An estimated 30 percent of individuals in the United States report experiencing chronic pain, with females reporting slightly higher levels than males (Johannes et al., 2010). Chronic pain impacts many areas of our lives: relationships, work, hobbies, and physical health, among so many other areas. And it is through the interaction of pain and each of these areas that individuals can easily fall into a vicious pain cycle.
What is it that starts this pain cycle? Well, first, let's distinguish chronic pain from acute pain. As the name suggests, chronic pain is, well, chronic. It lasts longer than three months, and the pain persists beyond the normal expected healing time or despite some sort of treatment.
People with chronic pain often stop engaging in their daily activities as much. This may not happen all at once, but little by little. And when one engages in less physical activities, bodies slowly start deconditioning. Sort of like a "use it or lose it" situation.
Usually, what goes along with this are negative, self-defeating thoughts, like "I can't do anything with this pain," or "I'll never be able to do __________." And anyone who is having these thoughts and the myriad of unpleasant emotions (e.g., shame, guilt, sadness) that go along with them will naturally start avoiding people, places, and things that involve movement because of the fear of causing more pain. Over the long term, that just means more pain, unfortunately.
Fortunately, though, there are treatments that have been shown to be effective for dealing with chronic pain, like cognitive-behavioral therapy (CBT). But let's be clear that even with these tools, it does not mean the pain will go away, but maybe we can make our lives around the pain a bit more tolerable. So with that said, see the five skills below that are used in this treatment to help deal with chronic pain.
1. Create SMART goals for yourself.
What makes a goal SMART? Make it specific, measurable, achievable, relevant, and time-bound. Don't just tell yourself you want to exercise more. When do you want to exercise? How many times per week? Where are you going to do it? For how long? With whom?
Ask yourself these types of questions to help you think through the steps you need to take. It's hard to move past your chronic pain if you don't know where you're headed, so make a SMART goal for yourself.
2. Exercise, but pace yourself.
"Motion is lotion," as they say. As you age, you do not have as much synovial fluid or lubrication in the joints. This can make movement more difficult, so low-impact exercise can be helpful in maintaining some muscle strength. Just make sure that before beginning any sort of exercise regimen, you talk with your PCP. No exercise regimen should be started without talking to your M.D. first.
When I say exercise, I don't mean to go run a marathon, but start by pacing yourself. It's common in people for chronic pain to want to overdo things when they feel better and then pay the price for the amount they did over the next few days. It's better to have a more consistent, less strenuous exercise routine than one that happens once every few weeks when you feel good.
This doesn't just apply to exercise, but any sort of activity. Take breaks based on how much time you have worked and not how much you have accomplished. Hopefully, by resting more, you can actually get more done in the long run and not wear yourself out after one hard day.
PS—Don't forget, exercise improves your mood!
I know: It's easier said than done. But people with chronic pain often live in a perpetual "fight or flight" state, where their bodies are tense. The tension actually creates more pain, so learning relaxation tools can be really helpful.
I recommend downloading some meditation apps on your phone and using them once per day. My personal favorite is Insight Timer. It has thousands of free meditations. Check out some focusing on progressive muscle relaxation or guided imagery.
4. Start having some fun.
Like I said, chronic pain often leads to an isolated life for fear of causing any more emotional or physical pain than is already there. However, the less you engage in pleasant activities, the worse your mood gets, and the more your quality of life decreases. I recommend googling "Pleasant Activities Schedule" if you need a list of hundreds of possible things you can do to improve your mood. But think about your own life and what might be useful.
5. Challenge your thoughts.
Research has shown that catastrophizing thoughts (e.g., "I can't do anything with this pain," "This pain will never go away," etc.) are often more predictive of the pain one experiences than the physical impairment itself or the imaging associated with the impairment. Specifically, those who experienced chronic pain and reported catastrophizing thoughts such as those that I wrote about above report more pain intensity, more disability, and more psychological distress (Severeijins et al., 2001).
So what does all this mean? Examine your thoughts. Imagine those thoughts were up for a trial, and a jury had to decide if they were true or false. Is it true that the pain will never go away, or is it sometimes a bit better than other times? Is it true that you can't do anything with the pain, or are there still some things you can do? You may not be what you used to be, but you may also not be who you think you are.
6. Get good sleep (or as "good" as possible).
Sleep is the body's time to recharge itself, and if you're not getting good sleep, that can increase your pain. So let's talk about about a few quick things you can do to improve your sleep:
- Set a consistent sleep/wake schedule so your body can get used to it and begin to recognize the cues that it's time to go to sleep. Create a nighttime ritual.
- Adjust your bedroom so that it is free from distractions and unnecessary lights as you're trying to fall asleep.
- Avoid caffeine, nicotine, or alcohol too close to bedtime.
- Address any emotional concerns you have during the day, rather than letting them fester as you try to fall asleep.
All six of these solutions used together in the long term can have really powerful effects. And while they are simple skills, relatively speaking, they are difficult to implement, given how tiring living with chronic pain can be. So while this is not a panacea, maybe implementing just one of these skills can provide a moment of relief. Reach out to a provider now who specialized in chronic pain and who may even be able to do cognitive-behavioral therapy for chronic pain.
Dr. Rubin Khoddam is a Clinical Psychologist currently working in private practice in Los Angeles, CA as well as at the West Los Angeles VA as the Team Lead in the residential rehabilitation program for individuals dealing with issues related to substance use and homelessness. Dr. Khoddam currently provides individual, couples and family therapy, as well as group therapy. He also runs the IMPROVE: Outpatient Substance Use Treatment Program, a low-demand, harm reduction substance use treatment program for individuals hoping to decrease their substance use or examine the impact of their substance use in their life. For more information, visit his site www.DrRubinKhoddam.com and follow him on Facebook, Instagram, and Twitter.
Johannes, C. B., Le, T. K., Zhou, X., Johnston, J. A., & Dworkin, R. H. (2010). The prevalence of chronic pain in United States adults: results of an Internet-based survey. The Journal of Pain, 11(11), 1230-1239.
Severeijns, R., Vlaeyen, J. W., van den Hout, M. A., & Weber, W. E. (2001). Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. The Clinical journal of pain, 17(2), 165-172.