Ten Steps To Overcoming Chronic Painby Mark Grant MAChronic
pain is a serious problem but is often made worse by misinformation,
negative attitudes and beliefs, outdated ideas, negative emotions. It is recognized that chronic pain is often mismanaged, not because we lack
adequate treatments, but because of fear and ignorance. These steps are
designed to help you mentally cope with chronic pain in the best way
possible.
1. Make sure you understand what kind of a problem pain really is.Chronic
pain is different to other medical problems, which can often be treated
relatively easily and successfully. Chronic pain is a complex illness,
caused and maintained by a combination of physical, psychological and
neurological factors.
These multiple causes make it difficult to
pinpoint any one cause for pain, or any one treatment. Pain is also
often dismissed or poorly treated because of the 'baggage' of old ideas
about pain - for example, pain where the physical cause is unknown is
often under-treated. This is despite the fact that the role of
neurological factors means pain can occur in the absence of external
causes and that such pain should not be dismissed or considered
abnormal.
The medical establishment has struggled to meet the
challenge of pain, and now recognizes that this problem cannot be
overcome without combining input from other disciplines such as
psychology and physical therapies. Pain is also a subjective experience
which is impossible to accurately measure. Pain involves a range of
emotional reactions including anxiety, fear and depression.
2. AcceptanceChronic
pain is so awful that sometimes it's easier to escape into wishing it
had never happened, or hoping for a miracle cure. If persistent, these
common reactions to pain can actually become a bit of a trap. You need
to face the reality of what's happened, and find constructive ways of
dealing with it.
Acceptance means more than just intellectually
knowing that you have pain, it means actually allowing yourself to feel
the anxiety, fear, anger and grief that go with pain. Acceptance is a
process, which requires progressively acknowledging all your feelings,
and getting your physical and emotional needs.
In order to accept
and go through the negative emotions associated with chronic pain, you
must have adequate safety and support. Safety means having adequate
control over your pain through the right combination of medical,
physical and psychological treatment inputs. Support means having
adequate emotional support from family and friends giving you a feeling
of containment and security.
The end product of acceptance is reduced pain, inner peace, less anxiety and better coping.
3. Take Control.After
many months or even years of pain and failed treatments, its easy to
slip into feeling hopeless and that nothing can be done. Pain sufferers
are often the butt of negative treatment and it's easy to end up feeling
angry and victimized. They often have some justification for feeling
this way.
Maybe you didn't cause the pain, and maybe you aren't
happy with some aspects of your treatment, but guess what? - life isn't
fair. Blaming others for your problems, however well-justified, turns
you into a victim and is like giving away control of your life. You are
allowing yourself to be led by your emotions, but you do have a choice.
Take the easy path (which isn't really so easy) and simply blame others,
or take control and get information, communicate assertively with your
doctor, practicing pain-management strategies such as regular exercise,
pacing and relaxation and stress-management.
You need to decide
whether you want to be a victim or a survivor, a passenger or a driver.
Your pain is no-one else's problem but your own. You do have rights and
even responsibilities as a health consumer and a patient. Because
chronic pain is difficult to detect or measure, you need to be an
informed, active participant in your treatment.
Don't be afraid
to ask questions, don't be afraid to tell the doctor what you think and
what you want, don't be afraid to ask for stronger pain relief.
4. Have a good working relationship with your doctor.An
open and trusting relationship with your doctor is essential. This
means being able to tell your doctor how you feel, ask questions and
feel listened to and understood.
The doctor-patient relationship
must be a two-way street. Although you rely on your doctor's "expert"
opinion for treatment advice, he depends on you for accurate information
on which to base his decisions. It is your responsibility to describe
your symptoms as accurately as possible and to report back regarding
treatment outcomes, even if unfavourable.
Under-reporting of pain
has been identified as one of the biggest causes of mismanagement of
pain. The doctor-patient relationship can be undermined by bad
communication, ignorance, arrogance and fear. For example, many people
are actually afraid to tell their doctor how they are feeling for fear
of being labelled as weak or a complainer. Other patients report
down-playing the severity of their pain because they don't want their
doctor to feel like a failure!
You should feel that you can talk
to your doctor, that he listens and respects you, and be satisfied that
he is working competently and thoroughly on your behalf. You also have a
right to change doctors if you are dissatisfied.
5. Never ignore pain.In
the treatment of chronic pain it has become fashionable to recommend
ignoring pain (after medical investigations are complete) in the belief
that it is only pain and there is nothing physically wrong.
This
approach represents a pendulum-swing away from the old fashioned notion
of prescribing bed-rest in favor of maintaining activity. The idea is
that inactivity only leads to depression and does not help the problem
anyway.
However, with certain types of pain, this can lead to a
cycle of aggravation, sleep deprivation, exhaustion and increased pain
and suffering, particularly if you are someone who typically ignores
pain (ignoring pain is of course, what causes most repetitive strain
injuries).
The other problem with ignoring pain is that every
time pain occurs, it leaves an imprint in your nervous system, a kind of
'pain memory'. These repetitive pain experiences lead to over-stimulation of the nervous system and the generation of spontaneous
pain signals, leading to a cycle of stress and pain. There are thus
sound reasons for wanting to avoid pain, but again, total inactivity is
not the answer. The best approach is a balanced one with paced activity
levels and avoiding undue aggravation of the pain.
6. Have a balanced approach to physical activity.It
can be tempting to adopt a "do nothing" approach, in the hope that you
may avoid further pain. As we have indicated, since chronic pain is
partly caused by neurological changes, avoiding activity will not stop
the pain. Avoiding activity also leads to muscle wasting and a build-up
of waste-products in the tissues, which can actually exacerbate pain.
At
other times, you may feel frustrated and force yourself to complete
relatively major tasks (eg mowing the lawns) knowing that it will hurt
later. This may cause you to have to take two days of bed rest to
recover. This "all or nothing" approach is inappropriate and ineffective
in the long run.
You need to pace activity levels. You can do
this on your own, via "trial and error" or with a bit of 'coaching' in
the form of professional help. The support and guidance of a sympathetic
health professional is highly desirable to maintain motivation and deal
with fears and obstacles along the way.
7. Sleep! Sleep! Sleep!Loss
of sleep caused by inadequately managed pain can lead to a cycle of
fatigue, depression and irritability. Inability to sleep, or waking up
feeling tired, are signs that your pain is not being managed properly.
Developing a restful sleep pattern is essential to coping with chronic
pain. Improving your sleep will give you more energy and help you feel
more able to cope.
There are many things you can do to get better
sleep including relaxing, perhaps by taking a hot bath, listening to
music or playing a favorite relaxation tape before going to sleep;
self-hypnosis; a good mattress; posture; medication; and good overall
stress-management.
8. Make sure you have adequate support.Many
chronic pain sufferers become isolated, alienated from loved ones,
their work-mates and society. Inadequate social or emotional support can
lead to isolation, depression, and increased risk of suicide. People
who normally pride themselves on being independent and not needing
others are particularly 'at risk'.
Unfortunately, the negative
reactions of others can discourage chronic pain sufferers from talking
about their problems or seeking help. The unhelpful reactions of people
you thought you could rely on can be very disappointing, it's another
thing that falls into the 'life isn't fair' basket.
The reality
is it's simply ridiculous to expect yourself to be able to cope on your
own with a chronic illness that robs you of your ability to work love
and play. Having adequate emotional support greatly increases your
ability to cope.
Talking to close family and friends is vital. A
family talk with your doctor of psychologist can also help by enabling
them to learn more about your condition and talk about things in a
neutral environment.
9. Don't expect people who don't have pain to understand what it's like.It's
frustrating, and easy to get angry when others don't seem to
understand. However, because chronic pain sufferers often have no
visible injury, it is easy for family and friends, and especially
children, to forget there is anything wrong. They may also 'forget'
because it is hard for them to have to live with the knowledge that a
loved one is in pain.
So don't expect people who don't have pain
to understand what it's like and be prepared to have to remind others
about your limitations. Children especially cannot be expected to
understand the implications of a condition like chronic pain. It's a
lesson that has to be repeated many times.
10. Forgive yourself.The
lost ability to work, love and play caused by chronic pain can create
feelings of guilt and failure. Become aware of your own expectations,
and any feelings of shame or guilt and examine them critically. Chances
are you didn't ask to be in pain.
Repressed feelings of shame
lead to resentment and later emerge as anger. Feeling guilty can also be
a subtle form of self-indulgence - when you engage in self-blame you
are really wallowing in self-pity.
Forgiveness and letting go of guilt will be easier if you choose a proactive approach by adopting these 10 Steps.
Recently re-introduced to Piet Mondrian's naturalism phase, followed by the move into the landscapes and luminsm, the lush yet stark color is almost intoxicating..jpg)
“A fireplace.” Murray sounds sardonic; I’m unsure if he’s joshing about the fireplace. He spent five months in Italy this past winter making The Life Aquatic with Steve Zissou, due out this Christmas, his third film with director Wes Anderson. Apparently, fireplace or no, it wasn’t fun, at least for Mr. Bill. All the action takes place on a boat—Murray’s character, Steve Zissou, is a Jacques Cousteau type seeking to avenge his partner’s death by shark—but Murray won’t discuss the awful details.
