Opioids are certainly in the news. The US Surgeon General recently issued a statement on the relationship between their widespread use for chronic pain and the subsequent epidemics of opioid addiction and accidental overdose (US Surgeon General, 2016). The US National Institute for Drug Abuse and Centers for Disease Control have also issued concerns (see here and here, respectively). Mainstream media reports on the problems of opioids appear almost daily.
After a couple of decades of strong proponents and persistent messaging on the benefits of opioids, the tide of public opinion and the opinion of health experts seems to be turning against the widespread use of opioids for chronic pain.
Among people with chronic pain who use opioids, this change in perspective on the use of opioids can be alarming. For about two decades, people with chronic pain have been encouraged to take opioid medications. Many have subsequently come to rely on them. Some may have even come to believe that it is impossible to manage chronic pain well without the use of opioid medications.
We now face a dilemma in the management of chronic pain. We have strong proponents for the use of opioids and strong proponents against the use opioids. Both sides have valid concerns that lead to their respective positions.
Often, the sides in this dilemma seem to get expressed in untenable ways. It’s as if the stakeholders in the field have to choose between two bad options: either you take opioids on a chronic basis and expose yourself to the risks of addiction and accidental overdose, which are actually occurring to people with chronic pain at epidemic proportions; or don’t take opioids, remain safe from addiction and accidental death, but expose yourself to pain, which may be intolerable. Healthcare providers seem to face a corresponding dilemma: either manage patients on chronic opioids while exposing them to addiction and accidental overdose or refrain from opioid management and expose them to what might be intolerable pain. Whether patient or provider, both options seem bad.
Is there a third option?
There is another way, of course. It’s called chronic pain rehabilitation and it effectively shows people how to successfully self-manage chronic pain without the use of opioid medications. Chronic pain rehabilitation clinics have been around for three to four decades. However, it’s hard to get people to go to them. It’s not because they are ineffective. Research over the last four decades shows clearly that they are effective (Gatchel & Okifuji, 2006; Kamper, et al., 2015).
Managing pain without opioids
People who’ve been managing their pain with opioids are often a little leery of recommendations to go to a chronic pain rehabilitation clinic. The recommendations seem to run counter to much of what’s been previously recommended throughout the long course of care for their chronic condition. After years of recommendation and encouragement to take opioids by some providers, it’s hard to understand why other providers might recommend and encourage the exact opposite. Maybe they are recommending learning to self-manage pain without the use of opioids because:
- They don’t believe my pain is as bad as it is.
- They think (wrongly) that I’m addicted to opioid medications.
- They think my pain is all in my head.
- They just want to make money off their program that they are recommending.
- They are ignorant of what’s most effective for chronic pain (i.e., they don’t know what they’re talking about).
- They are not as compassionate as the previous providers who recommended opioid management.
In all these concerns, people become leery of a recommendation to forego opioids because it’s hard to believe that the recommendation is being made in the best interest of the patient. It seems that relief of pain through the use of opioids is what’s best for the patient and anything that runs counter to that recommendation must be in the best interests of someone else.
Moreover, it’s a sensitive topic. Let’s face it, no one feels especially proud of managing their chronic pain with opioids. Rather, people with chronic pain do it because it seems a necessity – they believe that the pain will be intolerable without opioids. The recommendation and encouragement to take opioids by healthcare providers and by society, more generally, is helpful in this regard. Such encouragement supports the decision to use opioids, one in which there’s always been some ambivalence. Again, no one is exactly proud of taking opioids for chronic pain; upon reflection, there is always some degree of doubt or concern about their use that leads to a sense of vulnerability and sensitivity. It’s helpful to have others, especially healthcare providers, recommend and encourage their use.
When, however, other healthcare providers recommend against opioid use and encourage learning to self-manage pain instead, it can sting because it taps right into the inherent sense of vulnerability and sensitivity that occur when taking opioids.
It’s hard to see a healthcare provider as acting in the best interest of patients when they openly question the issue that can be so sensitive. The recommendation to learn to self-manage pain without the use of opioids shines a direct light onto the inherent sense of vulnerability or shame that so many feel when using opioids for the management of chronic pain.
The recommendation inadvertently breaks all the tacit rules that healthcare providers (and pharmaceutical companies) have heretofore been following. The rule up until now has been to reassure patients that it’s okay to take opioids for chronic pain. Over the last two decades, the field has asked patients to trust these assurances that they shouldn’t be ashamed of their need for opioid medications. Now, the field is changing and has begun to question the need for opioids. In so doing, we break the trust of patients who have been on opioids for some time: we expose them to potential pain, but also the shame that heretofore we alleviated with assurances that taking opioids is okay. It’s no wonder that patients are now upset.
In a microcosm, it’s this dynamic that occurs in the offices of chronic pain rehabilitation clinics everyday when, after the initial evaluation and recommendation to participate in the therapies of the clinic occurs, patients leave and refrain from accepting the recommendation to learn to self-manage pain. Such patients are doubtful that it will work and are afraid of the pain that would ensue if it doesn’t. Moreover, though, they tend to leave feeling somewhat ashamed that the provider so openly talked about the fact that they could learn to self-manage pain without the use of opioids. Providers are supposed to provide reassurance that it’s okay to be on opioids, not question their use.
Even when it’s well-informed and done in the best interest of the patient, the recommendation and encouragement to learn to self-manage pain without the use of opioids can be heard as a subtle yet stinging rebuke because of the inherent sensitivity that occurs when taking opioids for chronic pain.
How, then, do we bridge this divide?
The Institute for Chronic Pain has a new content page that may play a small role in such bridge building. When patients come to chronic pain rehabilitation clinics for the first time, they may have never had an experience of a provider talk to them about self-managing pain without the use of opioids. As we’ve seen, it’s a complex and sensitive interaction that occurs under the surface of the words that are spoken. It can be a lot to take in. It can feel like the rules are being broken. As we’ve seen, it can be easy to become angry and accuse the provider of incompetence, ill-will or insensitivity. Oftentimes, people need a little time to reflect on the discussion and talk it over with their loved ones. No one comes lightly to the decision to taper opioids and learn to self-manage pain instead.
The new content page provides assistance with this reflection. The hope is that patients can use the information on the page to further reflect on if and when it may be time to begin learning to self-manage chronic pain. Providers can refer their patients to the page too, ask them to read it, and come back for further discussion.
For countless people over the last four decades, chronic pain rehabilitation has provided hope and a way to take back control of a life with chronic pain. However, it must be approached with sensitivity and compassion. Initially, the idea that one can successfully self-manage chronic pain without the use of opioid medications can be threatening, especially for those who have been managing pain with opioids for some time and for those whose providers have long provided reassurance that it’s okay to take opioids. Nonetheless, if your providers have recently begun to express concerns about the long-term use of opioids or if you yourself have concerns about their long-term use, you might find it helpful to read the new ICP page on the common benefits of learning to self-manage pain without the use of opioid medications.
You can find the new page by clicking on the link here.
Gatchel, R. J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic non-malignant pain. Journal of Pain, 7, 779-793.
Kamper, S. J., Apeldorn, A. T., Chiarotto, A., Smeets, R. J., Ostelo, R. W., Guzman, J., & van Tulder, M. W. (2015). Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ, 350. doi: http://dx.doi.org/10.1136/bmj.h444
Author: Murray J. McAllister, PsyD
Date of last modification: January 23, 2017
About the author: Dr. McAllister is the executive director of the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Our mission is to lead the field in making pain management more empirically supported. Additionally, the ICP provides scientifically accurate information on chronic pain that is approachable to patients and their families. Dr. McAllister is also the clinical director of pain services for Courage Kenny Rehabilitation Institute (CKRI), part of Allina Health, in Minneapolis, MN. Among other services, CKRI provides chronic pain rehabilitation services on a residential and outpatient basis.
The post Is It Time to Talk About Managing Pain Without Opioids? appeared first on Institute for Chronic Pain Blog.
Countless studies have demonstrated that chiropractic care is a safe and effective way to treat musculoskeletal complaints like back pain, neck pain, or sciatica. Now a new study from Switzerland has looked at the relative benefits of chiropractic compared to medical care for the most common types of pain issues.
In this study, the authors examined data from people who reported spinal, hip, or shoulder pain. 403 patients saw a medical doctor for relief; 316 people saw a chiropractor. Four months after treatment, the patients were asked to fill out a survey reporting on their recovery.
The authors found that:
- “Patients initially consulting MDs had significantly less reduction in their numerical pain rating score…”
- Patients who saw MDs were significantly less satisfied with the care they received and the outcome of that care.
- Patients who saw a chiropractor had significantly lower healthcare costs for their treatment.
The authors conclude that patients should first be sent to a chiropractor for musculoskeletal problems, rather than a medical doctor:
“The findings of this study support first-contact care provided by DCs as an alternative to first-contact care provided by MDs for a select number of musculoskeletal conditions. Restrictive models of care in which patients are required to contact a medical provider before consulting a chiropractic provider may be counterproductive for patients experiencing the musculoskeletal conditions investigated and possibly others. In addition to potentially reducing health care costs, direct access to chiropractic care may ease the workload on MDs, particularly in areas with poor medical coverage and hence enabling them to focus on complex cases. The minority of patients with complex health problems initially consulting a chiropractic provider would be referred to, or comanaged with, a medical provider to provide optimal care.”
Houweling TAW, Braga AV, Hausheer T, et al. First-Contact Care With a Medical vs Chiropractic Provider After Consultation With a Swiss Telemedicine Provider: Comparison of Outcomes, Patient Satisfaction, and Health Care Costs in Spinal, Hip, and Shoulder Pain Patients. Journal of Manipulative and Physiological Therapeutics 2015;38(7):477-83.
In the last post, we began to introduce a broad definition of coping, as one’s subjective experience, or reaction, to a problem. In this post, let’s expand on this definition and explain how coming to cope better with a problem is a process of coming to experience the problem in a different and better way.
Coping is how we subjectively experience a problem
In our society, when having a problem, we tend to focus on the problem itself, its characteristics and how they do or don’t lend themselves to resolving the problem. In so doing, we put our focus and energy towards fixing or getting rid of the problem. This way of thinking about the problem is all well and good. It likely lends itself to our society’s successes in developing technological solutions to many of the great problems that we have faced.
As an example of this tendency to focus on problems and fixing them, we need only to look to the problem of pain and how we tend to focus on it, and how we try to get rid of it or otherwise reduce it. Knees and hips can now be replaced and we have a large assortment of different medications that can reduce pain and sometimes get rid of it entirely.
However, instead of focusing primarily on the problems itself, we might also bring our attention to the unique characteristics of each individual with the problem and how they understand it, feel about it, perceive it, and how they behave in regards to it. In effect, we might focus on the characteristics of each person and how these characteristics influence the way individuals experience the problem.
For wherever there is an objective problem in the world, there are also perceiving subjects who have the problem.
We typically call the ways that people experience problems “coping.” It’s something that usually we only direct our attention to when we can’t come up with a solution, or fix, to a problem itself. Nonetheless, it comes in handy in such situations because it offers a way to still get better even if there is no fix to the problem. Namely, we get better at coping with the problem: we can become less distraught by the problem or less impaired by the problem.
In this regard, in returning to our pain example above, we might focus not so much on how to get rid of pain, but how to get better at coping with pain. This change in the approach to getting better may come in handy when pain is truly chronic and you’ve already tried every reasonable procedure and medication without any significant benefit. In such a situation, you focus not so much on how to reduce pain, but on how to increase coping.
In doing so, you can come to learn to tolerate pain that at present is intolerable. You might even get so good at coping that you do more than simply tolerate it – you might get so good at coping that the pain goes from something that is the central focus of your life to something that occurs in the background of your life. It becomes a problem, in other words, that’s not very problematic.
Moreover, you can do such thing without ever reducing pain itself. It can all occur by changing how you experience, or cope with, pain.
It may sound too good to be true.
How coping better makes problems less problematic
It’s important to recognize that people who cope well with a problem tend to experience the problem as less significant or severe than those who don’t cope well with the problem. In other words, when we aren’t coping well, we tend to perceive or judge the problem that we face as more problematic than those who cope well with it. For example, if you had taken a speech class and had actually given many speeches before in the past, you might find the prospect of giving a speech to a packed auditorium as less problematic as someone without your level of expertise and practice. You might find it quite tolerable, in fact possibly even not problematic at all – something in the category of “Well, it was no big deal.” However, another individual, who faces the challenge of giving the exact same speech to the exact same auditorium, might find it overwhelming, paralyzing or intolerable. This individual might judge the problem as one of the hardest things he has ever done in his life.
Objectively, it’s the exact same problem, but the two people subjectively experience it in very different ways. We might say, in such cases, that the differences lie in how well the individuals cope with the problem of giving a speech to a packed auditorium.
How well we cope depends, of course, on how significant the problem is. Big or complicated problems are more difficult to deal with than small or simple problems. Most people will find talking to a group of two or thee people easier than an auditorium of two or three hundred. Nonetheless, how well we cope with problems is also dependent on other things too.
Notably, it’s dependent on certain characteristics of the person who is coping with the problem. If one knows a lot about the problem and is actually an expert on the topic, then typically that person copes better than someone who doesn’t know as much about the problem. Or, if someone has experienced the problem before or expects the problem to occur, then that person often copes better than the individual who has never encountered the problem before or someone who is taken by surprise by the problem. Confidence plays a role here too. Someone who knows a lot about the problem and is well-versed or well-practiced with dealing with the problem tends to be more confident and that confidence aids in coping better. Someone who lacks such confidence tends to be more alarmed or even distraught, which makes for more difficulty in coping. In any of these cases, the subjective experiences of the problem are different for the different people, even if the problem was objectively the same problem.
We could go on indefinitely about the subjective characteristics of the coper, which play a role in how well the individual deals with a problem. We might make a list of subjective characteristics that determine, in part, how well one copes:
- Degree of knowledge or expertise about the problem
- How one conceptualizes the problem
- Degree of accurate information that one has about the problem
- How much one has practiced overcoming the problem
- Other attitudes about the problem
- Degree of confidence in facing the challenge
- Degree of attention directed on the problem
- How one feels about the problem
- What one’s mood is at the time of encountering the problem (e.g., whether one is calm or irritable, depressed or anxious)
- How much sleep one has had in the past few days prior to encountering the problem
- How many other problems one is experiencing at the time of encountering a new problem
- What one goes on to do about the problem (behaviorally)
- Degree of loving support one has in facing the problem
There are literally countless aspects of the coper that determines, in part, how well one experiences, or copes with, a problem. Some of these characteristics lend themselves to better coping and some lend themselves to worse coping.
Getting better by getting better at coping
So, think about this simple fact: if you have a problem that can’t be entirely fixed, you could still get better by setting out in a concerted effort to get better at coping with it. You could, in effect, obtain training at having the problem and get so good at it that having the problem becomes less and less problematic. It could become, for example, something that occurs in the background of your day-to-day activities, but for the most part you’ve moved on and focus on the meaningful activities of your life. Indeed, there is simply no end to how good one can get in coping with a problem, even a problem that can’t be entirely fixed, like chronic pain.
Here is where true hope lies. Even when your pain is chronic, you can get so good at coping with it that living with chronic pain is no longer a distressing or impairing problem. Alternatively, you can get so good at coping with it that it no longer requires opioids to manage it and so you can move on with the rest of your life.
Usually, this level of advanced coping requires a concerted effort of training, done over time, and typically with a team of healthcare providers who coach you and support you throughout the process. Traditionally, patients find such support and training in chronic pain rehabilitation clinics. Such clinics are a type of pain clinic that involve an interdisciplinary team of healthcare providers (consisting of at least pain psychologists, medical providers, and physical therapists, but oftentimes other kinds of providers as well) who work with patients over an extended period of time in the pursuit of not so much reducing pain, but improving the patient’s coping. Such clinics are not new, but have been around since at least the early 1970’s and as a result they have about four decades of published research proving their effectiveness (see, for example, these meta-analytic studies and literature reviews: Chou, et al., 2007; Flor, Frydrich, & Turk,1992; Gatchel & Okifuji, 2006; Neusch, et al., 2013; Turk, 2002).
When talk of the possibility of coping better feels like a criticism
Sometimes, when healthcare providers like me talk in these ways, it feels to patients with chronic pain like a judgment. It feels like blame. It feels like you’re being told there’s something wrong with you — that you aren’t coping well enough.
Oftentimes, when patients have people in their lives who judge them or stigmatize them for how they have been coping, they can come to hear their healthcare provider talking about the benefits of learning to cope better as a similar criticism.
In such cases, patients can come to refuse the recommendation to participate in chronic pain rehabilitation. The hopeful message that there is a traditional and scientifically proven treatment that helps patients to learn to cope better with pain can be met with quick and sometimes sharp rebuttals. Common examples are the following:
- The provider must be insensitive.
- The provider must not know what he or she is talking about (i.e. the provider is incompetent).
- The provider doesn’t (or won’t) recognize that I’m coping as well as humanly possible given the amount of pain I have.
- The provider must not have chronic pain or otherwise he or she would understand.
- The provider must not believe me that I have real pain.
- The provider is just out to make money and so wants me to go to yet another treatment from which he or she will profit.
- The provider just wants me to get off opioid medications.
Obviously, talk of how to learn to cope better is a sensitive topic. It’s as if the same words can engender almost two opposite interpretations. The healthcare provider intends it to be a hopeful message – you can get better by undergoing extensive training over time and as a result come to cope better with a condition that is incurable. The patient, however, can hear it as an insensitive criticism of how the patient isn’t coping well right now.
Importance of trusting your healthcare provider
In such situations, what can make the difference is having a good, therapeutic relationship with your healthcare provider. If you know your provider and trust him or her, then you know that your provider isn’t just being mean or insensitive or ignorant of what’s it like to have pain or out to make money off you. Instead, you know that your provider has your best interest at heart.
Have you ever had a healthcare provider talk to you about chronic pain rehabilitation or learning how to cope better with pain? What were your reactions? Have you ever attended a chronic pain rehabilitation program? Why or why not?
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Chou, R., Amir, Q., Snow, V., Casey, D., Cross, T., Shekelle, P., & Owens, D. K. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7), 478-491.
Flor, H. & Frydrich, T., Turk, D. C. (1992). Efficacy of multidisciplinary pain treatment centers: A meta-analytic review. Pain, 49, 221-230.
Gatchel, R., J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic non-malignant pain. Journal of Pain, 7, 779-793.
Neusch, E., Hauser, W., Bernardy, K., Barth, J. & Juni, P. (2013). Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: Network meta-analysis. Annals of the Rheumatic Diseases, 72, 955-962
Turk, D. C. (2002). Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. The Clinical Journal of Pain, 18, 355-365.
Author: Murray J. McAllister, PsyD
Date of last modification: September 11, 2016
About the author: Dr. McAllister is the executive director and founder of the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Our mission is to lead the field in making pain management more empirically supported. Additionally, the ICP provides scientifically accurate information on chronic pain that is approachable to patients and their families. Dr. McAllister is also the clinical director of pain services for Courage Kenny Rehabilitation Institute (CKRI), part of Allina Health, in Minneapolis, MN. Among other services, CKRI provides chronic pain rehabilitation services on a residential and outpatient basis.
The post How to Get Better When Pain is Chronic appeared first on Institute for Chronic Pain Blog.
From the time before Socrates in ancient Greece there stood a temple built upon a spring at a location the Greeks would have considered the center of the world. Inscribed on the walls of this holy temple was the simple phrase, “Know Thyself”.
This simple phrase inspired Socrates to a life of learning and teaching, and, from him, Plato learned to be a philosopher and later came to teach Aristotle. Subsequently, Western civilization, in large measure, began.
This maxim – “Know thyself” — and others similar to it were not uncommon in the ancient world. Indeed, a few thousand years previously, early Hindus and later Buddhists practiced a form of moment-to-moment self-knowledge, later coming to be called mindfulness.
The directive inherent to this maxim has two components. The first is to pay attention. In other words, slow down and observe what’s happening. In today’s language, we might express the maxim as something like, “Get out of your head and notice what’s going on around you.” When we carry out such a dictum, we become observant and reflective. We see or otherwise perceive things that we might not have heretofore noticed. We subsequently create opportunity to consider what it is we observe.
Good things happen when we do. We see good things and become appreciative. We stop and smell the roses because we were observant enough to even notice them as we walked by and as a result we are able to appreciate their visual and olfactory beauty. Whereas in one moment our kid might be bugging us because of her need for attention is interrupting our apparent need to make a phone call or put dinner on the table, in the next moment, once we get out of our head, we recognize just how funny or cute the kid is and we subsequently are overwhelmed by how much love we have for her.
So much of life goes unnoticed because we are simply and persistently reacting to whatever thoughts, feelings and needs that pop into our attention. Whatever pops into our heads tends to have a sense of immediacy to which we react impulsively, without thinking in the sense of thoughtful consideration. It’s just a never-ending chain reaction of stimulus and response, like billiard balls knocking into each other. Notice that when we live life as if we are a player in a video game that goes on in our head, simply and persistently reacting to whatever momentary thought, feeling, or need that pops into our head, so much of what goes on around us gets missed.
We don’t see how cute our kid is in that moment. We don’t notice that our spouse made coffee for us before leaving for work. We don’t smell the fresh air. We don’t taste our lunch. We don’t fully appreciate how funny it was when our coworker or neighbor made that comment yesterday.
Instead, we were busying ourselves with the immediacy of whatever popped into our head at the time.
Notice too all the things we could have done in those moments but didn’t do simply because it never occurred to us. When we react to whatever thought, feeling or need that pops into awareness at any given time, it’s as if the reaction that we have is the only possible thing to do at the time. We might even justify the reaction, if anyone ever were to ask us about what we did, by saying ‘Oh, I had to,’ as if the thing we did was the only possible thing that could have been done. However, it’s not really true, and this point brings us to the second good thing that happens when we get out of our heads and start to observe what in actuality is happening in any given moment.
Namely, we become liberated from being a passive recipient of what happens to us to an active decision-maker of a well-informed life. By observing what in actuality is happening in life, and by considering the various possible ways we might respond, we exercise choice. No longer is our life dominated by the apparent ‘must’ and ‘have to’ and ‘got to’, but rather we are free to choose. When we pay attention, we recognize that we do not have to simply endure things happening to us. We are not victims. We have the power to choose among a number of different options as long as we slow down enough to recognize and consider the options that are available to us.
The simple maxim – Know thyself”, then, is a truth that sets us free. It’s freedom from a determinism of automatic reactions to whatever life gives us. We no longer ‘have to’ do this, that, or the other thing, but are free to choose how we live our life. We no longer ‘can’t’ do anything but the reaction that we have automatically done countless times in the past and are now free to choose how we might respond and move forward. From moment to moment, we are free to choose how to respond even to the things in life that we do not choose – like bad things that happen to us. We still are free to choose how we react to them and the perspective by which we see them.
In sum, the second good thing that happens when we observe what’s happening is that we become intentional about what we do, how we react to things, and even how we perceive the things around us.
This ability to observe life and intentionally choose how to respond to the things that come up from moment to moment is the main goal of psychotherapy. Freud called this ability the development of an ‘observing ego’ and considered analysis a way to develop this ability. In more recent psychotherapies, we call it an ‘observational self’. It’s the ability, as described, to step out of any given moment, consider what’s happening, and intentionally choose how to react. Of course, in this day and age, we also call it ‘mindfulness’.
What does developing an observational self have to do with pain?
The development of the ability to step out of the moment and reflect on how to react to pain is the initial and most important thing to do in pain management. Everything else in pain management follows from this skill.
Pain has a sense of immediacy about it. It’s a sensation that is inherently emotionally alarming and to which we automatically react with avoidance behaviors – we stop what we’re doing, pull away and guard. This sensory, emotional and behavioral experience happens all at once, of course, and it happens automatically. We don’t typically choose any of it. The sensation just is alarming and we pull away and guard without ever intending to do so.
For example, if you were out hiking in the woods and, without looking, you stepped in a hole and twisted your ankle, you’d have pain. That is to say, you would have a sensation that was emotionally alarming and to which you would stop walking and guard your ankle in some manner. The whole experience would be almost instantaneous. It would also be automatic, in a sense. The alarming sensation and behavioral avoidance would occur without any intentional decision-making on your part.
However, if you had chronic pain, and you set out to pay attention to the pain that occurred with activities, you could learn to make the whole experience more intentional. You would do so in a multiple step process. You would first simply pay attention to the pain that occurs and not be taken by surprise by it. Chronic pain often has a degree of predictability that the pain of an acute injury doesn’t have. So, by paying attention, you could practice the skill of not being taken aback by the pain. Just as importantly, you could recall that you have chronic pain and that you’ve had it for some time and you know what it is. In most cases, chronic pain is the result of the nervous system having become highly reactive to the stimuli of activities that are normally not painful to do – like walking, sitting, standing up, laying. You could consider that, even though it is painful, these activities are safe to do– that you are not injuring yourself even though it is painful. In this manner, you start to control the sense of emotional alarm that you have with pain. You set out to intentionally remain emotionally grounded in the presence of pain. To this end, you also practice taking deep, diaphragmatic breaths to assist you in remaining calm. From this new-found perspective, you can also choose how to behaviorally react. You intentionally choose to engage in the activity and have the sensation while practicing remaining calm.
Suppose, for example, every time an individual with pain sits down she knows she’ll experience pain. More often than not, however, she doesn’t keep this fact in mind and she goes about her day, like most of us, simply reacting to whatever pops into her attention. She does this and then that, checking things off her to do list. Each time she sits down, she lets out a soft groan, grabs whatever is within reach in order to brace herself, and becomes, for an instant or two, emotionally and physically tense. The pain is severe and it takes her breath away.
She could, though, with some proper coaching from a psychologist at her pain clinic, set out to learn and practice the ability to step out of the moment and pay more attention to her actions. She could then practice slowing down the process of experiencing pain. In doing so, she pays attention to what she does and predicts the severe pain prior to sitting down. In this way, she isn’t taken by surprise each time. With knowing that it’ll hurt, she takes some deep diaphragmatic breaths as she works and reminds herself that even though it is painful she isn’t injuring herself every time she sits down. She intentionally recognizes that it is safe to sit down even though it hurts badly. In these ways, she practices remaining grounded while having pain. With her budding abilities to remain calm in the presence of pain, she intentionally sets out to control her pain avoidance behaviors. She makes the decision to stop letting out the groan because she’s predicted the pain and isn’t taken aback by it as she sits down. She intentionally stops her tendency to abruptly reach out for something to hold on to while she sits, reassuring herself that it is safe to sit down. She also tries to refrain from grabbing her back and instead sets out to remain as calm as she can be in the presence of her pain, even severe pain. She intentionally does all things, moreover, on a repetitive basis through the course of her day, day after day. She discusses her strategies with her psychologist each week, and her psychologist gives her pointers, which she tries at home. Over time and with practice, she gets better and better at it. By developing her abilities to pay attention, observe herself and engage in intentional decision-making, she comes to be able to control, in part, her experience of pain. She comes, in other words, to be able to control the alarming and behavioral aspects of pain and subsequently becomes able to remain grounded and productive in the course of her day, even though she continues to have severe pain.
This description is what good coping looks like. Good coping is not getting rid of pain, but getting so good at reacting to pain that it is no longer as problematic as it once was. It requires the development of an observational self from which you can have pain, remain aware of how you are reacting to it, and intentionally attempting to remain grounded and active while having pain.
From the river Ganges to the temple at Delphi and all the way through to the modern pain clinic, the dictum to know thyself travels through time because good things happen when we follow it. The ability to pay attention and engage in intentional decision-making when having pain is the initial and most important skill to develop in pain management.
Author: Murray J. McAllister, PsyD
Date of last modification: 6-19-2016
The post Developing an Observational Self: How to Cope with Pain Series appeared first on Institute for Chronic Pain Blog.
Hey, sick chick! So glad you found this video. Now, press pause and go get your significant other, or your SO. I’ll wait.
OK, great! Hi there. I’m so excited to talk to BOTH of you. This week’s video is the last of 2016, and it’s for all those folks who love us ChronicBabes: husbands, wives, spouses, partners, girlfriends, boyfriends, lovers… this video is packed with advice for how to be a great significant other (SO) to a woman with chronic illness. I hope you find the advice helpful, and I encourage you share this video with anyone who might benefit:
*AWAP = As Well As Possible
Now it’s your turn:
How do YOU support your ChronicBabe? How does your SO support you, babelicious? I want to hear from both of you! Tell me all about it in the comments below.
Want more #AWAPwednesday? Check out our #AWAPwednesday video playlist, which has more than 130 videos packed with practical advice, lots of humor, and bloopers. Lots of bloopers.
Is there a question I can answer for YOU? Add it to the comments below, or shoot me an email.
Until we meet again: Be AWAP! Smooches!
Hi! I’m Jenni Grover Prokopy of ChronicBabe.com and today is AWAP Wednesday (that stands for As Well As Possible).
Each week, I offer you my personal favorite tips and techniques to help you craft an incredible life beyond illness. Yes! I know you can.
Subscribe to the ChronicBabe YouTube channel today to make sure you never miss another video, OK?
Everyone gets a little embarrassed about feeling sick and can feel afraid to burden friends and family with problems. That’s where you come in. Once a day, you should check in with your SO and ask how she’s doing and if there’s anything you can do to help.
Sometimes she’s really, really hoping for some help but won’t ask for it because she doesn’t want to create extra work for you. Checking in is a good way to let her know you are always willing to make the time to help her and show that you’re there for her.
Sometimes we just need a shoulder to cry on. Seriously. It’s understandable that you’ll want to problem-solve, because you hate to see your SO in pain or sad. But try not to assume that’s always the best move.
When your SO brings up a tough subject or challenge, consider asking this question: “How can I help you right now?” She might say “I just need you to listen so I can get this off my chest.” There will be time for problem-solving later.
Be a battle buddy
I recently spoke to a U.S. Army war veteran, who told me how battle buddies work when men and women are on the battlefield: They don’t leave each other’s side, they always make sure the other person is doing everything they need to be safe, and they always keep the necessary tools at hand. He explained that now that he’s back in the states and getting treatment for chronic pain and injuries, his wife is his battle buddy: she goes to all his health care appointments, she helps him remember the questions he needs to ask of his docs, and keeps him on schedule. So be your ChronicBabe’s battle buddy.
Understanding and non-judgement
ChronicBabes can experience judgement from all sides, even sometimes from close friends and family. You know her best and you know that when she’s lying in bed all day, unable to go out and get things done, it’s not because she’s lazy or selfish – it’s just an off day. You can make her feel better by being a shield from the judgement.
Make sure she knows that you know a day in bed is absolutely warranted and defend her from those who act like it’s not. The last thing she needs is another person demanding her to “pull it together” and “suck it up.” Some soup and TV in bed will go a long way.
Take care of yourself, too
This should go without saying but you can only be the best SO possible if you’re taking care of yourself as well. Always be there for her, but don’t neglect your needs in the process. She will be there for you too, as much as she can. Loving her and loving yourself go hand in hand.
The most valuable thing you can do for a ChronicBabe: Be her cheerleader. And when she can, she’ll cheer for you, too.
Thanks for watching today! What kinds of special things do YOU do for your SO that make your relationship strong? I’d love to know. Share your strategy in the comments here or head on over to the blog at ChronicBabe.com to join the conversation—I want to hear what YOU have to say.
If you liked what you saw today, subscribe to our channel—and watch another one of my favorite videos right now. I think you’re gonna like it!
Until we meet again, be AWAP! Smooches!
Sprains and strains are often considered to be “minor injuries.” They are anything but. Most sprains and strains can result in a significant amount of pain. The severity of some injuries may even require medication, physical therapy, or even medical procedures. Sprains and strains can create significant complications.
Sprains and Strains are the Most Common Work-Related Injury
Strains and sprains are quite common. In fact, according to a recent Bureau of Labor Statistics report,1 strains and sprains remain as the number one cause of all work-related incidents, accounting for nearly 31 percent of work-related injuries. For employees, strains and sprains can mean time away from work. For hourly workers, the lack of work can mean that there will be no money coming in. For small business owners, employees who suffer from strains and sprains may require time off. This can result in being understaffed or even unable to open.
Understanding one’s injury is critical to identifying potential medical and legal remedies. Both sprains and strains are considered to be “soft tissue injuries.”2 A sprain occurs whenever a ligament is either overextended or torn as a result of stress. The most common sprains are sprained wrists and sprained ankles. Although these sprains often occur during sports and exercise, they may occur at any time. Strains are similar to sprains but affect muscles or tendons.
Sprains and Strains are Capable of Causing Lifelong Medical Problems
Sprains and Strains can create lifelong complications. Doctors have concluded that these types of injuries can be considered permanent injuries. While they may become less painful with proper treatment and time, they will never completely go away. In fact, these injuries may be aggravated by minor movements. Further problems can arise whenever sprains and strains are neglected. Neglected injuries often become serious, chronic injuries.
Examples of Ways Sprains and Strains can Affect Your Life:
Recurring Pain. Many sprains and strains can be remedied with time and care. However, these injuries can cause nagging pain that doesn’t seem to go away.
Loss of Enjoyment of Life. The pain from an injury may keep you from being able to engage in some of your favorite activity. Lower body sprains may keep one from exercising, dancing, or even walking without a cane.
Ongoing Medical Care. Lingering injuries may require physical therapy, assistance such as a cane or brace, or even having to regularly take medicine to quell the pain.
If you have suffered a strain or a sprain, you may be entitled to recovering compensation by filing a workers’ compensation claim or filing a lawsuit against a third party. If your accident was the result of the negligence of someone other than your employer, you may be entitled to damages for your medical expenses, lost income, loss of quality of life, and physical and emotional pain and suffering.
Contact a St. Petersburg Personal Injury Attorney Today
If you or a loved one has suffered a sprain or strain as a result of another person’s negligence, you need an experienced, aggressive attorney. The attorneys at the Dolman Law Group have the experience and wherewithal to get you the maximum recovery. To schedule a free consultation, call us today at 727-222-6922 or contact us online.
Dolman Law Group
1663 1st Ave S.
St. Petersburg, FL 33712
The post Sprains and Strains can Affect Your Life appeared first on Dolman Law Group.
Losing an hour of sleep may do more to your mind and body than you realize.
As we age, the discs in our spine start to naturally break down due to normal, everyday living . This is commonly referred to as disc degeneration and can result in pain in the neck and/or back area–pain that is felt by almost half of the population 40 years of age or older . For those over 80, this rate doubles to a whopping 80 percent, which makes understanding what factors promote this particular condition critical to raising the quality of life as we enter our later years. Fortunately, recent research provides some very important information in this area.
Disc Degeneration Risk Factors Revealed In Recent Study
On November 9, 2015, a study conducted by health experts from Mie University Graduate School of Medicine in Japan, Osaka University (also in Japan), and Rush University Medical Center in Chicago, Illinois was published in BMC Musculoskeletal Disorders. In this research, these experts followed 197 individuals living in Miyagawa, Japan who were over the age of 65 for a 10-year period, measuring their disc height at two year intervals to determine what factors, if any, contributed to their spinal discs degenerating at a faster rate.
What they discovered was that, over the time span of the study, the participants’ disc height gradually reduced an average of 5.8 percent, with roughly 55 percent experiencing degeneration in one or two of their discs. Furthermore, there were three factors that they identified that increased the likelihood of disc degeneration. They were: 1) being female, 2) having radiographic knee osteoarthritis, and 3) the presence of low back pain when the study began.
Based on these results, women should take extra care to protect the discs in their spinal column, potentially saving themselves from experiencing neck or back pain later in life. Some options for doing this include maintaining a healthy weight, avoiding repeated lifting of heavy objects, and not smoking as studies have found that smokers tend to experience disc degeneration at greater rates than non-smokers . Chiropractic can help with the other two factors.
For instance, in one study published in The Journal of the Canadian Chiropractic Association, researchers looked at 43 different individuals between the ages of 47 and 70 who were experiencing osteoarthritic knee pain. Some participants received treatment three times a week for two weeks and others served as a control. The subjects who engaged in treatment reported more positive results than those who did not, citing that, after the treatments they experienced fewer osteoarthritic symptoms, had greater knee mobility, and felt that it was easier to “perform general activities.” And this was after just two weeks of care.
Chiropractic can also help lower back pain, further reducing the likelihood that your discs will degenerate at a faster rate when you age. That makes this specific remedy beneficial both now and well into the future–ultimately raising your quality of life.
- Akeda K, Yamada T, Inoue N, et al. Risk factors for lumbar intervertebral disc height narrowing: a population-based longitudinal study in the elderly. BMC Musculoskeletal Disorders 2015;16(1):344.
- Fogelholm RR, Alho AV. Smoking and intervertebral disc degeneration. Medical Hypotheses; 56(4):537-9.
- Pollard H, Ward G, Hoskins W, Hardy K. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. Journal of the Canadian Chiropractic Associations 2008;52(4):229-42.
The late Baseball Hall of Famer Casey Stengel once said, “The trick is growing up without growing old.” If you’re over the age of 65 (which roughly 13 percent of the United States population is), you’ve likely pondered this same notion at least once in your life as newly released information published by PLOS One reveals that this particular age group has many complaints when it comes to the aging process.
In this study, 7,285 individuals 75 years of age and older indicated that they experienced issues with walking, standing, seeing clearly, cognitive function, pain, weakness, and more. Additionally, the more complaints a person had, the lower their functional outcomes and quality of life.
Since the number of seniors is expected to rise from roughly 13 percent of the population to over 20 percent by the year 2050, that makes these types of issues a major concern for individuals in this age range. Fortunately, chiropractic can help as a number of studies have found that this particular healthcare remedy provides many benefits for people as they age.
For example, one study published in the Journal of Chiropractic Medicine involved 19 people over the age of 40 who struggled with issues related to balance, neck pain, and dizziness–three common complaints of growing older. However, after just eight weeks of chiropractic care, researchers noted “a clinically meaningful change” in the participants’ levels of dizziness, as well as noting improvement in their neck disability, level of pain, and balance.
Chiropractic has also been found to help older individuals with multiple other health concerns. In one specific case which was also published in the Journal of Chiropractic Medicine, an 83-year-old male with “a history of leukemia, multiple compression fractures, osteoporosis, and degenerative joint disease” was studied. Based on his physical condition, he reported his pain being 10 out of 10 on a pain scale and he also indicated that he suffered with spasms and tenderness in his lower back, making it very difficult to care for his disabled wife.
After receiving eight treatments using Activator Methods protocol, the patient stated that his pain dropped to 4 out of 10 (6 pain points in total) and that he no longer experienced pain or spasms in his spine. As a result, he was able to more easily care for his wife.
Regular spinal manipulations offer many benefits such as these for seniors, which ultimately means living a higher quality of life. Perhaps chiropractic is the trick to growing up without growing old?
- Raphel A. (2014, August 5). Trends and statistics relating to U.S. seniors, elderly: Census Bureau 2014 report. Journalist’s Resource.
- Roberts JA, Wolfe TM. Chiropractic spinal manipulative therapy for a geriatric patient with low back pain and comorbidities of cancer, compression fractures, and osteoporosis. Journal of Chiropractic Medicine 2012;11(1):16-23.
- Strunk RG, Hawk C. Effects of chiropractic care on dizziness, neck pain, and balance: a single-group, preexperimental, feasibility study. Journal of Chiropractic Medicine 2009;8(4):156-64.
- van Blijswijk SC, Chan OY, van Houwelingen AH, et al. Self-Reported Hindering Health Complaints of Community-Dwelling Older Persons: A Cross-Sectional Study. PLOS One 2015;10(11):e0142416.
The COPD Foundation reports that more than 24 million people in the U.S. currently suffer from chronic obstructive pulmonary disease (COPD). COPD is a disease in which the airways are hindered by some type of issue with the air sacs in the lungs, the walls between the sacs, or the production of an excessive amount of mucus. Ultimately, this makes it harder to breathe, usually resulting in the person spending more time coughing, experiencing tightness in the chest, and having a chronic shortness of breath.
At a minimum, these symptoms can hinder your participation in everyday activities. However, COPD is also the third leading cause of death in the U.S., which makes finding effective treatment remedies critical to helping many people live a longer, healthier life. While there are several different options to consider–ranging from medication to physical activity training to surgery–one systematic review has found that chiropractic care may just provide some relief.
This review was published in the Journal of Alternative and Complementary Medicine and it covered six different studies which involved people with COPD who engaged in chiropractic care. The intention of each was to determine what effect, if any, this particular remedy had on the person’s ability to breathe. What researchers found was that five of the six studies reported positive results when it came to the participant’s lung function and exercise performance after engaging in spinal manipulation therapy.
Of course, it also helps to quit smoking as this is the number one cause of COPD. Additionally, air quality matters too so, if possible, try to spend a majority of your time in a clean air environment. And if you work around different pollutants, take proper precautions to protect your lungs while on the job and you may lower your risk of developing this potentially life-threatening condition.
COPD Foundation. COPD Statistics Across America. Retrieved from http://www.copdfoundation.org/What-is-COPD/COPD-Facts/Statistics.aspx on January 6, 2016.
National Heart, Lung, and Blood Institute. What Is COPD? Updated July 31, 2013. Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/copd/ on January 6, 2016.
National Heart, Lung, and Blood Institute. Treatment Options. Retrieved from http://www.nhlbi.nih.gov/health/educational/copd/breathing-better/treatment-options.htm on January 6, 2016.
Wearing J, Beaumont S, Forbes D, Brown B, Engel R. The Use of Spinal Manipulative Therapy in the Management of Chronic Obstructive Pulmonary Disease: A Systematic Review. Journal of Alternative and Complementary Medicine. 2015 (December 24)