PAIN MANAGEMENT: is a special case of the body being out of kilter. When pain cannot be wished away, it is difficult to see how a safe experiment might help.
There some ways in which pain does involve a “learning” process. Please let me be clear here; I am not saying pain is imagined or ‘all in the mind’. Pain is real and it exists for an evolutionary, biological purpose – to protect us, so that we don’t move a part that shouldn’t be moved when it is injured. There is a benefit from pain – it can protect us. It ensures we put the hurt area in a state where it might be heal quicker.
However, that system has not evolved to be perfect. The brain ‘learns’ that there is a problem and it just gets better and better at just noticing our pain reaction. This, can widen our experience into a chronic pain. That can extend the time it takes to lose the experience of discomfort.
Basically, we can learn ‘bad habits’ that become self-reinforcing. As Ron Siegel said, the brain just gets used to it and we fall into a ‘rut’ that predispose us to go in a certain direction. This can happen as ‘neurons that fire together wire together.’ Many things are self-reinforcing; if we are lucky a series of small victories from safe experiments can build one upon another. There’s a kind of positive reinforcement that comes from that.
The brain is able to develop a habit of focusing with an anxious vigilance. We pay attention to certain signals and, in doing that, the brain can amplify those signals. Just the thought that something is going to be a problem amplifies it tremendously. Consider this rather frivolous example: “whatever else you do now, do not, under any circumstances, think about pink elephants“. Tell me, as you finish this sentence, what are you doing!! The point is – try as hard as we might, thinking can make it so and, indeed, thinking can make it more so.
Pain management, for the most part, has moved on in recent years. Rather than see ‘how do I get the pain to be less’, the emphasis has turned to ‘how do I learn to adapt to what I’ve got?’, or ‘how do I live my life with what I’ve got?
Is it feasible to direct our attention away from vigilant anxiety on my pain sensations and direct focus on the sensations of walking, sitting, or engaging in some activities. Doing that, may mitigate the fear and minimise magnification of the sensations – reduce our tendency to catastrophise.
If pain management can get us back into our life activities, then we are less likely to conclude ‘I’m going to be disabled by this‘. Instead it is may become possible to live a life, even though it hurts. This mitigates the fear, which also retrains the brain to not focus vigilantly on the pain.
So can we unlearn things so the healing is less protracted? If this is a possibility then safe experiments will have something to offer. The truth is that pain management is a difficult process and not easy to sustain on your own. Here, practitioners from a range of professions can be helpful to sustain motivation and advise on medication. For that reason, the best management is undertaken in pain clinics staffed by doctors, nurses, physiotherapists, occupational therapists, psychologists and home support and social workers.
It is an issue that depends on a good working team; a team that can call on any resource that helps. Different people are more or less able to call on the physical and behavioural safe experiments that can make a difference. The diagram, below, identifies a whole range of elements that could be included in a suitable safe experiment.
This diagram demonstrates that physical care of your body is not sufficient to ease pain. Our experience of pain can be shaped by our thoughts, feelings and attitudes. For that reason, theBody Scan is an helpful strategy. Some people are better equipped than others to develop thoughts that assist pain management. Such thoughts that focus not on cure but on training our mind and body to a certain relationship with the pain we experience.
As stated before, this is NOT a statement that pain “is all in the mind” – it isn’t – it’s in the body and mind, and it can really hurt. My observation is simply saying that different attitudes contribute to our experience of pain in different ways. Pain cannot be removed from chronic conditions. Some people are more able to say ‘hello’ to their pain and others spend much time seeking to wishing it out of their lives. The key to effective management appears to be telling the story of our experiences in a different way.
I will offer one safe experiment in the art of noticing your discomfort.
Find a place that is as comfortable as you can be; certainly, a place where you can have some peace and quiet for a time. Then:
- Give yourself permission to feel whatever you are feeling, however unpleasant that may be. Do it and allow it to be.
- Remind yourself that the pain you have does exist. It is valid because it is.
- Get into the rhythm of controlled breathing and remind yourself that you can ‘go inside yourself’. You may not know how quickly or deeply you will go inside but you can do that.
- You may or may not notice when you first start to relax more.
- Make a suggestion to yourself, e.g. I can experience some numbness (in that part of you that is experiencing pain). That numbness can be increased until you really notice it. Use the Subjective Unit of Discomfort (SUD) system to ‘measure’ your experience of pain and numbness.
- Increase that numbness by imagining a cold wave of experience filling your body from the very bottom, by your feet, travelling slowly upward, through your body, to the very top of your head. Do this as you keep up the controlled breathing and calling for that numbness to increase on your outbreath.
- Use your imagination to travel to a safe place of your making in which you can allow that experience of pain and numbness to exist for as long as you wish to do so.
- When you stop, remind yourself of your ‘ external reality’ (a practical example would be “I am sitting in this chair, in my living room on [date]”.
- Before you finish, consider future, positive safe experiments that appear to emerge from the result of your experiment today
- Consider using this affirmation at any time and in any place: “I can continue to eliminate any unnecessary discomfort and attend only to the necessary pain.”
There are versions of the relaxation and mindfulness that can be developed into useful experiments particularly as there a number of CD’s available to help here. I like to think that practising with these resources can bring some relief to some people, but always be prepared to consult your family doctor about local pain clinics as well.
Obstacles to designing safe experiments.