Pain is a subjective and deeply personal issue. There is no one-size-fit-all approach to pain, and therein lies the greatest benefit of having a psychologist as part of your pain management team – a personalised therapeutic approach to managing your individualised pain.
The key to reducing pain and increasing functionality is to adapt to your individual pain. Adaptation is necessary for life in general, a statement never more true than it has been during this very unusual year in 2020.
In this article, I will highlight the importance of using the right strategies, and will share ways to address emotional distress, and to adapt to a new functional normal as ways to assist with chronic pain.
The Importance of using the right pain strategies
Essentially, anytime we experience pain, we instinctively use some strategies to decrease pain. In general, acute pain is often met with great effort to decrease the pain and to avoid re-triggering the pain. This is often done by resting the area and administering supportive treatments to assist healing, often medical in nature. This reactive approach to pain often takes up resources (time spent off work resting, cost of medical care and paraphernalia, decreased productivity, heightened emotionality, potential sleep deprivation, etc), which could be tolerated (sometimes grudgingly) when the duration is short.
However, what happens when the pain does not go away, and lingers? While it may be possible to withstand the decreased productivity, increased emotional strain and financial cost in the short term, it is not a strategy that scales well to long-term. It is important to understand that there is a separate set of strategies to use for chronic pain. What works for short-term acute pain could either be ineffective, draining, or worse, harmful, for chronic pain. Hence, it is important to use the right strategies for your type of pain – not only to decrease pain, but also to ensure that you are able to function to the best of your ability in all aspects of life. There is generally a whole raft of different strategies provided by different allied health professionals to assist with pain. I will be focusing on areas your psychologist can help you with.
Addressing Emotional Distress
Chronic pain can bring about intense emotions. It is common to struggle over the grief of losing the pain-free life you had, and the loss of the pain-free future you had envisioned. Chronic pain can also bring about a loss of role – perhaps the function you had in your family or society can no longer be fulfilled as a result of your pain. It may lead to feeling unfulfilled and uncertain over your place in the world. There may also be feelings of insecurity and anger, especially if you are not sure if the pain will ever go away. There is often also frustration, that tasks you used to do easily now take additional effort and time.
Stress, anxiety and anger often creates muscle tension, which exacerbates our sensitivity and experience of pain. To manage pain holistically, it is important to address our emotions. The following suggestions may help you with reducing emotional distress. However, there are often a lot of emotions to process, and it is common to struggle with it. If that is your experience, I urge you to seek the assistance of a psychologist to help you process the emotions in a safe and healthy manner.
Adapting Mindfulness and Imagery
Mindfulness is often used as a technique to be in the moment and maintain a moment-by-moment awareness of our thoughts, feelings and bodily sensations. It is often used to decrease anxiety symptoms, and reduce the ‘mind chatter’ to aid sleep. Research has shown that mindfulness can assist with decreasing the experience of pain. However, there can be some difficulties with practicing mindfulness when it focuses on, or triggers, your pain, which would naturally distract you from clearing your mind and being in the moment. A good adaptation of mindfulness for pain is to focus externally. Sometimes, having an object in your hand to focus on can help maintain your mindfulness practice without exacerbating pain by focusing on it. Instead of focusing on your body, focus on the size, texture, shape, temperature and weight of the object you’ve picked. By adapting mindfulness and maintaining focus outwards, many pain clients have found success in practicing mindfulness to assist with pain.
Imagery exercises have also been used frequently to assist with pain. Imagery is the technique of imagining a place, person or time (real or fictional) that aids in making you feel relaxed and happy. Sometimes, pain may make it difficult for you to maintain concentration in your imagery exercises. In these situations, a good adaptation is to engage more of your senses. For example, if you like to imagine yourself sitting on the grass by the river, you could collect some leaves to feel in your fingers. You could also take the opportunity to record the sound of the river the next time you are there to play back when you need it. Scented candles or perfumes can also help to set the scene. Often, by engaging more of our senses, we can make the imagery more ‘real’ and effective.
Focusing on Sleep
A common complaint when working with pain is that pain often impacts sleep. Reduced duration and quality of sleep also drains emotional resources and decreases energy, making it more difficult to deal with the pain effectively during waking hours. If you are struggling with sleep, it is vital that you revisit your sleep hygiene – to maximise your chances of achieving a restful night’s sleep, and to negate any unhelpful associations your subconscious brain may have with your bed. If you are on the ball with your sleep hygiene and are still struggling with sleep, you may need to adapt your sleep in general. It could be sleeping with additional pillows for support, going to bed an hour earlier to account for the night awakenings caused by pain or deliberate timing of your sleep medication to allow yourself a stretch of uninterrupted, restful sleep. However, if pain makes it difficult for you to stay asleep and you are experiencing excessive daytime sleepiness, it may be necessary to adjust your sleeping habits – perhaps by incorporating a nap in the afternoons to ensure that you get an adequate amount of sleep over a 24 hour period.
Keeping an eye on your Automatic Thoughts
We all have automatic thoughts and beliefs that make their way into our minds during all hours of the day. Most thoughts are fairly harmless, some can be whimsical (do penguins have eyelids?) and others can be task-oriented (do I have everything I need for dinner?). The thoughts to watch out for are the unhelpful, distorted automatic thoughts that we may treat as fact or truth, as these are the thoughts that exacerbate emotional distress. There are many unhelpful thinking styles that can distort the relationship with pain, some of the common ones include:
- Black and White Thinking (Today will either be a good day, or not)
- Filtering (So what if I managed to clean a room today, my pain made it impossible for me to clean the whole house)
- Shoulding and Musting (I should be better by now, I must be doing something wrong)
- Catastrophising (I am in pain now, I will never get better)
It is important to critically examine your thoughts – either by yourself, using one of the multitudes of resources freely available online, or more effectively, with a psychologist – to ensure that you do not have a distorted perception of yourself, your pain and your future. Doing so will help you maintain a realistic view of things as they are and reduce emotional distress.
Adapting to a new Functional Normal
Given that Chronic pain, by definition, will linger, it is important to improve functionality to help you get back to living life as much as you can, as soon as possible. Research has shown that being sedentary and immobilised can be detrimental, as muscles weaken from underuse, which makes it more prone to injury. As long as you have consulted your healthcare professional to ensure that you do not increase the damage or hinder healing, it is important to get back to living life safely. Things may look a little different for a while (or even for a long time) and you may have to adapt to a new normal. Here are some ways to find out what your new normal is.
Assess and Prioritise your Tasks and Goals
It is important for you to assess what your goals are, and to be realistic about them. A good way to guide your goals is to examine your values, and your role in the family and in society. What is important to you? What do you need to do? Be ruthless in your assessment, and prioritise the ones most important to you.
One you have your list of tasks and goals, create 3 lists: Delegate, Adapt and Pace.
For the tasks that you can get help with, do so and accept help from a colleague, a friend, a family member or even an external service (for cleaning, food etc). It may not be ideal long-term, but it will ease up the pressure on you to get too much done too quickly. Once you get a steady rhythm going, you may want to take back a few of the tasks, but to start off with, accept help and delegate what you can. Ask for and accept help, even if it is not done the way you would have preferred. Prioritise your goals, work on the ones most important to you, and slowly add on more until you are back to full (or almost full) functioning in the roles you have.
For the tasks that you cannot delegate, you could try to adapt tasks to suit your needs if possible. This requires a problem solving approach to activities that may feel difficult for you. An example of this is cooking. Often, standing up in the kitchen for the duration to make a meal can be painful. A good way to reduce the time standing in the kitchen could be to do food preparation beforehand. Instead of standing up at the counter to chop vegetables, perhaps try sitting at the dinner table and chopping vegetables. You could plan meals a few days ahead of time and pre-chop the vegetables you will need (while seated) and store it in an airtight container until they are needed. Alternatively, buy pre-chopped vegetables if that is an option.
If you have tasks you struggle with, and are unable to get help to complete them or are unable to adapt it to a way to suit you, it may be a good time to visit an occupational therapist to get assistance in doing so.
For tasks that you absolutely have to do, or want to do, you could get back into it safely by engaging in pacing. Pacing is finding the level of which you are comfortable working at, given your current physical condition and pain levels. It is meant to be sustainable. Often, pain sufferers go through a cycle of feeling good one day, overdoing activities, triggering the pain and having to spend a few days sedentary as they manage the flare-up in pain. This cycle of a short burst of activity followed up a longer period of inactivity is detrimental. Pacing helps prevent that by helping you find out the level of activity you can do comfortably.
Here are some simple steps to use pacing to find an optimal level of activity for you:
- Set physical goals and targets for yourself – be realistic! (E.g. Walk the dog for 10 minutes)
- Cut it down to about 80% (E.g. walk the dog for 8 minutes)
- Attempt your activities at this level for approximately 2-3 days.
- If you find yourself struggling, decrease the activity level
- If you find yourself feeling good, increase it incrementally (by about 10%) for another few days
It is important that you remain patient and do not exceed your pre-determined activity level, even if you are feeling good. The key to successful pacing is to focus on the sustainability of it – this level needs to be feasible on both good and bad days! As your strength and confidence builds, you can increase your activity level and functioning.
As your functioning improves, you can move tasks from the delegate list to the adapting/pacing list to support yourself in improving your functioning whilst managing your pain. I encourage you to be curious, patient and compassionate with yourself as you journey to find strategies and adaptations to suit you and your unique pain needs.
If you need any additional assistance with your pain journey, please do not hesitate to contact us to help you flourish and thrive.