Venting the Pain

Too many people have had the experience of recovering from an injury or an operation still experiencing severe pain. They have been assured that they are fully healed and that there is no physical reason for their continuing pain. Yet their experience of pain is very real and debilitating. Such continuing pain lasting longer than six month has only recently been labeled a disease in its own right. It is estimated that the disease of chronic pain afflicts 30-50 million Americans.

Medical research has lately begun to focus on the kind of pain that persists when there is no ongoing illness or after healing is complete. More is being discovered about the kind of pain that not only lasts longer than its original cause but which can also worsen over time. And more is also being discovered about the complexity of the chronic pain syndrome. The International Association for the Study of Pain identifies chronic pain as interplay among biological, psychological, and social factors. This means that chronic pain both affects and is affected by every aspect of a person’s life.

At first , the person with persistent pain usually tires to cope actively with the situation by seeking a variety of medical and physical treatments, reducing physical activity, and taking medication. Over time, however, when none of these strategies results in relief, the person may become convinced that the pain is uncontrollable and adopt a passive, defeatist attitude. This attitude, defined as learned helplessness, can generate a chain reaction of psychological and social effects that make life almost unbearable for the pain patient as well as for his/her family.

One of the most harmful psychological effects of chronic pain is the undermining of the person’s sense of personal effectiveness and self-worth. “I used to be able to do anything I set my mind to. now I can’t do anything.” is a typical statement made by someone struggling with chronic pain. For those who have been hard working and physically active, chronic pain means a loss of both achievement and satisfaction. The decreased ability to work, often resulting in financial concerns, as well as the reduced ability to fulfil family expectations add to the sense of loss of control over one’s life situation.

Thus it is no surprise that the majority of those who suffer from chronic pain also suffer from some sort of psychological distress. Frustration, impatience, and irritability are common complaints even from those who have always been gentle and easygoing. Depression, anxiety, fear, panic, sadness, and anger are also common. The American Academy of Pain Management estimates that at least 60% of chronic pain patients also suffer from clinical depression and/or anxiety.

Depression and chronic pain have a cyclical relationship in that pain leads to depression, and depression enhance the subjective experience of pain. And anxiety arouses the nervous system in such a way that the pain threshold is actually lowered. When the pain/mood disorder cycle sets in, chronic pain sufferers are at risk of abusing their pain medication, taking more than is prescribed in an effort to reduce not only their pain but also their emotional suffering. This is why over half of all people with chronic pain are addicted to pain medication or other substances.

So, what recourse does a person have when the last doctor in a long series of medical consultations confirms that nothing more can be done to cure the pain? A person suffering from chronic pain can benefit from learning pain management techniques that are effective not only in reducing the emotional suffering associated with pain but also in actually reducing the pain itself. Research has led to a growing body of evidence that pain is intensely affected by thoughts, feelings, and actions that are the non-physiological components of the pain experience.

Pain management uses such techniques as cognitive-behavioural therapy, biofeedback, deep muscle relaxation training, hypnosis, psychotherapy, and family therapy to identify and address each factor contributing to the pain. Through this type of comprehensive approach to pain management, persons with chronic pain can discover that they have a great deal of control over the magnitude of their pain. The goal of pain management is to develop an array of pain coping strategies and to learn to detect subtle pain signals and address them right away with the appropriate strategy before the pain intensifies. This type of pain management training, in conjunction with medical treatment, can replace learned helplessness with learned resourcefulness and give the pain patient renewed self-efficacy and a sense of hope.

-Michele Gargan, Psy.D.