself to you and how you respond to it, can be illuminating. Author and professor emeritus of medicine, Kabat-Zinn (1990), works with patients with chronic pain, he notes how culturally averse we are to experiencing pain, rarely entering into it fully. Kabat-Zinn describes the benefits of befriending pain in a slow, systematic and compassionate way because it is here already. Often patients experience symptom relief although the focus is more on ways of working with the pain.
Strategies that can help:
- Bring attention to the thoughts and beliefs you have about the pain; reflect on whether these thoughts and beliefs are helpful to you. What we tell ourselves absolutely affects how we feel and sometimes these thoughts do not end up serving us. Through this awareness you can make more conscious choices about introducing new ways of orienting around the pain, or look at ways to re-frame the challenges you experience in a way that can better serve you.
Kabat-Zinn (1990) talks about how externalizing language can help reframe pain in a way that acknowledges its occurrence, but takes away the personal nature of it. Consider experimenting with using different language to conceptualize pain, for example, “The body is paining.” instead of “I am in pain.” Notice what happens.
- Consider observing your relationship with the chronic pain from a stance of curiosity and non-judgment. Instead of fighting or rejecting pain, or viewing it as a nuisance and trying to numb yourself from it, try noticing it, even just a fraction of it, and discovering what pain might have to tell you about itself? Is there a way to dialogue with your pain—if it could talk, what do you imagine it might say? Invite your body to reveal this information to you.
- Consider keeping a journal. Some people are surprised to learn that although they thought their pain was constant, when they became mindful, through regularly tuning in with their bodies throughout the day, there were moments when the pain lessened. Notice times when it is most and least alive in you and start to track this – see if there might be any patterns? Does it change throughout the day? Are there times when you get some relief? If so, when? When is it worse? What is happening during these times?
- Experiment with relaxation techniques. Tension typically increases the experience of pain. By integrating relaxation strategies into your day, it can help train your body to orient from a place of relaxation. Rejecting and fighting pain can add stress to your body, which risks magnifying your experience of pain. When we are relaxed, it has a direct effect on our nervous system. Endorphins, the body’s natural pain reliever, are released. There are many relaxation strategies to draw from i.e. muscle relaxation, imagery, body scans, and biofeedback.
- Consider consulting with a psychotherapist who works in an integrated way to address pain, and/or a clinician who offers clinical hypnosis (a treatment that helps introduce the body to a state of relaxed attention whereby positive messages relating to pain management are introduced). Find the approaches that work best for you.
Social Aspects: refers to the connection between you and the social environment in which you live. This can be your immediate family, work environment, as well as the culture and larger community you are part of.
Strategies that can help:
- Take time to reflect on the effect the interactions your outside social world has on you and your experience of chronic pain. Notice who supports your health and well-being and who may reinforce, consciously or not, your experience of pain.
- What messages have you received from others about your experience of chronic pain? Are others around you supportive and encouraging of you in taking steps to help yourself? Is the family system one that defers to health professionals and promotes a more passive role, or are you encouraged to take ownership over ways you can help yourself? Do others, intentionally or not, reinforce your identity as a pain sufferer? Is this helpful to you? How might your health affect your relationships with others, your financial circumstances, or your identity and role in your social environment?
Addressing the challenges that come with pain is a process; it takes time, energy, and the support of others. Understanding chronic pain using the biopsychosocial framework can be worthwhile as it sheds light on ways you have influence over your body and your experience with pain. Reducing chronic pain symptoms is a priority, while there can also be broader benefits resulting from feeling more in control, more attuned to your body, and ultimately, living your life in the fullest and best possible way you can, despite the pain.
Kabat-Zinn, J. (1990). Full Catastrophe Living (fifteenth ed.). New York: Bantam Dell.
Sarafino. E. P. (2008). Health Psychology: Biopsychosocial interactions (6th ed.). College of New Jersey: John Wiley & Sons. Inc.
Wells, C., & Nown, G. (1998). The pain relief handbook: self-help methods for managing pain. United Kingdom: Ebury Press.
© Danica Heidebrecht, Defining Solutions Inc., 2012