People living with persistent pain often report psychological consequences from their condition that may be as distressing as their physical pain. The integrative medical approach to caring for people with pain validates the psychic components of suffering, and addresses them along with the physical elements. In this way, integrative care for pain is truly mind-body centered. Informed Western medical professionals routinely incorporate psychological therapies into chronic pain care.
Unfortunately, some patients have had negative experiences with insensitive or ill-equipped doctors, who attributed their physical pain to being “all in their heads,” when an easy, obvious physical diagnosis was not quickly apparent in their medical work-ups. My patients with pelvic and sexual pain conditions commonly reported having experienced this; some wasted months in counseling as the first treatment they received. These patients may understandably be angry and distrustful, and decline further psychologically focused care. They, and all patients with chronic pain, are empowered by therapies that nurture an awareness of the mind-body connection, and enhance our body’s natural healing abilities, such as the practice of Body & Brain yoga.
Loneliness and isolation are the most frequently described feelings of people living with chronic pain. Many do not want to burden family and friends by talking about their pain, and the grief and loss of their ‘old self’ that often result. As most chronic pain conditions are ‘invisible’ to others, and exist as deeply personal experiences, loved ones may have difficulty appreciating the patient’s reality without open communication, further compounding feelings of isolation. As a Body and Brain member, Joyce, describes her experience: I have felt isolated and alone, even from my husband and closest friends. It is also distressing when people tell me how good I look; they have no idea of what is going on inside! I force myself to socialize. Even if I don’t feel like going, I often feel better after I go out.
Other frequently reported negative emotions triggered by persistent pain are self-reproach, frustration, impatience, and lost of trust in one’s own body. These may result from cultural and religious preconceptions that we ‘should be able to’ think our way out of pain or stoically ignore it and carry on. Patients also relate difficulties with remaining resilient and grateful for the good things in life. Some struggle with identifying with ‘pain as self’ or with being a victim. Stress also results from inability to fulfill roles at home and at the workplace. All of these reactions may lead to depression and anxiety, which often further intensify the pain experience. Many depressed patients also experience cognitive problems, with focus and memory, which worsen with the use of some pain-relieving medications.
Mind-body therapies have been shown in many Western research studies to benefit the emotional side effects of persistent pain, especially depression. By mindfully separating pain from self and self-worth, it can be appreciated non-judgmentally as an important voice of the physical body. Upsetting thoughts and feelings that are reactions to the pain experience can be seen as just that, reactions, and consciously self-regulated and eased through acceptance. Joyce advises: Be aware of your thoughts. Some of them are “old tapes” from your past which continually replay. Try to uncover the hidden thoughts from your past, which may be contributing to your physical discomfort. Also, take ownership of your past and your past decisions. Try not to regret. This is very hard; I am still working on this. The process is not linear; it is definitely up and down!
Mind-body practices enhance the natural healing action of our parasympathetic nervous system. But remaining objective and optimistic about slow or subtle progress in healing the conditions causing pain is often difficult. The use of charts every week or two to appreciate improvement is helpful. The most common system, that of rating pain level on a 0 to 10 scale, needs to be supplemented by assessing how pain interferes with general activity, sleep, mood, and stress level, as the Department of Defense advises.1 The scale of 0 to 10 can be used, with 10 meaning that pain totally interferes with each factor. For instance, if more activities of daily living are accomplished gradually over time, with the level dropping from 10 (high interference) to 4 (mild interference), that is a real mark of progress.
People living with pain need a support person to confide in; if a family member or friend is not available, then sharing feelings with a therapist, counselor, or support group can provide great comfort. Body & Brain practitioners may find that co-members and their center’s manager are sources of this support. The simple experience of being understood by another human being is special and unique. This became clear to me at the weekend retreats I help run for people with chronic pelvic pain. We request evaluations of our program at the end, and I at first expected compliments about our pretty PowerPoint presentations and small group workshops. But instead, we received many grateful comments centered on meeting, relating to, and being understood by other people with similar pain problems.
Regaining or maintaining a purpose in life is characteristic of many people living well with chronic pain, and commonly part of the advice they give to others in similar circumstances.2 Spirituality, as that which gives meaning to life and beckons one to live beyond self, is also important for many people who feel they can live well despite their pain. Western medicine is beginning to appreciate and even research the positive effects of spirituality on wellness and illness.
Alliance for Pelvic Pain Retreat in May 20-22, 2016
I would like to announce that we are opening up the pelvic pain weekend retreat to health care professionals, such as MDs. RNs. PTs, and psychologists who take care of people with chronic pain, in addition to patients. Come and de-stress while you learn to care for your patients and yourself, in beautiful peaceful surroundings, with people of like mind. A breakout session will be designed especially for you.
Click to download retreat details:
“It was wonderful to meet so many other women w/ similar symptoms. I felt incredibly supported & understood."
“I am in my upper twenties and connected to people in all age ranges. I received guidance from older people who also told me how much they respected me for having this challenge at such a young age.”
"I left the conference feeling much more of that sense of integration, and with a sense of connectedness to everyone else there.”
1. US Department of Veterans Affairs. Defense & Veterans Pain Rating Scale. Defense & Veterans Center for Integrative Pain Management. Washington, DC; 2010. Available at http://www.dvcipm.org/clinical-resources/pain-rating-scale
2. Owens JE, Menard M, Plews-Ogan M, et al. Stories of Growth and Wisdom: A Mixed-Methods Study of People Living Well With Pain
. Global Advances in Health and Medicine, January 2016, Vol. 5, No.1: pp. 16-28.