-Psychological Factors that can Impact Pain: Coping
Persons who have pain can get very frustrated when their medical professionals start talking about psychological and psychiatric issues, when they seek assistance for their pain. And many times, those suspicions on a patient’s part can be quite valid - some medical professionals genuinely do not believe their patient’s reports about their pain, or feel that they are exaggerating. However, clinical research on pain management has clearly shown that addressing psychological factors can significantly improve pain, and a person’s ability to accomplish what they want to accomplish when they are hurting.
What we know about the perceptual systems, or the brain systems that translate experiences into conscious thoughts includes information about how psychological states can significantly impact how we perceive many kinds of stimuli. The classic example is when you put your keys down in an unusual place, and when you go looking for them, you walk into the room where they are but do not see them, because that it not where you usually expect your keys to be. The same principles also apply to pain perception.
Attention: Dissociation (Distraction)
The first psychological issue that applies to perception of pain is simple attention. Things that we do not pay attention to do not register as powerfully in our minds as things we are focused on. When I was training in graduate school for my neurobiology minor in the physiology of pain, my mentor, who was actually the pain who first identified a nociceptor in the surface of the skin and was key in recognizing that nociceptors can actually register many types of information (polymodal nociceptors), when he found out that I had chronic pain issues, his first advice to me was, “I have three words for you - distractino, distraction, distraction.” Even as a medical doctor in addition to his training in research physiology in pain, he openly admitted that one of the most effective ways to deal with chronic pain did not involve procedures or medications, but the simple psychological act of moving attention away from that pain. This principle applies to all sensory systems, but with respect to pain, the ability to engage in pleasurable activities to take your mind off focusing on the pain can provide a very powerful means of modulating the pain that you experience.
The psychological coping strategy association with shifting attention is called dissociation, and what it involves is shifting your attention, and focusing on some other stimulus. The best way to employ this strategy is to engage in activities that give you pleasure, and which are intellectually challenging. One of my favorite ways to deal with severe pain focuses around my passion for reading - losing myself into a good book has always been helpful in reducing the pain that I am experiencing.
Association
Another psychological coping strategy which can be challenging to implement but extremely successful if you can use it, is called association. The opposite of dissociation, association is an active strategy that asks you to focus on the pain you are experiencing, and consciously tell yourself that it is not as bad as it might seem. High level athletes often employ this technique. A champion women’s soccer player at UNC (who went on to become a world cup champion years later), explained this technique to me as when you get stung by a bee, you actively think about how it hurts, but nothing is really long. She said that she would imagine that she was listening to a radio and taking the volume nob and turning it down, literally decreasing the amount of pain that she felt because she recognized that focusing on the pain would not make it any better, and importantly, that even though the bee sting hurt bad, there was nothing really wrong that she could actively fix. This is an advanced technique which I hope we can explore in more detail later, in that it involves addressing cognitive distortions, understanding, and acceptance, in addition to minimizing that pain that you actually feel.
Understanding
A second psychological coping strategy which can be critical in dealing with chronic pain, particularly chronic nonmalignant pain, involves understanding. Do your best to understand why you are hurting, and what strategies you can use to deal with that pain. Many people remain defiant in the face of medical issues, using language about how they are going to “beat it” and “triumph over it.”
Acceptance
This leads us to the next psychological concept, which is acceptance. You are hurting. It is not fair, and it is unlikely you can make that pain completely go away. But you can take active steps, which include medical treatment, taking medications, engaging in physical and occupational therapy, and seeking alternative means of pain management, like accupuncture and chiropractic. Accepting that you have pain does not mean that you surrender to it. It means that your life has changed. You can still have a rewarding life, but that life may be very different than what you had before you began to have chronic pain. Accepting that can provide a key means for you to move forward, to become the best person you can be. You may have limitations, but you need to understand what those are, if you want to try to push against them as much as you can.
Changing Your Expectations
This leads us to our next coping strategy - changing your expectations- again, in our culture, people like to have high aspirations for themselves. We like to dream high, and the truth of the matter is that pain in many ways can keep us from doing the things we want to do. But only in very rare occasions can pain keep us from doing EVERYTHING we might want to do. You need to shift your expectations of what you can accomplish, and approach those goals with baby steps. Again, classical psychological techniques can be your friend here - if you reward yourself each time you achieve one of those small goals, you will be more likely to set new goals, and attempt those. Also, you have to be able to cut yourself some slack - some days, you will want to get things done, and you simply will be hurting too much. But focus on what you CAN do, rather than what you cannot do. I say this as a die hard cynic and pessimist for most of my life. When it comes to coping with pain, allowing yourself some flexibility can make a tremendous difference in what you can actually accomplish. People who have unreasonable expectations that they continue to fail to meet can fall into patterns that can result in depression and anxiety. And research again clearly indicates that having realistic, achievable goals can improve your mood, as well as your ability to actively deal with your pain.
Calming and Relaxation
Finally, one of the most effective coping strategies for dealing with pain involves calming and relaxation. One of the most dangerous psychological strategies for dealing with pain involves catastrophizing, or blowing things out of proportion. Some people when they have pain over-react to that pain, focusing on that pain, which can significantly increase the amount of pain you experience. When your heart rate increases, your blood pressure increases, your breathing rate increases, and your muscles tighten, this can lead to panic response, which genuinely can increase the pain that you actively experience. Any methods to prevent those physiological stress reactions can help you reduce the pain that you feel. Ways to assist with calming and relaxation can include mindfulness, addressing cognitive distortions and irrational thoughts, and meditation techniques.
Balance
Any way that you can provide balance to your life can really help you deal with your pain. Many people who are hurting tend to focus their entire lives on an unwinnable battle, in that most types of pain cannot be completely eliminated. Many times, the best result you can expect is to reduce the pain you feel, and through that increase your levels of activity and your ability to do the things you really want to do. Taking active steps to take care of other aspects of your life, including your relationships, hobbies, and professional issues, can again improve your ability to live better with your pain.
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