Coping with
Chronic Pain
Why do we feel pain?
Pain is normally a signal that your body has been damaged, or that
something is wrong. It stops us from doing things, which has two effects:
✦ In the case of physical injury it stops us from making the problem
worse e.g. walking on a broken ankle.
Why?
✦ It forces us to rest, giving our bodies a chance to heal themselves.
We feel pain when the nerves in our body send electrical impulses to our
brain. The brain then interprets these signals as pain.
Thus you could say that all pain comes from the brain.
The brain controls not only whether or not we feel pain, but:
✦ The quality of that pain
✦ The way that we experience it.
“Pain is an opinion”
Vilayanur Ramachandran - Neuroscientist
Acute or Chronic?
Acute or Chronic?
✦ Acute Pain
Acute pain normally begins suddenly and has a clearly defined cause
e.g. an injury or infection. Acute pain might be mild and last just a moment, or it might be severe
and last for weeks or even months, disappearing once the cause of
the pain has healed.
✦ Chronic pain Chronic pain is pain that, has lasted for more than 6 months and
either:
- Persists after the initial injury has healed
OR
- Is the result of a disease with no known cure e.g. arthritis
Sometimes chronic pain has no known cause, which can be
particularly difficult to manage because of the uncertainty associated
with the condition.
Chronic pain can last months, or even years, and will have both
physical and psychological effects.
Side effects of Chronic Pain
Side Effects
For many chronic pain suffers the pain itself is not the biggest problem. It’s
living with the pain. The constant physical and mental toll that living with
pain takes.
Chronic pain often affects every aspect of the sufferer’s life. Things that
used to be simple to do become almost impossible. Things that used to be
pleasurable are now dreaded.
Chronic pain results in:
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Fatigue
Forgetfulness
An inability to focus
Depression, anxiety and anger
These things then often take their toll in all the areas of the sufferers life:
relationships, work, leisure.
So much so that people suffering from chronic pain can often find
themselves lonely and isolated with very little to look forward to.
What works for you
Factors that affect pain
There are a variety of factors that affect pain. Some are common to all
and some are unique to you.
1.
Diet
The better you eat, the healthier you will be and the more able to cope
with pain. Weight reduction can also significantly improve certain types
of chronic pain.
2. Alcohol and Cigarettes
Both alcohol and smoking affect your brain chemistry making it more
difficult to cope with and manage pain.
3. Exercise
This can be especially difficult if you are in pain, but the effort it may
take to find a suitable activity that works for you will be more than
rewarded, as the exercise boosts the natural pain-killing chemicals that
your body produces.
4. Sleep
Sleeping well is crucial to stress management, and hence to our ability
to cope with pain.
5. Pacing
Constant pain is exhausting. It’s important to learn your limits and how
to manage the things you want to do in a way that allows you to feel
productive without exhausting yourself.
Understanding Pain
The Pain Gate Theory
Rubbing it better
✦ If you then rub your foot, this
activates sensory nerve fibres.
FACTORS THAT SHUT THE GATE:
FACTORS THAT OPEN THE GATE:
➡
➡
➡
➡
➡
➡ Stress and tension
➡ Lack of activity
➡ Focusing on the pain
✦ Signals in sensory fibres travel much
faster than those in pain fibres.
Relaxation
Hypnosis, inc. self hypnosis
Physical Activity
Focusing on things you enjoy
Medication
✦ Signals in sensory fibres cause the
pain gates to close.
✦ If there are only a small number of
pain signals the gate can be shut
completely, and the pain disappears.
OPEN
CLOSE
✦ If there are lots of pain signals then
the gate can be shut partially, which
eases the pain.
It is believed this is why therapies such
as massage, acupuncture and TENS
can be so effective is helping to
manage pain.
They activate the sensory fibres and
close the pain gate.
FAST PAIN
FIBRES
SLOW PAIN
FIBRES
SENSORY FIBRES
(33 MPH)
(3 MPH)
(89 MPH)
Understanding Pain
It’s all in the mind
Because pain is your brain’s interpretation of a series of electrical impulses, your
mind can have a huge impact on how your experience pain.
Opening the Pain Gates
Closing the Pain Gates
1. Stress and Tension 1. Relaxation and Contentment Feeling depressed, anxious and / or
Thinking positively, focusing on the
angry and the accompanying stress
good and feeling relaxed has been
and tension cause the pain gates to
found to help to close the pain gates open and the signals to be amplified.
2. Thought Patterns
Because your brain is trying to
Focusing on things you enjoy can be
protect you it makes the pain
tremendously useful in easing pain
‘worse’ to try and make sure you
because:
don’t do more damage.
➡ The distraction helps to close the
2. Thought Patterns
gates.
One of the most effective ways of
➡ Thinking positively causes the brain
opening the gates is to focus on the
pain. to produce pain-killing chemicals that
work to close the gates.
When you are constantly in pain, it
3. Self - hypnosis
can be hard not to think about it.
Unfortunately though thinking about it
Because of the powerful influence your
makes the gates open wider.
brain has on your body, self hypnosis
can be a highly effective way of
For this reason boredom can also
managing pain.
lead to the pain gates opening.
Rubbing it better
Thinking about YOUR pain
The influence your brain has on pain means that your experience of your
pain will be completely unique.
It is simply impossible to understand or navigate your pain by using
someone else's experiences - even if their pain has exactly the same
cause.
Knowing about the Pain Gate Theory will allow you to experiment with
some of the ideas above to find out what factors cause YOUR pain gates
to open and close.
Factors that make my pain gates open:
1.
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2. ____________________________________________________
3. ____________________________________________________
4. ____________________________________________________
5. ____________________________________________________
What do you think?
Closing my Pain Gates
Factors that make my pain gates close:
1.
____________________________________________________
2. ____________________________________________________
3. ____________________________________________________
4. ____________________________________________________
5. ____________________________________________________
6. ____________________________________________________
7. ____________________________________________________
8. ____________________________________________________
As you experiment with different things you’ll be able to develop
comprehensive list of what works for you and what doesn’t.
Below I’ve suggested 3 ‘experiments’ that my clients have found to be
particularly helpful.
We’re all individuals
Experiment 1: Breathing
Over the next few pages I’ve outlined a few different things that you can
try to help train your brain to close your pain gates more effectively. The
first is breathing.
When you are in pain and your muscles are tense it can be easy to
breathe ‘badly’. Spending a few minutes focusing on your breathing can
really help to calm and relax you.
Here are 2 of my favourite breathing techniques:
Technique 1: Basic Breathing
You may have to experiment a bit with the exact timings. Once you have
them perfect for you, practise for a few minutes each day:
➡ Sit or stand up straight and place your hand on your tummy
➡ Breathe in slowly through your nose for about 5 seconds. Really focus
on feeling your tummy inflate like a balloon.
➡ Hold your breath for about 3 seconds
➡ Breathe out slowly and gently through your mouth for a count of about
7 seconds, concentrating on feeling your tummy deflate.
What works for you
Breathing
Technique 2: Rectangle Breathing
This technique is brilliant because we are almost always surrounded by
rectangles. Windows, door frames, cereal boxes…
The technique is very simple
➡ Focus on the rectangle of your choice
➡ Breathe in as you trace the top short edge
➡ Breathe out down the long edge
➡ Breathe in along the bottom short edge
➡ Breathe out up along the other long edge.
➡ Repeat until you start to feel calm.
Once you feel you’ve really mastered the art of breathing you might be
tempted to give meditation or mindfulness a go.
If you do I have listed some resources that might be helpful at the end of
this guide.
Experiment 2: Self Hypnosis
Breathing
It may seem almost unbelievable that a few minutes of self-hypnosis can
significantly alter your pain levels. However the power of your brain is
immense and I really urge you to try this before discounting it.
✦ Find somewhere quiet and comfortable to sit or lie down
✦ Close your eyes and spend a few minutes focusing on your breathing
using one of the techniques above.
✦ When you’re feeling nicely relaxed imagine, in as much detail as you
can, that you are inside your brain.
✦ In front of you, you can see a door. A big heavy industrial door that is
labelled “Control Room”
✦ Imagine opening that door and walking into a huge control room. Lining
the walls are dials, gauges, knobs, and levers.
✦ As you look around you will find a bank of instruments for controlling
pain.
✦ As you move closer you will see that each part of your body has it’s
own gauge and knob / dial / lever.
✦ Find the one for your pain e.g. Left Hip
✦ When you find it you will notice that the needle on the gauge may be
quite high. It may even be in the red.
Experiment 2: Self Hypnosis
✦ Notice where the needle is, and then look for the knob / dial / lever
that controls it.
Breathing
✦ Slowly begin to turn the pain down - watching the needle as it slowly
falls.
✦ As it falls you may notice other things going on in the room. The sound
of steam escaping from a vent, the loosening of a spring. The more
details you notice the more effective the technique will be.
✦ Continue to turn your pain down until the needle reaches a 1 or a 2 on
the scale.
✦ You can now leave the room and get on with your day - knowing that
you can come back at any time.
It’s best to experiment with this technique when you are calm and quiet.
However the more you practise it, the better you will get at it, until
eventually you will be able to quickly just nip into the control room and turn
down your pain whenever you are and whatever you are doing.
Of course no one technique is perfect for everyone, so in the resources
section at the end of this guide you will find recommendations for
resources with alternatives for you to try,
Focus on the Good
Experiment 3: Thinking Positively
My children are still at school, and at school when they finish a piece of
work they have to complete ‘3 stars and a wish’.
They have to look back on the work they’ve completed and write down
three things that have gone well and 1 thing that they would like to achieve
next time.
This technique can be great to help train your brain into a more positive
way of thinking, which will increase serotonin production and your ability to
cope better. So at the end of each day, write down:
✦ 3 things that have gone well in the day / that you are grateful for
✦ 1 thing that you hope to achieve the next day.
This might be something really small, but it might also be something
big. If it is something big take a few minutes to try and break it down
into smaller steps that are more achievable.
3 Stars and a Wish
Focus on the Good
Date: _________
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W ________________________________________________________
Date: _________
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W ________________________________________________________
Date: _________
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W ________________________________________________________
Resources
Resources
Books
✦
Teach Yourself To Meditate by Eric Harrison
✦
How to Meditate: A Practical Guide to Making Friends with Your Mind Hardcover
by Pema Chodron
✦
Mindfulness: A practical guide to finding peace in a frantic world by Mark
Williams
✦
Self-Hypnosis: The Complete Guide to Better Health and Self-change by Brian M.
Alman
Apps
✦
Calm - A meditation app (free and paid for)
✦
Headspace - A meditation app (free and paid for)
✦
Zen Garden - All the joy of zen gardening without the mess (free and paid for)