ALL ABOUT CHRONIC PAIN - LATEST ARTICLES

If you’re living with a chronic pain condition like I am you know how hard it is to explain what is going on for you to even close family and friends. It is also challenging to share with your healthcare providers what is really going on and often come away feeling like “they just don’t get it.” Even worse, some people come away stigmatized and accused of being histrionic or even worse “you’re just drug seeking.” 

Other people, including healthcare providers, make judgements on what they are seeing and hearing from someone living, or suffering, with chronic pain. They see “exaggerated” pain behaviors. When people try to share what’s really going on they are perceived as complaining or maybe “malingering.” Friends and family members mistakenly believe their loved ones are just “making excuses” for not keeping commitments or completing projects. 

When people live with chronic pain for a long time there are various mental health problems and emotional factors that complicate positive treatment outcomes for these people including those coexisting psychological (mental health) disorders including substance use disorders. These patients often become so overwhelmed that their levels of functioning and quality of life are significantly deteriorated. 

When coexisting conditions occur, the family problems also increase synergistically. Effective treatment can be challenging and confusing for therapists and other healthcare providers who may be inexperienced with chronic pain disorders or addiction, but especially problematic for the patients and their families. That is another reason why a concurrent integrated treatment approach is crucial. In the next section we will look below the surface of the Chronic Pain Iceberg.

Understanding The Iceberg Principle – What Is Really Going On Under The Surface

So, if you are trying to be supportive of someone suffering with chronic pain it is crucial to know what’s really going on that most people don’t even realize.  Below are some of the common problems going on below the surface.

Mental Health Conditions Under the Surface – What People Don’t See

• PTSD or other Unresolved Trauma
• Depression
• Anxiety Disorders
• Sleep Disorders
• Cognitive Distortions From Living with Constant Pain
• Medication management problems up to and including addiction
• Eating Disorders – Using food to cope

Pain Symptoms Under the Surface – What People Don’t See

• Aching, throbbing pulsing
• Irritating, nagging disturbing
• Spitting, piercing pounding
• Dreadful, severe awful
• Burning, stinging lacerating
• Irritated, sore, sensitive
• Excruciating, agonizing distressing
• Worrisome, saddening depressing
• Torturing, grueling punishing
• Exhausting, fatiguing debilitating 

Understanding Spoonies

Several years ago one of my patients said she was a “Spoonie.” I told her I had never heard that term before and could she explain it to me. She told me that unless someone walked in her shoes, they could not understand her and gave me a website to check out. Then when I did some research, I found this on the Patient Rising website she gave me regarding the “Spoon” theory:

“Because we look healthy on the outside, one of the greatest challenges we have is explaining to others how a person who looks so good can actually feel sick or be in pain,” writes The Daily Migraine’s Lisa Jacobson. “They do not understand the freedoms many of us have lost.”

One term that helps explain the inexplicable: Spoonie.

“A spoonie can refer to any individual who suffers from a chronic illness or chronic pain,” explains chronic migraine patient Sophie Cowley. “These illnesses are often invisible; to most people, spoonies may appear healthy and able-bodied, especially when they are young. The daily feeling of being invisible can be one of the most challenging parts of being a spoonie.”

The term “Spoonie” was coined by Christine Miserandino, an award-winning blogger and patient advocate, when she was trying to explain to a friend what it’s like to live with lupus. “I thought she already knew the medical definition of Lupus,” Miserandino recalls at her website, But You Don’t Look Sick. “Then she looked at me with a face every sick person knows well, the face of pure curiosity about something no one healthy can truly understand. She asked what it felt like, not physically, but what it felt like to be me, to be sick.” “How do I answer a question I never was able to answer for myself?”

So, she laid out a handful of spoons on the table and explained that the spoons symbolize all of a patient’s daily energy reserves. Every activity, no matter how thoughtless and automatic, depletes from the energy supply. Getting out of bed, showering, getting dressed, eating, and any number of mundane tasks threaten to deplete energy at any given time.

When you run out of spoons, you can choose to borrow against the spoons of a future date, but there are consequences. When you deplete your spoons, you are bedridden. Unable to manage the simple activities of life.

This is clearly what many people with chronic pain, chronic illness or disabilities deal with day in and day out. And yet it is still very challenging for someone who has never had these challenges to understand and help someone who is suffering with chronic pain. There is so much going on under the surface.

To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com.

If you’re living with a chronic pain condition like I am you may have noticed that sometimes you are so fearful about doing even the most basic tasks of daily living, that you become immobilized. It can also manifest as overwhelming anxiety, so much so, that a phenomenon gets triggered which amplifies your perception of pain. I call this Anticipatory Pain.

Because you believe you are going to hurt by doing a certain activity, you can activate the physical pain system. Just by thinking about doing something that you believe will cause you to hurt, you will start to feel pain. This can happen before you even do whatever it is you already believe will cause physical pain. All you have to do is to start thinking about doing that thing.

Once the physical pain system is activated, the anticipatory pain reaction can make your perception of chronic pain symptoms worse. 

Whenever you feel the pain, you interpret it in a way that makes it feel worse, and you think about it in a way that actually does make it worse. You tell yourself that “this pain is awful and terrible,” and “I can’t handle it.” You convince yourself that “it’s hopeless, I’ll always hurt, and there’s nothing I can do about it.”

This way of thinking contributes to the development of emotional reactions that further intensify or amplify the pain response. The increased perception of pain causes you to keep changing your behavior in ways that create even more unnecessary limitations and mounting emotional discomfort. These reactions can make you believe you are trapped in a progressive cycle of disability.

Coping and Moving Beyond Anticipatory Pain

One of the most requested articles I wrote was titled “Coping with Anticipatory Pain. I believe it’s vital for us to support people to not just cope with anticipatory pain, but to move beyond it.

I learned a long time ago that what we expect is usually what we get which can sometimes be both helpful and harmful. When it comes to feeling pain and developing an effective chronic pain management plan, it’s crucial to understand the role of anticipatory pain. It has both biological and psychological components.

On the biological side, the cascade of effects from a pain sensation occurs on many levels and involves a variety of different areas within the nervous system. As a result, a wide variety of nervous system chemicals are produced and dumped into the blood while other brain chemicals are rapidly absorbed or depleted. Pain doesn’t just hurt — it changes the most basic neurophysiologic processes in the human body.

On the psychological side, anticipation of an expected pain level can influence the degree to which you experience your pain. In some cases, when your anticipatory level of pain expectation is lowered, your brain responds by influencing special neurons. This renders your brain less responsive to an incoming pain signal and your sensation of pain decreases. In any event, both ascending (pain signals coming from the point of injury to the brain) and descending nerve pathways (signals from the brain to the point of injury) will influence or modify the effects on your body.

Fortunately, you can learn how to change your anticipatory pain response. You can lower the amount—or perception—of pain that you anticipate by changing what you believe will happen when you start to hurt. You can also change your thinking, or your self-talk, and learn how to better manage your emotions. You can learn new ways of responding to old situations that used to cause or intensify your pain. As you come to believe that you really can do things that will make your pain sensations bearable and manageable, your brain responds by influencing special neurons that reduce the intensity of your pain. Your brain becomes less responsive to an incoming pain signal.

 
There are things you can do that will make you habitually less responsive to incoming pain signals. Herein lays the rationale for including biofeedback, positive self-talk, meditation, and relaxation response training as part of your pain management treatment plan. In any event, both ascending (pain signals coming from the point of injury to the brain) and descending nerve pathways (signals from the brain to the point of injury) influence or modify the effects of pain on your body. 

To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com.

Using the Power Knowledge to Rescue The Hijacked Brain

In order to achieve the best quality of life and level of functioning, people living with chronic pain must learn as much as they can about the subject of pain and what constitutes effective pain management. We know that pain is a signal that tells us there is damage or something wrong with our system. However, with some chronic pain conditions the system (including the brain) gets altered. The pain system gets turned on and cannot be turned off. I call this the “hijacked” brain or what is often referred to as Neuroplasticity (also called brain plasticity, cortical plasticity or cortical re-mapping). 

A surprising consequence of neuroplasticity is that the brain activity associated with a given function can move to a different location as a consequence of normal experience or brain damage/recovery.  In the case of chronic pain this can mean that pain signals keep occurring despite lack of a trigger or tissue damage. 

Opioid Use Can Also Hijack The Brain

According to research published in Annals of the New York Academy of Sciences titled Spinal Cord Neuroplasticity following Repeated Opioid Exposure and Its Relation to Pathological Pain; states that convincing evidence has accumulated that indicates there are neuroplastic changes within the spinal cord in response to repeated exposure to opioids.  Such neuroplastic changes occur at both cellular and intracellular levels. Unfortunately, most pain conditions in this country are treated with opiates – research indicates that as high as 90 percent of people undergoing pain management are prescribed opiates. With so many people living with chronic pain and using opiates, these neuroplastic changes need to be better understood.

I like to use simple language and metaphors or visual images when educating my patients. Many of the people I have worked with would not understand the term Neuroplasticity so I use the metaphor of the hijacked brain. I tell them the reality or neuroplasticity science are much more complex but in essence what is happening is that the brain forms pathways (called neuro-networks) that eventually become super highways—in other words the new neuro-network becomes more complex and elaborate. 

Building Better Highways

What I believe needs to happen in chronic pain management is developing new pathways or highways to replace self-defeating pain behaviors or suffering that can lead to a reduction or elimination of pain. My Mentor and colleague Terence T. Gorski uses the example of living in a rural area with an outhouse over a hundred yards from the back door. Between the back door and the outhouse is a field of heavy vegetation that is very hard to walk through. On the first trip it takes a long time and is very difficult but some of the vegetation is getting tramped down just a little so the trip back is not quite as hard. After several trips it gets much easier.

I expand this metaphor by saying treatment is like gaining access to landscaping equipment that will assist you in putting in a paved path to your goal—effective pain management. It is crucial to develop new ways of thinking, more effective methods of managing painful emotions and new ways of behaving that will improve pain management and quality of life.  To do this, new neuro-pathways need to be generated and used over and over until the highway is built. Unfortunately, there are many obstacles that can get in the way and detour people back to the old highways and people need a strategic integrated plan to stay on the new highway. 

Utilizing Addiction-Free Pain Management® 

To assist keeping people on the new highway, I started developing The Addiction Free Pain Management® (APM) Manualized Treatment System in 1996. The APM™ System is a comprehensive method of addressing the four quadrants of suffering: biological (psychical), psychological, social, and spiritual. This system was first utilized by me in my own quest to find chronic pain relief without reliance on opioid medication and to stop suffering with my pain. 

The APM™ Treatment System is based in part on the Gorski-CENAPS® Developmental model of recovery. It also includes the best practice standards reported by the National Institute on Drug Abuse (NIDA), the American Society of Addiction Medicine (ASAM) and the Substance Abuse and Mental Health Services Administration (SAMHSA) along with the leading evidence-based chronic pain management best practice standards. 

To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com.

Chronic pain is often misunderstood and under-treated. In addition to the biopsychosocial impact a chronic pain condition frequently has on a person, a spiritual crisis often accompanies the situation as well. Long-term chronic pain is a body-mind-spiritual problem that requires a multifaceted solution. I believe that complementary spiritual practices are necessary components of any effective chronic pain management plan. 

Chronic pain is often misunderstood and under-treated. In addition to the biopsychosocial impact a chronic pain condition frequently has on a person, a spiritual crisis often accompanies the situation as well. Long-term chronic pain is a body-mind-spiritual problem that requires a multifaceted solution. I believe that complementary spiritual practices are necessary components of any effective chronic pain management plan. 

Many people have found spiritual interventions like the traditions of prayer and meditation to contribute to the reduction of the sense of suffering. Unfortunately, in our fast-paced world and the secular treatment modality, adding a spiritual component to chronic pain management does not get enough attention. 

The concept of spiritual pain requires healthcare providers to go beyond the bounds of traditional clinical treatments and be prepared to devote the time required to give supportive and understanding care.  It is crucial to explore spirituality and its impact on a person’s pain in a multidimensional assessment.

Spirituality is vital aspect of being human which is difficult to fully understand or measure using scientific methods; yet convincing evidence in medical literature supports its beneficial role in the practice of medicine. It will take many more years of study to understand exactly which aspects of spirituality hold the most benefit for health and well-being. 

Many of the world's great wisdom traditions suggest that some of the most important aspects of spirituality lie in the sense of connection, inner strength, comfort, love and peace that individuals derive from their relationship with self, others, nature and the transcendent.

I believe that spiritual healing is an important component of a multifaceted chronic pain treatment plan. One goal of spiritual healing is to help patients improve their well-being and quality of life, rather than to cure specific diseases or in this case eliminate pain. Spirituality as part of a treatment plan may include encouraging patients to use visualization, prayer and positive thinking.

The Difference Between Religion and Spirituality

Over the years I have found it important to have a discussion with my patients regarding spirituality and effective pain management, as a common understanding of terminology is essential as is an understanding of what their beliefs are. 

One concept that rang true was the simple saying: “Religion prepares people for the next life while spirituality helps them live this life to their fullest potential.” Many of my colleagues also recommend clarifying the difference between the terms “spirituality” and “religion.” They advocate developing a broad-based definition of spirituality that encompasses religious and nonreligious perspectives.

To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com.