Chronic Pain

Have you been told that “you’re going to have to learn to live with your pain” or that “you’re not coping very well with your problem?” What do these statements and questions mean when we hear them and how do we know whether we’re coping? These aren’t easy questions to answer but you may not be coping as well as you could be if you are tense, sad or unhappy, frustrated, feeling hopeless, irritable, angry, or snappy.

You may have noticed that you are less tolerant of noise, activity, and the many inconveniences of daily living than you used to be. You may find yourself saying things to family members and spouses that you would have never said before. You may be ashamed by your behaviour and feel all the more guilty for this but in some ways you don’t even care. You may start to smoke more or drink more alcohol. Eating is the only thing that doesn’t hurt.

With time, you may become more withdrawn at home and socially isolated. Your activity level may become smaller and smaller and you may start to resent depending on your family and others for help. And no matter how much help they give you it isn’t what you want because you really want to do it on your own.

Do you find that you are visiting your family physician way more than you ever used to, looking for help even though you know there is nothing he or she can do for you? There must be some test, medication or treatment that can help stop the pain and allow you to get back your life.

Research on coping and acceptance suggests that poor physical and emotional adjustment are associated with a number of factors. These include not understanding why you have pain, feeling hopeless and helpless, beliefs that medication and medical intervention are the only treatments for chronic pain, that chronic pain must interfere with normal functioning, that the pain is stable and that you are disabled by it, and the belief that you are somehow responsible for the pain and flare-ups.

If you have more control over your pain and life, you’ll adjust better than those who do not. If you believe you can do something yourself to change the pain, for example, exercise, pace, relax and rest when required, and use medication appropriately, you’ll do better than those who rely on medication or continue to seek treatments that you know don’t really help. If you do this, you’ll find that the pain interferes less with your daily functioning and that you’ll be happier and more in control of your life.

But this isn’t to say that your pain will go away! Your pain is real. This will only help you to live with it and have as good a life as you can in spite of the pain.

We’re more likely to become sad and depressed following uncontrollable events. Some people feel they have bad luck, feel they are being punished by God or fate, feel they have no say in their health care, or feel they have no options. Most patients who have difficulty coping with chronic pain tend to be victims in motor vehicle collisions and work related accidents. The accident was not their fault and it is one over which they had little or no control. People who feel helpless and hopeless experience more pain, distress, dysfunction, anxiety, and depression.

It is important to accept that you are the one who ultimately has to cope with your pain and make decisions about it and your life. Health care providers can facilitate this step by encouraging you to make your own informed decisions regarding your pain and disability but ultimately you have to decide what to do. This is part of accepting and owning the pain.

You’ll be able to do more if you believe you are capable of doing more. This isn’t to say that “positive” thinking is the answer --- but being very negative, critical, or hard on yourself, and feeling hopeless tend to make the situation worse. Feeling good about yourself can lead to increased activity and better adjustment.

Coping with chronic pain involves a number of physical and psychological factors. A psychologist can facilitate adjustment by helping the individual work through some of these issues.

1. Jensen, M.P. et al. (1991). Coping with chronic pain: A critical review of the literature. Pain, 47, 249-283.

2. Adapted from D. Turk. Assessment and treatment of chronic pain patients: Toward a multiaxial approach.

3. Caudill, M. (2002). Managing pain before it manages you. Guilford Press

4. MacDonald, M.R. (2009). Unbelievable pain control

5. Schnurr, R.F.: Relaxation MP3s


Image courtesy of Ambro at FreeDigitalPhotos.net

© Robert Schnurr 2012