Chronic pain management

chronic pain1

Researcher’s and practicing clinicians have now come to understand that the on- going chronic pain is related to a phenomenon that occurs in the nervous system which involves the conditioning or sensitization of the nervous system

Chronic pain affects some 100 million Americans and puts some people on permanent disability. Chronic Pain has been defined as pain that lasts 3-6 months beyond the original injury. Typically there is little that can be done medically to end or resolve the pain. Many of these patients were treated with increasingly stronger dosages of opioid analgesics.  The problems that have arisen with the continued use of analgesics has become obvious in the last 10 – 20 years. Addiction problems, depression and suicide have become epidemic. It now has become relevant for nonpharmaceutical treatments or minimal pharmaceutical treatments to assist these patients to have some improved functioning.

Researchers and practicing clinicians have now come to understand that the on- going chronic pain is related to a phenomenon that occurs in the nervous system which involves the conditioning or sensitization of the nervous system. The person suffering with pain has become highly attuned to any little pain signal or anticipation of a pain signal that can set off the alarm in the Sympathetic Nervous System (SNS). This system has been referred to as the “fight, flight or freeze system” because it serves as a signal that some danger or potential injury is threatening the person. This built in alarm cautions us to take action to prevent injury or harm. The difficulty is people with chronic pain cannot “flee” or escape from their pain. Yes, alcohol and drugs can be used but unfortunately with deleterious consequences because of the potential for building tolerance and then addiction as stronger and stronger dosages are required for analgesic relief.

When a patient’s nervous system becomes conditioned in this way the process is called Central Sensitization. It is a condition that can be diagnosed and an actual scale has been developed to asses this disorder. It is also common that these patients suffer with depression partly due to their tendency to catastrophize the perception of even minor body sensations. Cleary if someone has had chronic impingement or herniation of vertebrae in the spine some new sensation can ignite a sense of fear and panic that “oh no here we go again” with the onset of more pain and suffering.

Because of this tendency patient’s who are afflicted in this way develop severe clinical depression which exacerbates their pain and anticipation of more pain and suffering. It is because of this process that psychologists in the treatment and management of chronic pain now use Cognitive Behavioral Therapy (CBT) as a way to make inroads into the faulty narrative that chronic pain patients suffer with. The CBT therapist assists patients in identifying the cognitive distortions that are underlying many of the perceptions they have of everyday life.

It has been demonstrated that the use of mindfulness meditation is effective in helping patients to become expert in catching the negative self- talk and distortions they operate with.  Mindfulness also assists in relaxing the patient by accelerating the parasympathetic response. Patients can and do find comfort in working with concepts of impermanence and self-observation which assists them in exiting the catastrophe paradigm and recognize that it will pass or change in some way.

When patients suffer with chronic pain and depression there are typically sleep problems. The use of meditation and gradual relaxation through a body scan process has been helpful to manage sleep better without medication. When patients start sleeping better and they can get there head out of the dark clouds of negative self-talk they are then more willing to engage in some nonthreatening activities and even mild movement which gives them a sense of achievement and will actually help with pain and reducing body tension.

Patient’s with movement or energy limitations due to chronic pain have been encouraged to practice a system called the “spoon theory” of energy conservation which suggests that patients alot themselves 5 spoonfuls of energy per day and that they should use their spoons wisely to not deplete themselves in one small time period when they are feeling good and then feel depleted the whole rest of the day or the next day. Wise discernment of how to use energy is called for so some activities are allowed but not to the point of exhaustion.r