A self-help supplement to manage chronic pain.
Posted Aug 05, 2019
Anyone who has suffered from chronic pain wants one thing—their pain to be gone. Chronic pain is a frustrating condition:
- Surgery may not improve or may even worsen it (e.g., as in low back pain)
- Non-opioid pharmacological treatments do not remove the pain.
Chronic pain is debilitating physically, emotionally, socially, and occupationally. It is also prevalent. That is, the National Institutes of Health (NIH) Office of Disease Prevention estimated in their 2014 report that chronic pain impacted one-third or 100 million Americans. It has a high cost in terms of lost work and medical expenses. The dollar cost was estimated by NIH at $560 to $630 billion a year.
Opioids are often a first response by physicians to chronic pain. Ironically, opioids do not improve quality of life. In fact, the CDC guidelines regarding opioids for chronic pain indicate there is little evidence to demonstrate that opioids provide sustained pain relief. Although opioids may lessen pain in the short-term, long-term use remains problematic because it may produce a chronic pain state, may potentiate abuse, and may deepen feelings of depression. More importantly, opioids in combination with other drugs (prescribed or illicit) or because of respiratory suppression (through misuse, in concert with co-morbid conditions such as sleep apnea, etc.) can lead to death.
Overprescribing opioids for chronic pain has been identified as playing a prominent role in what is now labeled an “opioid crisis” (Traylor, 2019). Estimates from the Centers for Disease Control are that between 21 to 29 percent of people who are prescribed opioids misuse them, and between 8 to 12 percent develop an opioid use disorder. Deaths involving synthetic opioids other than methadone (such as fentanyl, fentanyl analogs, and tramadol) showed a significant rate of increase—on average by 8% per year from 1999 through 2013 and by 71% per year from 2013 through 2017 (Hedegaard, Minino, & Warner, 2018). One positive consequence of the opioid crisis has been increased support for alternate or adjunctive non-pharmacological interventions.
Alternate treatments include:
- Psychotherapy (such as cognitive-behavioral treatments to address distorted thinking)
- Mindfulness treatment to re-frame pain
- Acceptance commitment therapy to augment psychological flexibility
- Meditation, yoga, aromatherapy, and acupuncture
Chronic pain can readily overtake one’s life and create a sense of helplessness and lack of control. Enhancing a sense of control over one’s pain can help lessen its intensity. Psychologists have long observed that a sense of powerlessness over one’s situation can trigger a cascade of negative emotions, including anxiety, depression, and hopelessness. In fact, our sense of well-being is more related to how we perceive the world than it is to the actual circumstances themselves (Diener, Lucas, & Oishi, 2002). Interestingly, our sense of pain, like our sense of well-being, is also colored by our perception. Chronic pain seems to activate brain centers related to the interpretation of pain (pre-frontal cortex) and emotion (limbic system). For example, an individual interprets their pain as unmanageable, which then leads to the emotions of hopelessness, anxiety and depression; these emotions, in turn, may make the pain feel worse.
Therefore, understanding and managing one’s emotional nutritional intake can be a self-help supplement to professional intervention. In order to take back control the pain has over one’s life, consider these steps as a guide:
- Assess your quality of life and the quantity of time you focus on the pain. What is the cost of this to your well-being?
- Recognize and track how many of your negative emotional reactions (such as fear, anxiety, worry, and depression) are triggered by pain.
- Regulate how much time you spend in these negative states by putting yourself on an emotional diet (e.g., only allow 5 minutes at 9:00 am, noon, 3:00 pm, and 6:00 pm for worry, or fear, or anxiety about your health).
- Incorporate a period of time (e.g., 5 minutes at 9:00 am, noon, 3:00 pm, 6:00 pm, and right before sleep) that you dedicate to a deliberate intake of at least one positive emotion and an awareness of its effects. For example, thinking of people who were kind to you or toward whom you showed kindness, or listening to music that puts you in a good mood.
- Savor simple pleasurable moments (e.g., the crispy taco, the purple flowers springing up on the highway, the fresh smell of the earth after a rain).
- Focus deliberately on activities that do not center on pain (e.g., dedicate a half hour to reading/watching a movie/television show that makes you laugh; or engage in an activity that absorbs you, such as woodworking, water coloring, or cooking).
The sense of being in control of one’s pain (internal locus of control) rather than at the mercy of the pain (external locus of control) can help lessen one’s perception of the intensity of the pain. Strategies that help re-frame thoughts and feelings about pain may actually bring about changes in neural activity (such as reducing activity in the amygdala linked to anxiety/stress responses) that in turn help decrease the perception of pain. You may not be able to control when and how pain strikes; yet, you can control how you react emotionally to it. It may feel forced or unnatural at first to track emotional nutrition. However, practice will make perfect. Healthy emotional nutrition means moving toward living a more joyful life; one that places pain in the background rather than the foreground.
Diener, E., Lucas, R. E., & Oishi, S. (2002). Subjective well-being: The science of happiness and self-satisfaction. In, C. R. Synder and S. J. Lopez (Eds.). Handbook of positive psychology (pp. 63-73). New York, NY: Oxford University Press.
Hedegaard, H., Minino, A. M., & Warner, M. (2018). Drug overdose deaths in the United States, 1999-2017. National Center for Health Statistics (NCHS) Data Brief (Number 329). Hyattsville, MD: National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db329-h.pdf
National Institutes of Health. (2014). Pathways to prevention workshop: The role of opioids in the treatment of chronic pain (Final Report, September 29–30, 2014). Bethesda, Maryland: Author. Retrieved from https://prevention.nih.gov/sites/default/files/documents/programs/p2p/ODPPainPanelStatementFinal_10-02-14.pdf
Traylor, C. (2019). Medicaid strategies for non-opioid pharmacologic and non-pharmacologic chronic pain management. Baltimore, MD: Centers for Medicare & Medicaid Services. Retrieved from https://www.medicaid.gov/federal-policy-guidance/downloads/cib022219.pdf