Venting the Pain

At least once a week I am asked some version of the following question: “My doctor says I have to learn to live with my pain. Does this mean I’m making it up?”

As reassuring as I would like to be, I cannot give a short or simple answer to this heartfelt question. A doctor’s advice to learn to live with the pain generally comes after many medication trials, physical therapy, various procedures, perhaps acupuncture, and even surgery, all of which have been unsuccessful in providing lasting pain relief. By the time a person in severe pain hears that nothing new can be tried and this is the best it can be, he or she is exhausted, discouraged, and anxious about the future. It is at this point that pain patients are referred to behavioral medicine specialists, psychotherapists who not only deal with the emotional aspects of living in pain but also teach specific pain management techniques. When they are finally referred to us, pain patients ask if the pain is all in their heads.

One of the first concepts we explore in behavioral pain management is the distinction between pain and suffering. Pain is purely sensory. Tissue damage stimulates a response in sensory nerves that carry pain signals to the brain. Suffering, however, encompasses much more than the physiological response to tissue damage. Suffering is the experience of emotional distress that can accompany pain. It s based on the way a person perceives the pain and includes mental, emotional, and even social components. It is that aspect of the pain experience that is “in your head.” When not much more can be done to alleviate the pain, there is probably quite a bit that can be done to reduce the suffering.

Anyone who has spent time with young children has probably noticed how different children react to injury. One child will be running at full tilt, trip and fall, bleed a little, and hardly notice the interruption in her rush to resume the game. Another child will trip in the same way, skin the same knee, and dissolve in tears. Often a mother’s kiss can make it better, and the crying child will be reassured enough to get back to the activity. Sometimes, however, even a mother’s kiss and a band-aid are not sufficient to convince the child to return to play. This third child clearly is suffering the most from his pain-causing fall.

Adults, just like children, can have very different responses to similar pain. That is, they have different levels of suffering. Those who experience suffering can learn to alter their experience through persistent and consistent practice in new ways of thinking as well as new ways of doing things. If before your pain condition you were able to work a full time job, run five miles a day, keep the house shipshape, coach your child’s sports team, belong to the PTA and serve on your church’s community action committee, you might very well experience considerable suffering due to reduced activity. You may feel grief over your loss of functioning. You might even consider yourself worthless because you can only accomplish a fraction of what you are used to doing. Your sense of yourself can become eroded if you believe your worth as a person is based on what you do instead of on who you are. Pain management for you starts with examining your beliefs and expectations of yourself and redefining yourself in terms of personal qualities such as generosity, sense of humor, kindness and compassion instead of in terms of how many tasks you can accomplish in a day.

Most of my patients are surprised at how much their own attention, awareness, thinking, and even their imagination impacts their pain experience. They learn to turn their minds away from the pain by using such techniques as relaxation, meditation, imagery, and self-hypnosis. They learn to identify and manage the daily stressors that exacerbate their pain. They learn to modify their physical exertion, both in quantity and quality, so they can keep physically active. They learn to define priorities of action and use the phrase “that’s good enough” as they get through their daily chores. They learn to live in the present moment and not in past regrets or in future disasters that may never come to pass. By focusing on the specific thoughts, behaviors, and physical exertions that increase the pain as well as those that reduce it, they gain control over their pain experience and thereby over their lives.

-Michele Gargan, PsyD