Can you remember the last time you were struck down with a blinding headache, banged your big toe against the corner leg of the bed, or felt the searing electric shock pain of a blow to the elbow? Can you remember the lightning flashes of intense pain and the feelings of misery that came with them? We have all known pain – it’s part of the human condition.
Coping with acute pain is uncomfortable and inconvenient, but we quickly get through it and continue on with life.
Now try to picture a very different scenario – a life in which intense pain is your closest and most constant companion, night and day after night and day. It’s almost too difficult to imagine unless you’ve experienced it. Sadly, for the millions of sufferers of chronic pain, this is their ever-present reality.
Our ability to experience pain is an essential survival tool. Brush up against something hot, for example, and the sudden and intense sensation of burning tells you to move in a hurry. Our experience of acute pain begins with special nerve endings called nociceptors or pain receptors. These nerve endings are activated by illness or injury, or by chemical changes inside our body signalling that tissues are damaged. As pain receptors are switched on they release a flood of chemicals that send a lightning-speed message through the spinal cord to a spinal ‘pain computer’ called the dorsal horn. From here, pain messages are transmitted up the spinal cord to the thalamus in the brain.
Our experience of pain is not just about these pain messages flowing from our injury to the brain. Rather it is a combination of the gate-like dorsal horn controlling how nerve impulses reach the brain and how our brain then interprets these impulses. The pain that we experience is the composite of nerve messages flowing up the spine, and pain ‘blocking’ messages travelling down the spinal cord. Depending on the nature of these blocking messages, the intensity of the nerve impulses travelling up the spine from the injury site can be greatly reduced.
Our feelings and thoughts about the pain we are feeling can either increase or decrease the pain blocking messages from the brain. The more negative, anxious and depressed we are, the less effective the blocking messages, and the more severe the pain we experience.
Acute pain and chronic pain are completely different phenomena. With acute pain, the pain is a symptom of an illness or injury. With chronic pain, the pain itself becomes the disease … the disease of pain.
While acute pain signals injury or trauma and lasts for the duration of the affliction, chronic pain persists long after the initial injury or trauma has healed. Chronic pain conditions occur when nerves in the spinal cord and areas of the brain become hypersensitive and go on firing over and over again long after the pain stimulus from an injury has gone.
When does an acute pain become chronic pain?
Technically, pain is considered chronic if it persists for more than three to six months and outlasts the normal healing time of the injury or illness which first triggered the pain.
With chronic pain the relationship between the disease or original injury and the ongoing pain is complicated. When pain has persisted for more than three months, the perception of pain is no longer just about the nervous system – often a complex psychological component develops.
It’s very common for chronic pain sufferers to emotionally and physically withdraw from the relationships and activities around them. Isolation leads to long hours of introspection and almost exclusive focus on their experience of pain. Frequently, resulting anxiety, depression and muscle tension further exaggerate feelings of pain. With the increased pain, less and less ‘normal’ life is possible, and boredom, isolation and loneliness become the norm. As the emotional state plummets and feelings of pain increase, energy levels dive and lack of activity eventually leads to greater and greater loss of physical function. The sufferer becomes trapped in an ongoing pain cycle fuelled by both physical and emotional factors.
How to cope with chronic pain
There are many ways to treat pain. Lady Gaga lives with fibromyalgia, a chronic condition that causes widespread pain and extreme tiredness. Despite the pain being in her body, Lady Gaga has used mental health treatment to help manage her pain.
“Fibromyalgia is essentially a chronic pain condition that makes your body hurt through your brain. Now, someone that might be watching this that has it might be saying, don’t tell me that my fibromyalgia is in my head because my whole body hurts. Even sitting here with you today, I’m in head-to-toe pain. But what’s interesting about it is that I’ve found through neuropsych research and my relationship with my doctors that fibromyalgia can be treated through mental health therapy. And mental health is a medical condition. It should be treated as a medical condition. It should not be ignored.”
“Being free of pain on stage is a real healing experience because I’m able to dance and sing and enjoy the audience, enjoy the show…and really tell a story.”
Manage your stress levels
Chronic pain is inherently stressful. Living with such a chronic stressor leads to greater feelings of anxiety, which in turn exaggerates the perception of pain. Try to manage your heightened stress levels by eating well; getting adequate rest and sleep; avoiding stressful situations and obligations and exercising regularly.
Wherever your thoughts are, so too is your attention and your feelings. It is easy to get trapped in a cycle of persistent negative thinking about your pain, which leads to feelings of sadness, helplessness and frustration. Such a negative mental state in turn increases the perception of pain. Be mindful, focus as much as you can on the small achievements of your day, or the happy and positive things happening in your life or in the lives of those you love.
Engage and distract
Stay connected with people and activities around you. Isolation and loneliness will accentuate your feelings of pain. Even if you are physically limited by your condition try to find an enjoyable activity that allows you to connect with others. If you are physically limited, it may be something such as a Scrabble or cards group, or some sedentary voluntary work.
Reach out and connect with others in a similar situation who will understand your highs and lows.
Even when your pain is severe and ongoing, if you look carefully there will be much in your life to be grateful for. Cultivating feelings of gratitude helps produce relaxing brain chemicals that can reduce feelings of pain. Try starting and ending every day with a 10-minute journaling session focused on events, feelings or observations that you are grateful for.
Learn how to relax and turn off the ‘fight or flight’ response in your body. Progressive relaxation, self-hypnosis, meditation, tai chi or therapeutic massage each help to produce the relaxation response in your body and mind, and in turn lessen feelings of pain.
Chronic pain often causes us to become increasingly sedentary. Staying active as long as possible is vital for managing stress, low moods and pain. Staying active and supple increases pain-killing endorphins in the brain. If you are unable to walk, using an exercise bike, swimming or water walking may be possible.
Depression and chronic pain often go hand in hand. Untreated depression exaggerates the perception of pain. Treating depression through counselling, herbal medicine such as St Johns Wort, or antidepressants if needed, can reduce your experience and perceptions of pain.
Do men and women experience pain differently?
Contrary to the folklore that men are marshmallows when it comes to enduring illness, most studies suggest that women have a lower pain threshold than men and are more prone to chronic and widespread pain syndromes such as Irritable Bowel Syndrome or Fibromyalgia.
Women suffer more from anxiety and depressive disorders, which play an important role in perpetuating and magnifying feelings of chronic pain. Women with chronic pain disorders seem to experience more pain-related emotional distress compared to men, although some researchers suggest this is simply a reflection of the male/female differences in emotionality and expression.
Distraction is a commonly taught technique for dealing with chronic pain. Sex differences influence how effective it is, with women responding to distraction techniques much less than men.
Women are also more prone to getting stuck in a constant cycle of introspective rumination and obsessing over their feelings of pain. Studies suggest that women catastrophise their pain, and feel far more helpless and powerless to deal with it, compared with men.
When it comes to coping with ongoing pain, women tend to be more relational and social than men and more likely to reach out to others for social support and encouragement. In women this connection can help buffer the stress of chronic pain. However, their relational make-up often means that they end up as emotional or physical caregivers for others. This, in turn, can lead to increased fatigue and greater pain.