COMPREHENSIVE – HOLISTIC MODEL
Treatment of Pain Requires Assessment of All Relevant Factors. The prescription for treating pain requires accurate diagnosis not only of the underlying pathology, but assessment of all the symptoms and consequences often associated with pain.
Principles for the management of chronic pain are very different than those for acute pain and injury. The following is an overview of chronic pain management principles noting some of the differences.
PAIN IS NEVER GOOD WITHOUT AN AUDIENCE.
Avoid excessive social reinforcement for pain and pain behavior, especially from family. This can appear in the form of excusal from usual chores and responsibilities to include but not limited to sanctioned absence from work or involvement in important family decisions. Many times there are can be strong social reinforcement that sustains chronic pain and disability through excessive sympathy and undo attention.
PEOPLE DON’T HURT AS MUCH IF THEY HAVE SOMETHING BETTER TO DO.
The best treatment in the management of chronic pain is return to work for anyone with return to work capability. It is well accepted that patients suffering with chronic pain do not hurt as much if they have something better to do.
MEDICATIONS USED SHOULD BE ‘TIME CONTINGENT’ NOT ‘PRN’
It is well accepted that medications used for the treatment of chronic pain are best taken ‘by the clock’ or on a regularly scheduled basis and fixed daily dose, and not on a ‘PRN’ or on a ‘as needed for pain’ basis which is much more likely to cause physiological ‘wind-up’ is less likely to control pain, and more likely to create a pattern of addiction.
WORK AND ACTIVITIES TO ACHIEVE SET GOALS, NOT TO PAIN TOLERANCE
Rather than let pain alone be your guide, it is best to set tangible and realistic goals and consistently follow through with your plans. While it is reasonable to make modifications when necessary, keep reinvesting and upgrading your goals after enjoying every accomplishment. Don’t allow yourself to make unnecessary excuses.
VALUE OF FITNESS, STRUCTURED EXERCISE AND HIGH LIFESTYLE ACTIVITY
It is scientifically proven that those who are most physically fit, have the lowest risk for a disabling back injury, and should injury or illness occur, they recover much faster.
Recent studies have proven that moderate lifestyle activity is equivalent to programmed aerobics for improving fitness and decreasing cardiovascular risk.
EMPOWERMENT/ ‘GOALING’ PROCESS
It is critical for you to be an active participate in your recovery and rehabilitation process…”Take charge of YOUR pain problem, and you will take back control of YOUR life.” Expand upon your understanding, and become independent and self-sufficient. Progressive conditioning, work hardening principles, practical conflict resolution, and a cognitive-behavioral approach can be instrumental for overcoming a pattern of chronic pain and disability.
PACING AND INJURY PREVENTION
Attention to pacing strategies and a healthy lifestyle is critical. Good body mechanics, and sound ergonomic principles can avoid a vicious cycle of repeated aggravation and re-injury. Look carefully at internally generated and self-imposed, or externally driven time pressures. While some degree of emotional and physical stress can be beneficial, when stress becomes excessive, then the mind and body produces toxins resulting in cellular injury which can contribute to a pattern of multi-organ distress. A sustained “fight or flight” response and sympathetic over-reactivity can be extremely destructive on both the mind and body, and can contribute to insomnia, depression, anxiety, irritability, irritable bowel syndrome, gastrointestinal bleeding, ulcers, lowered immunity with vulnerability to infection, cancer, stroke, heart attack, and death.
DIFFERENCE BETWEEN PAIN AND EMOTIONS
While sometimes there is little that can be done for pain and living with some degree of pain is necessary, suffering is an emotion. We all look at the world through a window framed by our thoughts, attitudes, values and beliefs. While you may not be able to alter the sensation of pain, you can dramatically change your perception of it. Forging a positive mental attitude makes all the difference in the world. This is why dissatisfaction at work, at home, or with ones life significantly contributes to the risk for suffering chronic pain One must choose the proper adaptive response…while for acute pain excessive activity can result in further injury, in chronic pain conditions, a maladaptive and passive rather than proactive response can unnecessarily sustain disability, cause a vicious cycle of inactivity and de-conditioning, prevent healing, and reinforce suffering, anxiety & depression.
SELF-DESTRUCTIVE AND SELF-DEFEATING HABITS AND BEHAVIORS
If you have a problem with drug addiction of any type, excessive drinking or alcoholism, heavy smoking or consider yourself a ‘workaholic’, this drastically reduces or eliminates your chance for successful management of your chronic pain problem, and you will require specialized help…please ask for it. If you are having difficulty with self-destructive behaviors, face up to it, seek professional advice, and get active in helping yourself to make the life changes essential to eliminate the problem.
LANGUAGE DESCRIBING PAIN AND PAIN BEHAVIORS EFFECT PAIN
What you say about your pain not only reflects on how you feel, it affects how you feel…and substantially worsens the outcome. Negative thinking, pessimism and thinking about your problem and everything as hopeless and a catastrophe, will become a self-fulfilling prophecy…what you think is what you get! Avoid this trap and seek help. There are well known techniques that can help overcome this type of self-destructive pattern
When vocational potential exists, a rigorous ‘goaling’ process with vocational exploration, retraining plan and return to work plan is necessary. It is important to focus on yourself as an efficient and productive worker, and these thoughts and actions will help make it a reality. This process requires self-determination and unwavering commitment.
If someone believes that his or her problem is the result of someone else’s fault, and in turn that someone ‘owes them’ something, or if there is an active process of litigation or a contested compensational issue, then the outcome is invariably poor. This is undoubtedly true as it eliminates self-responsibility for securing the best outcome possible, and it becomes impossible to become
un-disabled at a time when it may be important to prove the presence and severity of disability.
Create your inner advisor and elect yourself as CEO. Demand from yourself a well constructed short and long term plan with the intent in helping the bottom line – YOU!
For those suffering from chronic pain, it is increasingly scientifically understood, that waiting to take pain medications until pain levels are severe, can result in lasting repercussions which significantly contributes to poor pain control, a phenomenon called ‘Non-Nocioceptive Pain’. It is for this reason that for those patients having chronic intractable pain, that using long-acting medications covering pain 24 hours per day can be instrumental in controlling pain levels, and thus strongly recommended when indicated. This is also why escalating and severe pain should be treated early on to avoid central nervous system “wind-up”.
Communicating effectively enhances our health and self-esteem, nurtures relationships, and helps us cope with stress. When we communicate effectively and feel understood, life is more joyous and satisfying, and we feel more in control over life events. People trust and respect us – even sex is more fulfilling. When communication breaks down, we experience more cardiovascular stress, and are more susceptible to headaches, neck and back pain, irritable bowel syndrome and become more sensitized to pain. Fortunately, effective communication can be learned. There is increasing evidence that even minor improvements in communication, can produce major results. Some important points: learn to listen, ask for friendly clarification, summarize content for clarification, reflect feelings and meanings, watch for body language, learn to be assertive and know when to say no, respect conversational styles, practice praising.
THE IMPORTANCE OF HUMOR AND LAUGHTER
Laughter was been proven to increase pain tolerance and raise pain thresholds, reduce stress and boost immune system function. Laughter has been called “inner jogging” and a robust laugh allows oxygen to surge through your body, and upon relaxation, allow muscles to relax and blood pressure to drop and create a mellow euphoria. A good laugh can burn as many calories per hour as a brisk walk. The brain releases neurotrophins rousing one to a high level of alertness and numbing pain through release of endorphins, the brain’s naturally occurring opiate. Expose yourself to humor, keep a humor journal, listen to and tell jokes, look for the funny side, healthy exaggeration can put life into perspective, don’t forget to laugh at yourself.
RELAXATION AND SELF-HYPNOSIS
Becoming good at self-hypnosis or meditation and creating inner peace known at the ‘quieting response’ takes practice. Creating inner space enables you to control your attention and filter out painful or unpleasant thoughts, feelings or sensations. By becoming skilled at self-hypnosis, you can capitalize on your natural ability to concentrate to reduce anxiety, relax muscles, control fears, diminish pain, improve mood, boost creativity, and help to change unwanted habits.
THE INTERACTION OF MIND AND BODY
Adhering to principles well known to assist professional athletes achieve a peak performance can help those with a handicap trying to overcome disability. Maintaining Feelings positive, Attention in the present, and energy level high is vital, and is known as athletic poise. An important checklist includes: being mentally relaxed and focused, physically relaxed and ready, confident and optimistic, concentration in the present, highly energized and feeling ‘in the cocoon’. Take responsibility for healthy and constructive thinking. Intensely visualizing yourself doing your targeted task, and living your dream can be invaluable.
A ‘Cognitive-Behavioral Approach’ for the management of chronic pain has become well accepted and extensively utilized in pain clinics around the country, and is defined as the ability to think & behave adaptively in order to facilitate positive emotional experiences. In other words, it is the ability to utilize adaptive thoughts & actions to decrease emotional suffering. The goal is to improve upon the quality of life independent from the pain problem.
If there is any technique that you are interested in to help you maximize physical and psychological well being and adaptation, please ask for additional resources and/or a referral.
Edgar S. Steinitz, M. D., F.A.A.N.E.M., F.A.A.P.M.R., F.A.B.P.M.