Coping With Chronic Pain
Chronic pain is an issue for millions of people. It produces additional layers of frustration, sadness, and anger, and the challenges of coping with limitations of activity. Limitations due to chronic pain complicate social relationships and precipitate adjustment of the sufferer’s identity. When coping is inadequate, all of these issues can worsen.
Chronic pain is miserable. I know this because I have been a therapist for over twenty-five years and have worked with many patients coping with chronic pain. I also lived with chronic pain for many years. I’ll share below my thoughts on interventions that work to help cope with chronic pain.
The Secondary Stress Of Chronic Pain
Chronic pain:
limits the range of activities one can do
limits enjoyment of things even when direct ability remains
increases financial stress
reduces sleep quality
complicates relationships
No life is uncomplicated. Before the onset of your chronic pain, you likely had some life, work, and relationship issues. Chronic pain often adds new complications rather than making those more simple.
When someone faces limitations or complications in life due to chronic pain, this causes challenging emotions to arise. This emotional pain can be intense. Emotions themselves can create their own complications. Think of a time when you were angry and the way you experienced and expressed your anger created more of a challenge for you, and possibly, those around you.
We face secondary adjustments due to chronic pain. For example, we might have to reduce, or end, an enjoyable activity due to pain. We might have to limit our work hours or even stop work altogether. We might have to stare at more clutter than we like at home due to not feeling up to cleaning.
Secondary challenges due to chronic issues create meta-stress. Primary stress is the direct, real-time experience of pain in a particular moment. But, if you feel pain when you try to do the dishes, then stop, you experience meta-stress when you then think, “I can’t even do simple things to keep this house clean. I suck.” Or, you might think, “My partner is going to be upset that they have to do more than their share of chores, again.”
Meta-stress is stress on top of stress. While taking a look at your meta-stress can be informative, the experience of meta-stress can add extra layers of misery to your primary stress. When these various types of meta-stress endure, they negatively impact self-esteem. There are so many limitations and adjustments we face when coping with chronic pain, we have to deal with not being able to be the person we were prior to having the pain. We call this an existential crisis.
How Chronic Pain Can Become Even More Challenging Over Time
The process in our bodies that produces the subjective experience of pain is called nociception. Our nervous system and big brains have very complex parts that work together in complicated ways to take the original stimulus and produce the experience we call pain. There are some important things to know about how this mechanism works.
The experience of pain is a complex process where our nervous system co-creates the experience of pain. It’s not like a simple wire that powers a light bulb.
Our psychological state at the time of the pain stimulus has significant influence on the pain experience. If we are emotionally upset or have an elevated stress level at the time of the pain stimulus, we will feel more pain.
The brain parts that process pain signals are the same ones involved in emotional regulation and the stress response. This is part of the explanation for why pain causes such robust emotions and triggers the stress reaction.
When pain persists, the brain adapts by changing the structures that process the pain signal. This can result in increased subjective pain, greater propensity for negative emotional states, and increased potential for the stress response.
The brain changes that happen due to chronic pain help explain why sufferers of chronic pain are more likely than the general population to experience clinical anxiety and depression.
Our stress response is mediated by our big brain, our endocrine glands (especially the amydala), and the stress hormones that get pumped into our blood stream. This system allows us to go into fight-or-flight mode to deal with physical threats. But, this system was designed for danger triggers that are short-lived. Sustained stress not only makes is more miserable. It causes undesirable changes in the system itself.
In summary, long-lasting pain is not only a big stress load because it multiplies misery over time. The stress load increases due to psychological fatigue from having to endure the chronic stressor. That fatigue factor then multiplies the stress loading. And, as describe above, the chronic stress can change the system itself in ways that cause the fundamental coping to get degraded.
There is good news!
Research (and, my practice experience) shows that the negative effects of chronic pain can be significantly improved through mindfulness-based cognitive interventions. These include: therapy, coaching, and self-practice. I’ll describe each.
Therapy
Mindfulness-Based Cognitive Therapy (MBCT) includes Acceptance & Commitment Therapy (ACT) and Dialectical-Behavioral Therapy (DBT). Research shows that MBCT is more effective for ameliorating issues related to chronic pain than general therapeutic approaches. My opinion of why that is the case is: mindfulness is more effective than general interventions with the goals of improving stress-tolerance and emotional regulation.
When you get therapeutic support from a competent mindfulness-based clinician, you get:
Improved social support
Help working through meta-stress
Instruction to learn stress-reduction and stress--moderation techniques
Support with relationship issues
Support for existential issues and adjustments
Therapy is so very important when long-lasting stress is building up or evolving to create more severe types of anxiety and mood reactions. When anxiety or depression or poor mood regulation become their own things, they create more secondary issues. Competent therapeutic support can help you avoid suffering those compounded issues.
Another benefit of therapy is having a place to get some quality social support from your therapist who is a neutral person in your life different from informal supports. While friends and family can be very good supports, each of those relationships is a two-way street. When you get support from your therapist, you can do so without having to be concerned about how what you share with your therapist will affect them or come back on you later.
One common issue with any chronic stress situation is confusion about what one can do. We can lose our sense of agency and power when nothing we do seems to work the way we want it. Over time, this loss of sense of agency can induce a state of helplessness which makes us feel more miserable and confused about how to move forward. Therapy often serves to support people in exploring things that can be controlled versus those that can’t and people often feel an enhanced sense of agency through the therapy process.
Coaching
Coaching is similar to therapy though is likely to be more focused on skill-building in order for you to learn the best techniques to address your issues with pain, stress, emotions, and adjustments. In my coaching practice with people coping with chronic pain, I teach reliable, easy-to-practice techniques that are proven to lower subjective pain by 20-45%. Usually, this focused coaching process is accomplished in around four sessions (which is a more limited number compared to a more wide-ranging therapy process).
Self-Practice
Part of the goal of therapy and coaching is to teach techniques which you can practice on your own in between sessions and after you discontinue your therapy or coaching service. You might have already explored these types of self-practice by listening to guided meditations or reading a book on coping with chronic pain. You can learn these through an online course.
It’s so important to address stress, emotions, and adjustments when coping with chronic pain…
Elevated stress from chronic pain is miserable and makes pain worse. Same with challenging emotions and negative attitudes. After some time, chronic pain starts to become an even more complicated set of issues when meta-stress sets in. The types of impact that chronic pain has on life and one’s identity are complicated and challenging to sort out. When things worsen, the risk for clinical anxiety and depression increases. So, I recommend that you get good support if you need it to better cope, reduce your pain, and to lower your risk for more negative aspects of dealing with chronic pain.
Jon
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The stress response
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