For countless people around the world, living with chronic pain is a daily reality.

According to a 2011 report by the Institute of Medicine, Relieving Pain in America, there were 100 million Americans dealing with chronic pain in 2010 alone and this number has certainly grown as the population ages. The costs associated with chronic pain, usually defined as pain lasting longer than three months and without a clear prognosis, are astronomical. One recent estimate by health economists at John Hopkins University puts the annual economic costs linked to chronic pain at $635 billion annually, far greater than for cancer, heart disease, or diabetes. This includes direct costs such as health care and indirect costs resulting from lost work days or productivity.  

And then there is the psychological burden of dealing with chronic pain on a regular basis. Not only do chronic pain sufferers experience a sharply reduced quality of life, but their prospects for relief are limited at best. Concerns about prescription drug abuse often causes doctors to treat their pain patients as conservatively as possible, something that can result in greater suffering as a result. Even worse, pain patients may acquire a reputation for "medication seeking" which can lead to their pain medication being terminated altogether.  

So, are there effective ways for people to deal with chronic pain? A new research study in the journal Traumatology examines how resilient pain patients can be in coping with chronic pain and what that can mean for long-term recovery. A team of researchers led by Abigail Rolbiecki of the University of Missouri's Department of Family and Community Medicine and her fellow researchers conducted a series of semistructured interviews with 12 chronic pain patients who were asked to provide their own unique life story about how they coped as well as how they developed resilience.  

Aside from being diagnosed with chronic pain, their case histories varied widely with some patients developing pain after a physical injury, others due to a genetic condition, and in some cases, the origin was unknown. Diagnoses included fibromyalgia, psoriasis, undifferentiated connective tissue disease, complex regional pain syndrome, and a combined diagnosis of ankylosing spondylitis and psoriatic arthritis.

During the course of each interview, patients were asked questions such as "Can you tell me how you came to have chronic pain" as well as questions concerning the treatment they are receiving, whether their doctor involves them in treatment, and the kind of information their doctor provides them about the pain. They were also asked to rate their pain in the previous 24 hours in terms of the amount of pain relief they received and how debilitating their pain actually was. All interviews were conducted by telephone.

Results showed that patient resilience typically focused on some common themes:

  • Developing a sense of control over their pain by seeking out information as well as cross-checking the medical advice they received using other sources. Many patients report becoming their own advocates, often checking their symptoms online and using what they learned to understand what was happening to them as well as helping them describe their symptoms to their doctors more clearly.   For many pain patients, it also allows them to educate their doctors about their diagnosis as well as what tests to order. As one patient named Sue reports about herself, "If I was not my own advocate...and if I didn’t have other means of finding information...I would be much worse off, and I think a lot of people are with conditions like this. They spend years looking for the right diagnosis. I’m even lucky that three and a half years after my initial pain [I received a diagnosis]...the average amount of time that it takes for this is five years."  Collaborating with their doctors makes them feel less like patients and more like co-therapists.  
  • Becoming actively engaged in medical or alternative healing techniques which can make a difference in their ability to cope. Many patients may try controlling their pain through active exercise, changing their diet to eliminate potentially harmful substances that could be aggravating their pain, yoga or meditation, etc. One patient named Henry described how walking became his prime coping strategy for dealing with pain. “Walking helps me...by losing weight. It builds up my muscles and keeps me flexible. After you exercise you feel mentally alert.” He said, “[I decided to walk] basically on my own, not under any kind of order from a doctor.” Another patient decided that eliminating caffeine and artificial sugar from her diet would allow her to control the inflammation accompanying fibromyalgia.
  • Establishing social connections to develop support networks to help with coping. For many pain patients, recruiting friends, family members, and fellow pain patients is an important part of coping. In the study, some pain patients described how participating in online communities helped them feel supported.  One patient described online groups as a "double-edged sword," however. "I found some stuff online, but I do not know... Reading some of it is helpful and encouraging, but a lot of times I just think it’s really sad," she said. "I feel like I find dealing with my own [stuff] hard enough that it makes me even sadder to have to think about somebody else dealing with the same stuff." Other patients turned to religious faith and the support they found in fellow churchgoers which can also act as a source of emotional support.
  • By accepting their pain as a part of their own self-narrative and learning to make the most of their lives.  As one patient stated, "My goal is to live life the best I can. Deal with the cards that I have been dealt. That’s pretty much where I am at. I do not think I’m going to get much better than I am right now. I think I’ve reached pretty much the maximum improvement...life is what it is and what it’s going to be...I am pretty much doing everything I can do right now."   

So, what do these results suggest? According to Abigail Rolbiecki and her co-authors, these different coping strategies are all effective ways for chronic pain patients to become more resilient and learn to function on a daily basis. It also highlights how important psychological coping strategies can be for pain patients. This is especially important considering that clinicians often focus on relieving pain through narcotics and medical therapies that eliminate pain rather than encouraging patients to cope more effectively. While there is certainly a place for better and more powerful medical treatments when dealing with chronic pain, we also need to recognize that chronic pain patients need to accept their symptoms as part of their own self-narrative. Through truly adaptive coping, pain patients can draw on their own strengths  instead of seeing themselves as invalids.

As the study authors point out in their conclusions, chronic pain is a complex, poorly defined, and, consequently, poorly understood issue. Only through studying the life stories of chronic pain patients can we get a real sense of how to develop the basic resiliency that makes true coping possible. Health care professionals need to take a broader approach to treating chronic pain by showing patients concrete strategies they can use to become more resilient and and learn to truly move on with their lives.

References

Rolbiecki, A., Subramanian, R., Crenshaw, B., Albright, D. L., Perreault, M., & Mehr, D. (2017). A qualitative exploration of resilience among patients living with chronic pain. Traumatology, 23(1), 89-94. http://dx.doi.org/10.1037/trm0000095

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