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Dealing with pain
Dealing with pain
Vast improvements have been made in our understanding of chronic pain. BeWell spoke with the team at Stanford’s Systems Neuroscience and Pain Lab (SNAPL) about what we’ve learned and how we can use that information to better manage and cope with chronic pain.
What are the major types of chronic pain?
Almost any type of pain can become chronic, but some of the more common and most burdensome chronic pain conditions include low back pain, fibromyalgia, headaches and migraines, complex regional pain syndrome, and pelvic pain disorders.
Has our understanding of pain changed in the last decade?
We now have a better understanding of how the nervous system can process pain signals abnormally, which can lead to persistent or chronic pain. We now realize that pain management is impacted greatly by the social factors in how people perceive and cope with their pain. For example, it has been shown that physical pain and pain that is more social in nature (such as interpersonal rejection) share common neurological pathways. This research, coupled with the common complaints of social conflict, highlight the importance of social support in understanding how people cope with chronic pain.
We also know that unhealthy psychological reactions to pain can worsen emotional distress, and may also affect responses to medical intervention, such as surgery. This has led to a much stronger emphasis on addressing emotional factors when treating chronic pain. Similarly, we have begun to understand how some factors, such as personal goals and positive emotions, can help people with pain continue to function and cope effectively.
We still have a poor understanding of which individual will respond to one type of treatment over another. SNAPL is working to understand this problem in order to more effectively tailor the interventions which we can offer people suffering from pain.
Is there a relationship between pain and our thoughts/emotions?
Yes! The way people think and feel about their pain as it is occurring can have an impact on their pain experience. Pain is both a sensory as well as emotional experience; they are inseparable by nature.
Pain psychologists will often say that pain is comprised of three components: a sensory component, an emotional component, and an evaluative component. Sensory aspects of pain indicate where the pain is located and what it feels like. For example, it feels different to twist your ankle than it does to burn your hand on a stove.
It is also important to understand that all pain has an emotional component. No one experiences pain without some type of emotional reaction; we know that pain increases the likelihood of feeling angry, afraid, frustrated, or depressed. We also know that ongoing emotional states can change the perception of pain; when people are already feeling afraid or sad, they are more likely to interpret the same sensory experience as more painful. Alternatively, those people who maintain more positive emotions show less nervous system response to pain, rate the same pain stimulus as less painful, and are able to continue to function more effectively despite the presence of pain.
We also know that pain is an effective teacher, which is the “evaluative” component of pain. Pain, in its acute form, is theorized to keep us safe; it is what keeps us from walking around on a broken leg, or keeping our hand on a hot stove. This is useful when pain is signaling a new or dangerous situation for the body. However, pain can also teach us bad habits that are detrimental when pain is chronic. For example, one of the typical responses to a painful episode or injury is to rest and stop activity. While this is completely adaptive and reasonable for the short-term (or acute phase of healing), the problem with continuing with this approach of inactivity in the long-term is that it leads to deconditioning and weakness — which can delay recovery of function.
Therefore, it is important to take a multifaceted approach not only to the experience of pain itself, but also to the behaviors and emotions that are associated with pain.
Is understanding how you mentally interact with your pain just as important as how you physically interact with it?
Individuals have different ways of coping with pain. Some behaviors have been shown to be detrimental, such as avoidance behaviors (for example, not rehabilitating an injured limb). However, you can learn different techniques to help manage your response to pain in a more positive and constructive way. These include treatments such as MBSR, CBT, or cognitive regulation and attention regulation, which help one to use one’s mind and thought processes as a pathway to manage and cope with pain.
For many, it is counter-intuitive to think of physical activity as a recommended treatment for pain. Should we change our thinking about this treatment choice?
Increasing physical activity, despite the pain, has been shown to reduce the disability associated with the pain state, while enhancing function and emotional well-being. Exercise helps improve strength, which contributes to pain relief and improves physical function. For some types of acute back pain, the discomfort is largely associated with weak back and abdominal muscles. However, there are exercises that target and strengthen these areas, decreasing the pain felt from certain everyday behaviors (such as sitting in a chair at a computer). Physical activity also helps improve mental health, which in turn helps one deal with the pain.
Returning to physical activity also has other benefits for people dealing with pain. For example, one of the strongest predictors to later disability in chronic pain is a fearful or catastrophic view of pain, which can lead to other unhealthy responses — such as overusing pain medication or avoiding healthy behaviors such as working or exercise. Physical activity helps to address this fear and anxiety by helping people with pain understand that pain does not always equal a damaging or dangerous situation.
Physical activity also has the added benefit of improving other factors important in recovery from pain, such as decreased depression and improved quality of sleep. Physical activity can also lead to weight loss, another important aspect of managing chronic pain, as weight loss can help reduce the stress load on your back and joints.
Are there broader choices for pain management other than medication?
Absolutely. Pain medication can be one of many helpful tools, but it is treating the symptom rather than the cause of pain. Plus, pain meds often come with other costs, such as unwanted side effects.
The best evidence for the treatment of pain indicates an interdisciplinary approach involving physicians, physical and occupational therapists, and psychologists. Medication is often not enough to effectively treat a person with pain. We therefore need to have a wide-ranging set of tools that can help people manage their pain in the most effective way.
For some people, this may involve seeing a psychologist to address emotional struggles related to pain or developing strategies for pain management that can be used, with or without the use of pain medication. For others, strategies to address their fear of movement or existing difficulties with physical weakness or imbalance may include treatments such as physical therapy.
Can you provide a brief description of your research program?
At SNAPL, we study many types of pain conditions, and partner closely with both the Pain Clinic and other basic science labs to further our understanding of pain.
Our biggest study currently is the Stanford Complementary and Alternative Medicine (CAM) Center for Chronic Low Back Pain, which is a collaborative and multidisciplinary research program. The Center aims to understand how different CAM therapies work for chronic low back pain (CLBP). We are studying several research treatments:
- Real-time functional magnetic resonance imaging (fMRI) to address mental processing of pain and the resulting brain activation;
- Mindfulness based stress reduction (MBSR) and cognitive behavioral therapy (CBT) to manage chronic low back pain;
- Acupuncture’s underlying mechanisms in the treatment of chronic low back pain compared to the effects of placebo acupuncture.
This is one of many studies we are doing to explore treatments to improve pain outcomes.
In addition to working with patients with pain, we always need help from people without pain to act as controls. If you or someone you know would be interested in getting involved in pain research, get in touch and we can discuss specific studies you may be interested in!
For more information: visit snapl.stanford.edu.
Interview conducted by Julie Croteau and edited by Lane McKenna Ryan.
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