Chronic pain

“Chronic pain” means it’s been there for months to years. Assuming you’ve either tried many pain medications or have chosen to bypass that route, there are many things you can do to both “manage” the pain better AND to truly diminish and sometimes eliminate the pain. By “pain” I mean both the intensity of the sensation and its complex effects on your behavior, your feelings, your attention, and your functioning. All of these can be altered so that pain becomes less of a problem.

The tools for doing this include cognitive change, mental techniques, imagery, behavior change, hypnosis, and biofeedback. These are all useful, and give you more power to intervene in your own pain. They do, however, call for some time and practice.

Biofeedback involves measuring what the body is doing, and displaying the information, like a mirror. Here is a sample of muscle activity from the lower back of someone with left-sided back pain:

emg-trace-jpegThis example doesn’t apply to everybody with back pain, but it does show how biofeedback instruments can detect patterns in the body that may correlate with the pain site, and then be used to gain control — in real time — of what’s happening.

Controlling attention is another way to improve the pain experience. Many people with chronic pain develop a negative loop between focusing on the sensation and feeling distress. The instinct is to pay attention to something that hurts, but with chronic pain, it usually leads to pain just being more noticeable. There are ways to change this situation.

Hypnosis is usually worth trying also, in order to learn self-hypnosis. This technique can alter attention, sensation, emotional response (anxiety vs. indifference, for example), and to some extent the physiology itself. People vary in capacity to respond to hypnosis, but most people have more ability than they expect.

My role in all this is, first, to help you select one or another of these techniques, and then coach you to develop the change you want. The way you react to pain is of prime importance, and can make things better or worse. For example, constant “catastrophizing” — letting your mind leap to the worst possible predictions — really does increase your suffering, in part through biochemical  pathways. If you can make your pain worse by thinking the worst, then you can learn to do the opposite.