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6 Articles in Volume 1, Issue #6
Accurate Diagnosis
Getting Off the Pain Roller Coaster
Getting to the Point
Opioid Rotation: Mechanisms, Concepts, and Benefits
The Neural Plasticity Model of Fibromyalgia Theory, Assessment, and Treatment: Part 4
The Pain and Sleep Relationship

Getting Off the Pain Roller Coaster

Identifying the psychological aspects of pain can lead patients on the right track to recovery.

“I’m a changed man. If it weren’t for my looks, no one would know me,” Lenny, a 43-year-old ex-truck driver, who was in a serious accident seven years ago, is typical of many patients we see with chronic pain. After many surgeries and treatments and several attempts to get back to work, he was still in pain. He currently spends much of his day on his farm doing a few odds and ends and watching TV, waiting for his wife and children to come home. This is very different from his active life style many years ago when he rode motorcycles, sailed on his boat, and played basketball with his children. “I feel like I’ve been cheated out of life,” he says. “There’s been times, I’ll tell the truth here, if I felt my wife and children could go on with their lives, if my wife could find someone physically able and who’d support her, I’d kill myself. I’d do it. It’s crossed my mind but no, I’ve never put the gun to my head…it’s the thought.”

Pain As An Identity Crisis

Lenny’s story comes in many different shades and variations. Not everyone with pain goes through what Lenny has, but many people are influenced to some degree or another — some just sporadically and intermittently; others on a daily basis.

For Lenny, pain is more than a physical nuisance that he has to tolerate but a factor that crosses into every aspect of his life. Lenny’s pain affected the general quality of his life, his relationships with his family and friends, and his identity — “Who am I if I am no longer a provider, husband, father, friend, athlete, man? What good am I if I can’t do anything now?” Certainly the physical losses for Lenny were very pronounced as he could no longer work or do the recreational activities he once enjoyed. He had to forego almost all the physical pursuits that both defined him as a man and gave pleasure to his life.

His pain impinged upon his relationship with his wife and children. How does it feel for a man to rely on his wife’s paycheck for support? How does it feel for a father not to be able to play basketball with his son? Like many families whose loved ones experience pain, Lenny’s curtailed their activities as well. If he couldn’t motorcycle, boat, fish, dance or go to the mall, neither would they. So this naturally gregarious person got more and more withdrawn, avoiding friends altogether. His anger and impatience at the situation further alienated his family and friends.

The financial losses for Lenny were also great. Whereas he was able to live comfortably before, things changed. Lenny could calculate to the penny how much he had lost in wages. Even more significant, however, was his feeling about himself as a provider. In a nation where one’s worth is measured by one’s productivity, the financial loss reflects his reduced value as a person — “If I can’t contribute, what good am I?”

The emotional frustrations are also noteworthy. To look at the chores that need to be done and not being able to complete them, to get tired after working for only brief periods of time, and to have to continuously interrupt a task to rest is very disturbing to those affected.

Pain As Loss

For Lenny and others, pain involves loss — physical, financial, self-esteem, and otherwise. In Lenny’s case, it involved the loss of his mobility, his livelihood, his friends, his role as a provider, and countless other privations. Others report losses in daily activities most people take for granted, such as walking, sitting, moving, and lifting.

Physical Losses

One of the biggest losses is the loss of health, which has several components, including the ability to feel physically comfortable, to engage in “normal” activities, and to see oneself as a healthy person. Pain is a loss of feeling good. Living with daily, often excruciating discomfort and the prospect of always having to tolerate this unpleasant state of affairs is more than some patients can stand. “It’s indescribable. I can’t breathe, I can’t lie down, I can’t focus…I cannot even begin to describe this agony and I can’t imagine anything worse,” said one woman. “It’s like a hot searing iron all over my body.” “Hell would have to be better than this,” said another. We hear statements like this, which only highlights this loss of feeling good.

The loss of mobility is also devastating. Not being able to move your arms or legs, to walk, stand, lift or turn your head can be more than one can handle. Many people do not even realize how many daily activities are affected by not being able to move even one part of the body. Others report losses in the most routine activities that would not be considered excessively physical by most people. Together with the loss of mobility comes the loss of independence. Not being able to complete a task without help and relying on others to do things they used to be able to do themselves can be both humiliating and frustrating. For example, those in pain may be able to fold laundry, but not carry it or perhaps they can vacuum, but not move the furniture.

The loss of a full life is another major trauma. As Lenny stated, “I feel that I have been cheated out of life,” and like him, many people with chronic pain cannot engage in most of the activities they used to. They find that they are no longer participating in the daily events that give them pleasure and start feeling excluded from life.

Financial Losses

In addition, the loss of job and income for some can include an even more dramatic change in lifestyle and is more pronounced for some people than others. However, for many people with chronic pain, these reflect a loss of identity. Some begin to question their very value in life. Not only do they ask, “Who or what am I if I am not a provider?” they ask, “What good am I if I cannot pay the bills, clean the house, take my children fishing, or cook dinner?” In a culture where one’s worth is dependent on one’s doing and contributing, this can be a very real crisis. For many, the loss of identity is also the loss of self-worth. Many individuals with chronic pain are afraid that their identity will be that of a “sick” person and that they will be defined by their illness. This is particularly true if they are given labels like “disabled” or “invalid,” together with the stigma that is associated with those epithets. They view themselves as “damaged goods,” which is a further assault to their dignity as human beings.

Self-Esteem Losses

The loss in self-esteem comes from the shame of having a body that defies control, a body that doesn’t function the way it should. Unlike a vehicle that doesn’t work, it cannot be traded for another model. To feel trapped in a body that fails daily, is it any wonder that so many people come to feel hate and shame at this very large part of themselves?

The loss of self worth frequently is accompanied by a loss of meaning in life. Some ask themselves all the philosophical questions, “Why me? Why is this happening? What good is living if I am suffering and in pain? What is my purpose in life if I cannot contribute?” Many start questioning their basic beliefs about their purpose in life.

Other Losses

Frequently, there are also other losses, including very visible changes in appearance. These changes are apparent in weight gain from the inactivity, bloating from medications, sloppy grooming due to the difficulty in washing one’s hair and taking care of one’s hygiene, or the bodily changes that may accompany pain. The insult to the body image that frequently accompanies pain extends not only to one’s feelings about one’s attractiveness but also to seeing oneself as a sexual being. Self-love is necessary for healthy sexuality but is not easy to achieve when the body is not working properly. It’s so difficult in a society, which places so much emphasis on physical fitness and bodily perfection. Self-worth is frequently defined by how sexy or attractive one is to the opposite sex and therefore the cost in self-esteem can be damaging. So many people with chronic pain begin to question their identity, “If I can’t do what I used to do, if I don’t even look the way I did, who am I? What is my value?”

General Principles of Pain Management

Not everyone with pain undergoes all these changes, of course. Some may only encounter these losses once in a while, whereas other people may have worse experiences. However, regardless of the degree of deprivation, most people go through a series of stages in dealing with their loss and grief.

Since pain can impinge on almost every aspect of one’s life, new pain management must deal with all parts of the patient’s life, not just the physical. Pain management is looking at the person as a whole. Since pain has a direct bearing on emotional, social, and optimal well-being, then a pain management program needs to address all those factors.

Pain management is a daily undertaking and is not a one-time quick fix. Many people with chronic pain are still looking for the magic pills or the treatment that will magically “cure” their condition once and for all. Unfortunately, that does not often happen. Pain management is comprehensive and a combination of many different treatment modalities.

Pain management is also a daily commitment, not a one-time event that takes care of the problem once and for all, just as maintaining healthy teeth requires daily flossing and a well-toned body needs exercise.

Figure 1.

Pain management is also pain prevention. Preventing pain from getting out of control requires ongoing care. One cannot trade in his or her body for a new model if it doesn’t function the way it used to. In managing pain, one needs to take preventive steps to avert further breakdown of body parts. Pain management requires a patient’s active participation in his or her treatment. Doctors and other health providers can help but they can’t do it all. Taking personal responsibility provides one with a sense of control. Whereas patients cannot undo tissue damage, they can reduce their pain signal. They can also take charge of how they react to pain and learn ways to minimize the effects on their life.

The Pain Stress Cycle

Chronic pain and emotional stress interact. Chronic pain frequently leads to reduction in the ability to function at home or work settings, as it did in Lenny’s case. Many persons with chronic pain begin to isolate themselves from others; they don’t want to be a burden to their friends or families. Unfortunately, they cut themselves off from the very people who can most provide them with emotional nourishment, which only escalates their feelings of depression and frustration. These negative feelings are very harsh on the body. They can have a direct impact on our physical organs and intensify muscle tension, heart rate, and blood pressure. Muscle spasms can occur, which only aggravate the pain and make it worse. This can become an escalating cycle, with pain and depression reinforcing each other, and both can magnify and spiral upward. To help patients break the cycle and feel better, health care clinicians need to intervene in each of the steps, including the depression, anger, withdrawal, and interactions with others. Figure 1 is a guide that can be given to patients to help them relate to and deal with their pain.

Conclusion

Persons with chronic pain frequently lose much of their independence and have to depend on others to do what they used to. They are unable to do chores at home or to parent the way they did in the past. They also are unable to do many of the social and recreational activities that gave them pleasure. This can lead to a host of negative emotions including anger and irritability, guilt, depression, and a general lack of energy and enjoyment in living. By combining sound psychological principles with practical tools, we can help patients get off the emotional roller coaster of pain. n

Last updated on: May 16, 2011
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