The Pain Relationship
Patients living with chronic pain develop a long-term relationship with their pain, whether they choose to do so or not. In terms of interpersonal dynamics, this relationship is usually negative, characterized by feelings of fear, resentment, hostility and mistrust.
Most therapists and counselors agree that developing and maintaining healthy, positive relationships is one of the most challenging of all human endeavors. Two questions I like to ask that give a good sense of the health of any relationship are: 1. "How do you feel when you're with ___?" and 2. "How does ___ make you feel about yourself?"
We generally feel good when we're with someone we love – they usually make us feel good about ourselves. How do our patients feel when they're with pain, and how does pain make them feel about themselves? Not so good, which is why many of them start the relationship looking for a "pain killer." How healthy is a relationship when one party attempts to "kill" the other?
As an alternative, I think it's better to first find out what pain may be trying to communicate before attempting to kill it. Using Interactive Guided Imagerysm techniques, I frequently invite my patients to close their eyes, allow an image of their pain to appear and begin a dialogue with it. During this dialogue, I suggest they ask their pain why it's here, what it wants, what it needs, where it's going and under what conditions it would be willing to leave.
After listening to thousands of these "inner conversations" with pain, it's clear that most of the time, pain is not an enemy to be killed, but an overzealous, often misunderstood ally that believes (sometimes mistakenly) that it is protecting the patient from further harm.
I encourage my patients to develop a new kind of relationship with pain, one that is characterized by open, honest communication, integrity and a sense of mutual cooperation.
For example, one patient complained that despite all attempts at therapy, his back pain had ruined his life, destroyed his career and ended his marriage. As in most relationship disputes, the other side (the image of his back pain) had a completely different perspective. It told him, "When you first injured your back by lifting a load that was too heavy, I gave you pain to let you know that this was a problem. At first, you listened and stayed in bed for a day, so I turned the pain down. The next day, though, you returned to work, which I didn't understand at all since you were still injured. So, I turned the pain back on and you responded by taking pills and ignoring my message. I had no choice but to turn the pain up even higher, and you responded by getting injections so that you could get back to work. This made no sense at all to me, and since you still didn't seem to get the message, I turned the pain up even higher and began running it down your leg. This does seem to work because when you overexert, it's the one way I can get you to lie down and stop hurting yourself. This works for me, and I'm not going to turn the pain off since you can't be trusted when I do." This mutual mistrust is a common scenario when looking at the pain relationship. Patients don't trust their pain, and their pain doesn't trust them. Perhaps we don't help when we tell patients, "Tough it out. Don't listen to your pain. Do it anyway. No pain, no gain."
So, how does one establish trust in a relationship? It happens only when both parties act with integrity over time. When someone is consistently honest, keeps agreements and reliably does what they say they are going to do, we begin to trust them. It takes a lot of time to establish trust, but only a few seconds to destroy it.
From this perspective, I encourage my patients to develop a new kind of relationship with pain, one that is characterized by open, honest communication, integrity and a sense of mutual cooperation. Rather than remain embittered and resentful, I invite them to communicate with their pain, take care of their pain, give their pain random acts of kindness and then to see what happens.
For example, if a patient in pain is on the fence about whether they are up to doing something, they typically complain, "If it weren't for that *$#&! pain, I'd be able to do this easily." I recommend they try an attitude adjustment, and give their pain a gift by not doing it. I urge them to tell their pain, "This one's for you. I'm going to pass because I want to listen to you and take better of myself."
I'm not suggesting that people surrender to pain, or give in to it. It's not about fighting, winning or losing. It's about having good communication, working together, mediating disputes and watching out for each other's interests. It's about developing the best relationship you can have.
Patients ask me, "Does it really help to talk to my pain?" I tell them, "How successful have you been trying to fight with it your way? Have you 'conquered' it? Why not try it my way and see what happens? It's about 'rock turning.' When you turn over rocks, what do you see? Some dirt, maybe a few bugs, and once in awhile, a treasure. I can't promise you'll find a treasure if you turn over rocks, but I can promise that you won't find a treasure if you don't try it."
Like any other relationship, the pain relationship is always enhanced by clear, honest, direct communication. When patients are able to make their pain relationship more positive, their tolerance to pain, and subsequent functionality is often dramatically enhanced.
One patient visualized his lumbosacral pain as a swayback donkey with an aching back. During his dialogue, the donkey said he had been carrying too heavy a load for too long a time. The patient replied, "I can relate to that." This began an important dialogue that led the patient to a rehab program that embraced a different attitude of greater compassion for his back.
To learn more about Interactive Guided Imagerysm and how it can be used to facilitate inner dialogue, contact the Academy for Guided Imagery at 800-726-2070 or www.interactiveimagery.com. For further reading, I recommend my book, Free Yourself From Pain (Awareness Press, 2000) and Guided Imagery for Self-Healing by Martin Rossman, MD (H.J. Kramer-New World Library, 2000).