I would like to introduce you to two people; in fact, more than introduce you. For the next several minutes, I would like you to become these people. The first is a chronic pain patient, and the second is the family member caring for that patient.
We’ll call you Chris. You are of working age and are one out of the every three Australians who live with chronic pain. Yours started years ago at your job at the mail order delivery company. Rushing to get heavy merchandise indoors as a huge rainstorm approached, you lifted and twisted, herniating three discs in your spine. The next morning when you woke up, you couldn’t move. You went back to work, but the deepening pain eventually meant that you had to quit. You tried part-time work, but with the back pain you were somewhat uncoordinated and had several falls, injuring yourself further, you are now unemployed.
Pain, stigma, depression, and constraint
Your back causes you pain all day and keeps you from sleeping at night. It grinds you down relentlessly, so much so that you (like 20% of chronic pain patients) have considered suicide. Yet no medical professional seems to believe you are really in pain. You were not surprised to learn that four out of five people like yourself experience that most others doubt the reality of your pain. You can no longer commit to social events because you will be exhausted the next day. Your world has become narrow - and constrained, because the disability pension does not cover your living costs. Exhausted, depressed, stigmatised, cash-strapped, with eroded self-esteem, you are a shadow of your former active, upbeat self.
Now please de-role from being Chris. For the next few seconds, imagine that you are Pat, the only child of and caregiver for Chris.
Chris was widowed a number of years before the accident, so when Chris could not work anymore, you offered to have your parent come and live with you; you work full time and give care to Chris the rest of the time. You are doing your duty, but at great cost to yourself. You are continually exhausted, on edge, approaching burnout, and aware that, as caregiver, you have a 58% higher premature mortality rate than non-caregivers. It is not just the stress of the caregiving that gets you; you also have lost both meaning and hope. You are depressed, with no end to your situation in sight.
Closing the pain pathways
OK, now consider this last bit as yourself. The sketches of Chris and Pat are depressing, but they are all too common. How can we help chronic pain patients or their caregivers? To reduce the $34.3 billion expenditure Australia makes per annum on chronic pain (about $11,000 for each person with chronic pain), we probably need to alter the way you think about it. Medication, physio, surgery, and some allied health modalities are well-known to fight chronic pain. Not everyone knows about retraining the mind and refocusing the attention through Cognitive Behaviour Therapy. Here are three crucial thoughts from CBT to consider if you are either in chronic pain or trying to help someone who is.
1. Focusing on pain means more pain. Every sensation of pain which registers on our consciousness sends a signal through our pain pathways. The more signals we send (that is, the more thoughts focusing on pain), the more pain receptors our nerves create to handle all the signals. The more receptors we have, the more sensitive our nerves become, leading to our spines becoming highly sensitised. The more sensitivity we have, the more pain we experience. The more pain we experience, the more pain thoughts we have, creating a vicious cycle.
2. Attention is finite. To interrupt the above cycle, people can be reminded that each of us has a finite amount of attention to give to life. Putting major amounts of attention onto one’s pain means much less attention for anything else. By inserting pleasurable experiences to life, we increase our production of the so-called “feel good” chemicals – the neurotransmitters – such as the endorphins. With a high percentage of attention on our enjoyable experiences, we emotionally and chemically reduce our pain.
3. Attention is like a muscle: It can be strengthened by using it, and it can be directed to do the “heavy lifting” in whatever direction we require. Therefore, in pain control the objective is “attention enhancement”: growing the capacity for attention and then directing that newly enhanced capacity to those experiences that generate “feel-good” (i.e. pain inhibiting) chemicals, thus limiting or closing the formerly active pain pathways.
All of this means that we help people control their pain by encouraging them to distract themselves from the pain, reducing pain signals, adding in enjoyable sensations and experiences, facilitating the production of pain-inhibiting endorphins. When we help people grow their capacity for paying attention, they are even more powerful at regulating these processes.
Mindfulness exercises and techniques can help people do this. We don’t have space to explain those in this post (watch this space for later posts), but an internet search on the subject yields many interesting mindfulness exercises. Mindfulness exercises are great for both Chris and Pat, and even for those of us blessed to live without chronic pain!