On a recent Saturday morning, I met with 15 of my patients, each of whom suffered from chronic pain. The group medical visit is a relatively new way for a physician to provide care to patients suffering from a common condition. They are more commonly used for conditions such as diabetes, congestive heart failure or chronic lung disease.
I chose to use this special type of visit for my patients to allow sufficient time to explain new concepts in the approach to chronic pain, discuss how pain affects our lives and introduce them to new evidence-based self-management tools to improve their function and enjoyment of life.
Pain itself plays an important physiologic role. When it is acute and caused by harm or injury to the body, it provides useful information to us so that we can take immediate steps to attend to the affected area and remove it from danger. If you could feel no pain, you wouldn’t know that you had stepped on a nail or that you were developing a serious foot infection. Therefore, it would not be desirable to be completely pain-free.
Similarly, both fear and sadness are normal, functional human responses. If you had no fear, you would not take appropriate care when facing dangerous situations. We feel sadness when we experience loss or when we are not satisfied with our circumstances. It can be the first step in looking at our lives, setting new goals and improving those circumstances.
The central nervous system is very efficient. When certain patterns of thought and behaviour are repeated, particular patterns of neural connections become more entrenched. If we take the same way home each day, it becomes so automatic that we don’t have to think about it. If we think the same good or bad thoughts day in and day out, they become patterns of thought and limit our ability to perceive anything else. This is how we tend to narrow our points of view, become prejudiced and pigeon hole the people around us.
When pain becomes chronic, it can affect every aspect of our lives – the activities of daily living, our relationships, our enjoyment of life – how we see ourselves and our future. Because pain is at the root of these negative changes, it can become the focus of our attention and our daily lives. Pain can shade our emotions and shape our thoughts.
As we lose a sense of control in our lives, we may feel helpless, and helplessness begets anxiety. If we become pessimistic, we may lose hope, and hopelessness begets depression. Our emotions restrict our outlook and narrow our thoughts.
When we are anxious, we catastrophize (imagining the worst), we overestimate the challenges before us, and we underestimate our ability to manage them. When we are depressed, we think negative thoughts about ourselves, our world and our future.
We can get stuck in a vortex of negative thinking and emotion, and this cognitive state actually worsens the pain.
There is no single pain generator in the human nervous system. The pain we experience is the product of the interplay of the original injury, the nervous system’s ability to modulate sensations and how we cope.
Even if the original injury has resolved, we can become stuck in a maladaptive reaction to pain, and the nervous system becomes very efficient in signalling pain. In fact, less of a stimulus (perhaps just a light touch) can trigger a greater pain response.
We now know that we need not remain stuck. Through functional MRI, we know that meditation, cognitive therapy and hypnosis can change how our brains process sensations and perceive pain. The relatively new field of neuroplasticity has shown us how we can retrain and change our own brains.
The first key to mastering chronic pain and enhancing our levels of comfort is to recognize how our thoughts, emotions and behaviours influence our experience of pain. By adopting and practising more adaptive approaches, we can increase our comfort, improve our function and again enjoy the activities we value most in our lives.
After ensuring that a patient’s condition has been sufficiently investigated and appropriate medication and physical therapies applied, I now offer my patients three self-management tools. Mindfulness meditation helps us to centre our minds, increase our awareness and calm our nervous systems. Cognitive therapy trains us to uncover our underlying beliefs and assumptions, control our conscious thoughts, reframe our situation and shape our emotions. Self-hypnosis engages our subconscious minds to reinforce positive thoughts, emotions and behaviours and allows us to visualize a positive healthier future.
With these three tools, we can regain our sense of control, transforming helplessness and hopelessness to engagement and empowerment. In upcoming columns, I’ll provide more details, including both adaptive and maladaptive approaches to chronic pain.
Dr. Davidicus Wong is a family physician and physician lead of the Burnaby Division of Family Practice. To learn more about meditation, cognitive therapy and achieving your positive potential in life, see his blog at davidicuswong.wordpress.com.