Here’s a very interesting new study of a movement therapy for pain. Dr. Moseley at Oxford studied a specific sequence of thinking about movements and actual movements that seems to lessen pain and increase function. This treatment is very exciting work for several reasons:

• it lessens pain
• it increases functioning
• it helps in difficult-to-treat conditions like CRPS (RSD) and phantom limb pain
• it doesn’t rely on medication or invasive procedures

Patients in the study went through the following sequence:

1. Looking a pictures of hands and feet, and determining if each picture was from the right or left side of the body.

2. Imagining moving their hand or foot into the same position as each picture.

3. Actually moving their hand or foot into the same position as each picture.

As in all treatment I write about on this blog, this is NOT something to try at home. In previous studies of Dr. Moseley’s that I’ve read, for example, patients experienced increased pain if the treatment was out of a particular order. So this treatment is to be undertaken only under a doctor’s guidance; it’s not harmless because it’s “just moving.”

The decrease in pain seems to come from a re-training in your brain, having the brain focus on normal movements rather than pain signals. But the exact way it works isn’t known. If you’re interested in reading the study, it’s published in Neurology, Volume 67, Issue 12, page 2129, 2006.

Family Issues #2

Today’s post is the second in our series about family issues and your pain.

Is the pain all in my loved one’s head?

Chronic pain is rarely imaginary (psychogenic) or simply a way for your loved one’s psychological problems to come out. Even if a patient is referred to a pain management psychiatrist or psychologist, this rarely means they’re imagining pain. The pain is real. However, negative emotions such as depressed mood, anger, or anxiety can play an important role in making pain worse.

For example, anxiety or anger can cause an increase in muscle tension leading to more pain. Post-Traumatic Stress Disorder (PTSD) causes one’s nervous system to become very sensitive and can make it harder to recover from a physical injury. Certain types of personalities may find it more difficult to cope with pain and/or the losses and disabilities it brings. For example, some people get much of their self-esteem from working and can’t tolerate being disabled.

Could they be faking it, say, to get out of work?

Faking pain, on purpose, to get out of something or to get a reward is known as malingering. While it does occur, it’s rare. Most patients feel very guilty about not being able to do the things they used to do, whether working at a job or taking care of their family around the house. Very few patients with pain make more money out of work than working. Most suffer severe financial losses.

Unconsciously producing symptoms to get rewards or get out of unpleasant things is called “secondary gain.” It’s rarely the cause of someone’s pain, although it sometimes may reinforce a negative situation. For example, someone on disability may fear vocational training because they’re afraid to lose their income, in case going back to work doesn’t work out. For some, there may be positive outcomes that make it easier to accept one’s situation. However, for most pain patients, the losses far outweigh the gains. Remember, this is a family challenge, not just an individual one. Try to see it as one that you’ll face together – ‘we,’ not ‘he’ or ‘she,’ will fight this together.

Pain conditions affect not only patients, but family, friends, co-workers, etc. I’ve co-written a handout to provide information for family members and to help them with what they’re going through. You’re invited to copy these posts and discuss them with your loved ones.  Please see all the links below for topics.

Family Issues #1

What is chronic pain?

Chronic pain is pain which persists beyond the time usually required for the healing of an injury or illness. Some definitions set a specific time period, for example, pain which lasts longer than three months or longer than six months.

How is it different from acute pain?

Acute pain is what most of us are familiar with. It’s what happens when you twist your ankle or burn your fingers on the stove. It’s a signal that tissue damage is happening. While it may be severe, it’s time limited and responds to appropriate treatment.

Chronic pain is different. It may occur without ongoing tissue damage. It’s what happens many times when nerves get injured (known as neuropathic pain). Examples include shingles (postherpetic neuralgia), diabetic neuropathy, and Complex Regional Pain Syndrome (CRPS, also known as Reflex Sympathetic Dystrophy, RSD).

It’s difficult (or impossible) to imagine that someone can be in severe pain continually if one hasn’t experienced it. It’s normal for family members not to understand it if you haven’t lived through it. It may also be hard to stand by and accept that your loved one’s pain can’t be fixed or cured (although it may be eased and the suffering associated with it may be reduced). It may also be hard to accept that you can’t make it better.

How am I affected by their pain?

If you’re in a close relationship (spouse, significant other, parent, child, sibling or even close friend) with someone with chronic pain, you’re likely to develop a variety of negative feelings as a result. For example, you may feel guilty at times for not being able to help them more. You may feel angry at them if they’re irritable or withdrawn. You may resent having to take over tasks they previously performed. You may feel depressed as a result of a withdrawal of affection or a decline in your sex life. You may get anxious about financial problems which result from your loved one’s disability. You may feel stressed by the reactions of others. For example, relatives or neighbors may say “He (she) doesn’t look that disabled to me” or “Should she (he) be taking that addictive pain medication?” In fact, both you and the family member in pain are victims of the pain problem, as are those others who are part of the family (and this applies to close friends too).

You may experience significant lifestyle changes. You may have to live on a reduced income or have to work harder to stay afloat financially. You may have to spend time getting your family member to medical and to other appointments if he or she can’t drive. You may end up doing most or all household chores and childrearing activities. You may have less time for friends and experience reduced social support.

You may experience intrusions into your life from outside agencies. For example, some insurance companies (primarily workers compensation) may follow or film your family member. You may be stressed also by lawsuits, disability evaluations, or independent medical examinations (IMEs).

You may also experience some positive outcomes, although this is less common. For example, if your spouse was controlling, you may actually have more freedom. If you have very strong needs to help others, you may feel good about needing to help your loved one so much. If you were experiencing intimacy with your loved one (including sex) as unwanted, a decrease in intimacy may feel positive. You may get additional support or sympathy from other family members. These positive outcomes can lead one (not always intentionally) to try to keep the situation as it is. These have been referred to as “tertiary gains.” Being aware of these can help you identify more effective ways of dealing with problems in your relationship.

If you’re the spouse of a patient with pain and you have children, you may worry about the effect of the pain on them. Children may blame themselves for their parent’s pain. It’s important to let the children know it’s not their fault. They may also get depressed about the loss of attention and affection from the parent in pain or from the loss of activities due to financial limitations.

* * * * * * *

Family Issues #2:  Is the pain just “in her head”? Is he just faking this?

Family Issues #3:  Family members need to take care of themselves too

Family Issues #4:  Tips for talking to a person in pain

Family Issues #5:  Medications for Pain

Family Issues #6:  What helps besides medication?

Family Issues #7:  How to tell how my loved one is doing

Family Issues #8:  10 things those of us in pain would like you to know

How to help your family cope

You need to continue to do your hobbies, to exercise, to do things around your home to stay active despite your pain. Some of you might need to watch out for a tendency to avoid these things for fear of causing pain. However, some others of you might instead need to step back from overdoing activities, which prevents your body from getting the rest it needs to heal.

Here’s a technique to help you stay in control of your pain, and balance activities and rest.

The $1.00 Technique

1. What Activities?
First, discuss with your doctor what types of activities you can do and for how long.

2. Experiment with Activities
Next, experiment with different types of activities and different lengths of time doing these activities. You want to see if, and by how much, your pain increases when you do certain things. Your goal is to do as much activity as possible, even if your discomfort increases somewhat, but not to the point of higher and higher pain levels as days go by. For example, let’s say you start Monday morning at a pain level of 5, and by the end of the day, your pain level is 7. That’s okay, as long as by Tuesday morning, your level is back to 5 again.

3. $1.00 Worth of Activities
After experimenting, you’ll have a better idea of the amount of activity you can do. Assign that amount of activity $1.00. Now each day you can “spend” $1.00.

4. Be Creative – and Careful – with Your $1.00
So, you have $1.00 each day. Let’s look at some examples.

If you garden for 3 hours in the morning, and this spends 75¢, you know you only have 25¢ left for the day. So you can’t garden for another 3 hours in the afternoon. But perhaps you can walk at a slow pace with your family for 30 minutes.

If you have an event you want to go to at night, and you estimate that this event will spend 80¢, you’ll need to take it easy during the day, so you’ll have enough reserve for the evening.

At times you’ll go over your $1.00 on a given day. But then recognize that either the day before, or the day after, you’ll have to take it easy. Maybe you can save up 50¢ from the day before, and use 50¢ from the following day, so you can do more than usual. For example, if you have friends visiting on Saturday and you’ll be doing a lot, plan for this. You might take it easy on both Friday and Sunday. You might also be in more pain than usual at the end of Saturday during their visit, but you’ll have a plan to manage that.

Sometimes Being in More Pain is Worth It…
You’re deciding what to do, rather than your pain dictating what you do. There are many things that are worth more discomfort – you decide what they are. You’re balancing activities with rest. By using the $1.00 technique, you also have a way to keep track of your pain levels across the day and across several days.

5. Earning Money to Add to Your $1.00
You also have ways to add to your $1.00 by using all the pain management skills you know. Perhaps some quiet time in the afternoon will bring your pain levels down. Do a relaxation technique. Talk with a friend. Take a bath. Do a guided imagery. Watch a funny movie. If your pain levels go down, you’ll have more activity “money” to “spend.”

Once again, your goal is to live your life as fully as possible, despite having chronic pain. Happy spending!