As you may know, 1 of my all-time favorite websites isI Can Haz Cheezburger, where it’s imagined what cats are really saying. The picture above got me thinking about the 2 extremes of handling pain. There are those who do too little for themselves, and who let their pain control their activities. And there are those who do too much, who won’t “give in,” who have problems accepting help.
The picture above certainly illustrates the “do too little” tendency. Readers, which side of the see-saw do you tend to come down on?
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Today’s my birthday! Readers, how do you celebrate special days and events, even with pain?
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Welcome to the continuing series Why You Should See a Pain Management Psychiatrist. This week we’ll look at how supportive therapy can be useful to you.
Supportive therapy consists of helping people cope with a difficult situation through listening and support, problem-solving, and instilling hope. Supportive therapy can be helpful in many ways to patients with pain.
1. Telling your story Chronic pain is, for many, a life-changing situation. Research by Viederman and others has shown that telling your story to someone who listens, cares and responds is important. In addition to concrete help, exploring how a life-changing situation fits in with the rest of your life is beneficial. “Life Narrative” work has been done with patients with cancer and is very positive.
As well, sometimes your friends and family give the message that they don’t want to continue hearing about pain and its consequences. Having a place to talk about and make sense of your experiences is necessary, and can happen in supportive therapy.
2. Ongoing adjustment
With chronic pain, you don’t adjust to 1 situation and then go about your life. Chronic pain usually requires on-going adjustment, as your condition changes. As well, your life changes, and your pain will impact your life differently at different points.
For example, when you have little kids, not being able to do some activities with them can be discouraging and require creativity to work around. In contrast, when your kids are older, they may require less physical interaction. But then, perhaps, the financial stress of your not working may affect your family more. Having a place to work through some of these issues is important.
3. Family support As you know, your pain affects not just you but your family and friends. Having your family get support during difficult times is useful, too. In my practice, I often see not just the person with pain, but a spouse or family, too. A good resource for families is: Surviving a Loved One’s Chronic Pain.
Readers, in what ways have you found supportive therapy helpful?
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I’m continuing a new format for our monthly pain-blog carnivals. Instead of submissions, I’m featuring some of my favorite posts from great blogs. I hope you find these helpful to read.
That’s all for this month. Hope you have a moment to sit back and enjoy some of the writings. The next edition of the Pain-Blog Carnival will be July 29.
For even more reading, stop by Florence Dot Com for this week’s Grand Rounds, a medical blog carnival.
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Welcome to the continuing series Why You Should See a Pain Management Psychiatrist. This week we’ll look at making changes in how you see your pain condition and the disability it causes.
When you experience ongoing pain, both the pain itself, as well as the changes it causes in your life, are challenging to cope with. People often experience loss - loss of:
good health
being pain-free
doing enjoyable activities with family and friends
going to work
hope or spirituality
Many go through the “Stages of Grief,” which are:
Denial - you can’t believe this is happening to you
Anger - that so many negative changes are occuring
Bargaining - you’d do anything to get back your previous life
Depression - difficulty coping, and mourning for the loss of your pain-free life
Acceptance - coming to terms with pain and the changes it brings
These stages are a process, a working through, and for many, are slow. And I believe that to move forward, you often must first recognize and mourn for what you’ve lost.
Let’s look more at acceptance, acceptance of both pain and the changes in your life.
Acceptance is: 1. No longer struggling with pain. You might say, “I don’t like this, but I accept it.”
2. A realistic approach to pain. You might say, “I’ll put realistic energy towards getting better.”
3. An engagement in positive everyday activities. You might say, “I’ll put my energy towards my life.”
Is this worthwhile to work towards? Yes! A pain researcher, McCracken, has shown that - no matter what level of pain intensity - greater acceptance of pain all by itself predicts:
lower reports of pain
less pain-related anxiety and avoidance
less depression and disability
better work status
How can you move towards acceptance? Again, the process is often slow. What I’ve found to be helpful is:
1. Grieve for what you’ve lost
2. Mindfulness training = acceptance of what is
3. Have a goal of living a full life despite pain
To read more about acceptance, here are several other How to Cope with Pain articles:
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I’m sharing relaxation ideas from YouTube on Fridays. I hope you try and enjoy them!
Today’s video is from iSSerDc, featuring one of my favorite musical pieces, Pachelbel’s Canon.
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I asked a new physical therapy colleague of mine, Chad Durboraw, to write about his perspective on chronic pain. Of particular interest for those in the NJ/PA area, he offers education group sessions for patients to learn about pain. Chad writes:
Persistent Pain and Neuroplasticity: A Physical Therapist’s Perspective
My name is Chad Durboraw, PT, OCS. I’m a physical therapist with a special interest in treating patients with persistent pain conditions. When treating persistent pain, we must take into consideration the phenomenon known as neuroplasticity. Neuroplasticity is defined as the changes that occur throughout the nervous system. In persistent pain conditions, neuroplasticity can contribute to the increased arousal of the nervous system. This creates an environment in which the nervous system may overreact to innocuous stimuli such as movement, touch and changes in temperature.
The good news is that we have the ability to harness neuroplasticity to restore the function of the nervous system. Research supports that the chemistry of neuroplasticity is enhanced by movement, especially movements that are novel, fun and demand our attention. These are the types of movement strategies, along with an “Explain Pain” education program, that I employ as a physical therapist for patients with persistent pain.
The programs that I offer are based on the latest research about the neurophysiology of pain as described by some amazing colleagues in the physical therapy profession such as Lorimer Moseley, David Butler, Neil Pearson and others. Their work has demonstrated the importance of understanding the changes that occur throughout the nervous system in those in persistent pain. When treating patients with persistent pain, an understanding that their nervous systems should be the primary target for treatment is certainly a new paradigm that a majority of therapists are not aware of.
At my clinic, I offer informational seminars based on the principles of Lorimer Moseley and David Butler’s work in their book “Explain Pain.” I cover the latest research that pertains to pain neurophysiology. I go over:
the processes that occur in the nervous system that makes it more sensitive to movement and touch
the changes that occur in the virtual body map of the brain
how thoughts, attitudes and beliefs about pain and its meaning influence our experience of pain
the ways in which persistent pain affects a host of body systems, including the immune, endocrine, and neuromusculoskeletal system
Once patients learns how persistent pain can affect their mind and body, I then educate them about strategies to help them take control of their pain. As their therapist, I feel it’s my role to help the patient reconnect with their own mind and body, and to facilitate an environment for their nervous system to adapt in a positive direction. I find that teaching them ways to down-regulate their nervous system is very helpful.
To begin, I teach relaxed breathing techniques that help calm the nervous system. Then I move into teaching body self-awareness. I want to teach them how to feel their body again, how to reconnect the body and mind with various movement strategies. These techniques, along with manual therapy, helps to facilitate a connection with the nervous system and promote neuroplasticity.
Thank you for allowing me to share my philosophy of treating persistent pain conditions.
Thanks very much to Chad for his perspective. Readers, you can write your thoughts in the comments section below. If you’d like to contact Chad directly, or for information about his educational classes, his email is: durboraw@gmail.com.
Grand Rounds, a weekly medical-blog carnival, is up this week at ACP Internist.
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Welcome to the continuing series Why You Should See a Pain Management Psychiatrist. This week we’ll look at what kind of behavior changes can help you live better and get better.
1. Support your doing positive activities
It’s important that you keep up activities when you have chronic pain. A pain management psychiatric will help you with pacing, which is not doing too much nor too little. A clever idea is using the concept of $1 to help you pace yourself. You’ll also be learn how you can get yourself to regularly do your assigned physical therapy exercises.
2. Alter old activities or choose new ones
A pain management psychiatrist will work with you to figure out what activities you can do, what you should avoid, and, if you need to, how to replace or alter favorite activities so you can still do them.
Let’s say you love gardening, but you can’t do as much as you once did. It’s important not to drop something you really enjoy. So figure out what aspect of gardening you love. If it’s seeing green by your front door, try container gardening instead of doing the whole backyard. If it’s being outside, garden for 15 minutes instead of 5 hours, then sit in or walk through a garden to enjoy the outdoors. You get the idea - alter what you need to, so you can continue to enjoy your favorites.
These changes in behavior help in several ways:
you focus on what you can do
you avoid having pain determine what your life is like
you focus on living, rather than pain
your nervous system benefits, too, by having signals from normal activity compete with pain signals
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As most of you probably know, there is a great deal of advertising to doctors to try to get us to choose one medication over another. Finally, medicine is shifting away from this practice, as we doctors come to realize that much of it is not in our patients’ best interest.
More and more medical schools are banning the practice of drug reps visiting doctors to encourage the use of their particular medications. U Penn was one of the 1st medical schools to limit this common tradition. My national medical organization, the American Psychiatric Association, is now phasing out pharmaceutical and other health industry sponsorship at our annual meetings.
No more lunches. No more pens. And although I was tempted, I just declined a drug-sponsored dinner at Philly’s fanciest restaurant, Le Bec Fin. I’m actually very happy about this shift away from drug company influence. Doctors can now better treat patients based on medical evidence and without possibe conflicts of interests.
I guess I’ll just have to get my husband to take me out to that chic French restaurant for our anniversary instead!
Readers, any thoughts pro or con on this change in medical practice?
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