Pain

By Louise E. Koepfler

Pain is the second most common condition (after the common cold) bringing patients to the attention of their family doctors. It is estimated that in North America approximately 11 per cent of the population suffers from chronic pain.

Pain sufferers are often frustrated by advice from health care practitioners to simply "learn to live with" their pain. I would like to review some practical strategies to learn to live without pain. But first one needs to have a basic understanding of how pain really works.

We all have had experiences where we discover large bruises at the end of the day which could only be caused by significant blows. Yet, at the time of injury, they produced no pain. On the other hand, we have all had the experience of a paper cut which, although it is rarely life threatening, can be excruciatingly painful. More serious examples of the hurt-harm correlation can be understood in cases where people have serious heart disease or cancer, but no warning signs prior to a major heart attack or surgery. Individuals who have severed spinal cords or amputated limbs continue to experience pain below the level of the lesion or beyond the area of the amputation, suggesting that no sensation is required at all from the affected area in order to produce pain.

A second important fact is that the brain is not simply a giant switchboard directing us to various injured parts. The brain is also a gland producing a variety of chemicals, some of which act as natural painkillers while others increase or decrease our experience of fear, anxiety and stress.

Pacing and Scheduling
The point is that many factors besides injury increase or decrease our experience of pain and a variety of other emotional responses. You can actively work to increase the availability of natural painkillers in your body and help control your pain.

A number of strategies commonly employed in a pain management clinic are discussed in the post-polio literature. Polio survivors are advised to pace themselves and decrease activities which increase their pain and fatigue. At the same time they are advised to find the optimal level of exercise which will help to keep them strong without over-stressing the muscles and joints.

It makes sense to find a level of activity which will not over-stress your muscles and joints. For health reasons, you want to avoid further damage to your muscles. From the point of view of pain management, you do not want to be constantly setting the brain up for a harm signal and thus equating activity with pain.

It is most frustrating for people to have to discontinue activities partway through when they start to experience pain. In addition, you may not realize until it is too late that you are very fatigued. Rather than working to a pain schedule, then, we recommend that pain sufferers be scientists in determining how much activity they can reasonably do before fatiguing or increasing their discomfort. We call this baselining. This is a simple procedure which requires a watch or timer. You set your timer and commence an activity, noting the time. You continue the activity until you start to experience fatigue or pain, and note the time elapsed. You can then pick an amount of time which is somewhat less than your maximum capability. In this way you will be able to plan your activities rather than having your pain set the schedule.

Exercise
Regardless of an individual’s medical condition, too much or too little activity will promote and increase the subjective feeling of pain. Conversely, the right amount of activity actually increases the individual’s sense of well being by releasing serotonin and endorphins. A skilled physiotherapist or occupational therapist can best advise each individual on the types of exercises and the duration and intensity of exercise recommended. Generally, gentle stretching exercises to keep joints flexible and non-stressful cardiovascular exercises, including swimming and riding an exercise bike with little or no tension, are recommended.

Relax!
Relaxation is a valuable tool in pain management in several ways. First, it helps reduce muscular tension, which often accompanies muscle fatigue and produces muscle and joint pain. Secondly, it has a general effect of calming the central nervous system. It also helps relieve mental and emotional stresses, adding to general sense of well being. Systematic relaxation, as opposed to simply stopping an activity, gives you some active control over your pain.

However, relaxation, like love, has to be experienced and cannot be forced. You cannot order yourself to relax any more than you can order yourself to fall asleep. Be prepared to "let it happen". And practise! You may wish to consult a therapist or pursue relaxation on your own through tapes or books.

Emotional Response To Pain
For individuals who have worked hard to overcome a physical disability such as polio, the recurrence of symptoms later in life can be doubly traumatic. The loss of physical strength when recovery was thought to have been permanent, combined with a lack of understanding about the condition and negative attitudes in the community towards any disability, can have a devastating impact on an individual’s emotional well being.

Individuals with pain problems must be willing to examine all aspects of their lives, including their attitude towards their medical condition, their self evaluations and their emotional state, in order to take control of pain.

Stress Is Not A Four Letter Word
Stress is a word that we generally use in a negative context; however, all stress is not bad, and in fact it can often be a motivating force in our lives. It is when we are overwhelmed by stressors or are unable to cope with a given stress that it can become injurious to our mental and physical health and can contribute to a pain problem.

People with chronic pain often say that they have lots of stress in their lives which they will deal with as soon as their pain is diminished. But stress is not merely a result of pain and disability. It can contribute to the experience and make manageable pain overwhelming.

Essentially, stress management is problem-solving. Be creative in your problem-solving. The usual way you do things is not the only way. Be flexible and remember that it is okay to ask for help.

(Louise E. Koepfler, Ph.D., C.Psych., is the director of the Health Recovery Clinic in Toronto. For the complete version of this transcript, contact Ontario March of Dimes, 60 Overlea Blvd., Toronto, ON, M4H 1B6, or phone: (416) 425 0501.)