Sometimes opportunities to grow personally and professionally just fall in your lap. That's what happened for me around three months ago in the outpatient rehabilitation centre of St John of God Healthcare in Warrnambool.The demand for a group approach to treating Persistent or Chronic Pain grew from an ever expanding number of patients presenting with debilitating pain, long after their injuries had healed. Their pain often prevents them from going to work, seeing friends, exercising and having fun. In many cases, it appears to simply stop them from living life.
Much of our Chronic Pain program is based on the information we have learned through workshops with the Neuro Orthopaedic Institute (NOI Group) and their incredible resources, including the book Explain Pain, written by David Butler and Lorimer Moseley.
For the purposes of this article, I'll be highlighting the psychological components of chronic pain and introducing some of the strategies we recommend in order to return to a meaningful and purposeful life. For a more detailed account on the physiology of pain, please see A New Way to Explain Pain - The One by the Physiotherapist written by Adrian Benson.
Important Point Number 1 - Your pain is real!
Many of our clients arrive at the initial assessment distraught and anxious, expecting feedback that matches the opinions of previous healthcare professionals that their pain "is all in my head." It seems that no matter how the message that the brain plays a vital role in the experience of pain is delivered, our clients never fail to hear "you are making it all up."
Hence, our very first step is in validating the person and reassuring them that we believe their pain is real. Because it is. It just usually isn't coming from where they think it is.
In fact, it's very important to realise that we can have pain without tissue damage, and tissue damage without pain. The problem is the misconception that all pain must indicate tissue damage, injury or threat and that simply isn't accurate in the case of chronic pain.
Most injuries will be well and truly healed well before the twelve week mark post-injury. Pain that persists after this acute phase is deemed to be chronic.
So why doesn't the pain go away?
Adrian's article explains this in greater detail, but essentially, if the brain perceives a threat, it will send a pain response. This is normal. Unfortunately, the brain can be prone to misinterpreting what it perceives as a threat, and if you ignore its warnings, the pain messages will get 'louder' in an attempt to make you stop whatever activity you are doing.
Persistent pain is a sign that this 'alarm system' has become more sensitive. That is to say, it involves a broader area of tissues and nerves and becomes hypersensitive to 'threats'. It becomes a bit of a drama-queen if you like.
What about the psychology of it?
Well, this is where thoughts and beliefs come into play. We know that what we think is very closely related to what we feel. If we negatively evaluate something e.g. "They can't find the cause of my pain, so it must be really serious", it's more likely to impact in a negative way on how we feel. You can imagine the thought in the example could easily lead to an increase in anxiety and fear for someone anticipating the worst.
We also know that anxiety and fear, stress, depression, unhelpful thoughts and beliefs, all increase pain levels.
The other thing we know is that with anxiety and fear, often comes the tendency to avoid.
Usually it begins with avoidance of movements that might make the pain worse, but let's think about that for a minute.
Why might increasing our movement make the pain worse?
For all intents and purposes, the brain interprets your increase in activity as a sign that you are ignoring its pain messages that are telling you to stop. It's like your mother, when you were small. If you ignored her request to go to her when she called you the first time, her voice would tend to get louder and more demanding the second time, right? Same with the brain and pain. The problem is though, that we are so used to interpreting pain as a signal that there is damage occurring, that we usually listen to the brain and stop the movement. We avoid moving.
Why is avoidance bad?
Well, avoiding certain movements at the very least is likely to impact on your ability to function in your normal daily activities. Avoiding using one of your arms will mean you'll have difficulty showering, washing your hair, going to the toilet, driving, eating etc. It's also likely to increase your dependence on others. That might not sit well with you. You might start to lose self-confidence in your abilities. Your self-esteem may suffer. That will impact on your mood which in turn will increase your stress and, you guessed it, all of that will increase your pain. The complete opposite of what you were trying to achieve! See what we're doing here?
What can you do?
Adrian's article has already introduced you to DIMS and SIMS. You need to do more of the safety behaviours (SIMS) and less of the danger behaviours (DIMS) in a nutshell.
To do that you first need to increase your understanding of chronic pain - your chronic pain - through seeking education and information. You've already started that by reading our series of articles.
A value-driven approach coping style will not only give you a sense of control over your pain, it will lessen it.
Managing your unhelpful thoughts and beliefs, improving your attitude and the relationship you have with your pain will also be important factors. There'll be plenty of articles coming up on thinking strategies in The Coping Toolkit.
You'll also need to slowly and safely increase your physical activity levels and return to a better quality of life through pacing and setting appropriate goals. There is some room to move between the point the pain begins and when tissue damage occurs. We urge our patients to set goals within these two boundaries, ensuring no further injury occurs. Both of these points will increase over time in response to your growth.
Ultimately, aim to do the things you used to enjoy - eat out at restaurants with the family, go camping, walk, meet friends for coffee.
These are the things that will mindfully pull you into the present moment.
These are the things that will eventually help your pain.
For more information, check out this. You can also look at our "Stuff We Like" page for extra links and resources.
The third and final article in this series is an excerpt from my book - a chapter titled Moving into the Moment. It describes how I used mindfulness strategies to cope with the chronic side-effects of chemotherapy. I think you could find the strategies useful for chronic pain, or any other chronic discomfort.
We hope you've found this information useful and we look forward to your feedback.