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01
JUL
2012

Living Well News – An Integrative Approach to Chronic Pain

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Chronic Pain: A Growing and Controversial Problem

The American Academy of Pain Management considers pain as a silent epidemic in the United States, noting that an estimated 50 million Americans live with chronic pain caused by disease, disorder, or accident. It is also estimated that an additional 25 million people suffer acute pain resulting from surgery or accident, with approximately two thirds of these individuals living with this pain for more than five years. The most common types of pain noted as including arthritis, lower back, bone/joint pain, muscle pain, and fibromyalgia. The consequences of untreated or failed treatment attempts are costly, with the loss of productivity and daily activity due to pain is substantial. In a study done in 2000 it was reported that 36 million Americans missed work in the previous year due to pain and that 83 million indicated that pain affected their participation in various activities.

Although pain cannot be seen, touched or measured, it is very real. It is a signal which is produced in response to “injury” and is processed in the complex, central nervous system creating an array of physical and emotional responses. Hence the terms “pain” (relating to the physical component) and “suffering” (to the emotional distress) are intimately related. Chronic pain is pain that continues beyond three to six months, has lasted beyond any useful function, and may or may not have a clearly defined physical basis.

But why are some people more affected by pain than others? Pain is a subjective and personal experience unique to each person. Our response to pain is based on many factors, including, gender, age, and prior experiences with pain and illness, attitudes / beliefs, social influences, environment, circumstances, biochemistry, and the various dimensions which contribute to the making of who we are. For instance, if a person has had prior experiences with pain, they may anticipate its course which will affect their expectations. If a person has had a history of being abused as a child – emotionally, physically, or sexually – his or her perception of pain may differ accordingly, impacted by fear, compounded stress, and diminished ability to cope. If a person has a shy personality and has a difficult time asserting and asking for his or her needs and wants, pain may present another layer of complications. Our sensitivities and level of resilience can really impact our own unique response to pain, all of which are valid. Essentially, it is reasonable to believe that the unique characteristics of each individual impact one’s experience of pain.

This brings us to the term “psychosomatic,” which refers to the connection between the mind and the body recognizing it as one interdependent system highlighting the influence of emotional factors. Unfortunately, as emotions are involved, it can also be assumed that the pain sufferer is somehow making the pain happen or that the pain is “all in one’s head” or the possibility of drug seeking behavior is occurring. Pain is, however, very real and is considered a medical priority attached to an ethical obligation out of respect for human life within healthcare. It is important that we understand the dynamics of pain so that productive steps are taken towards resolve. Understanding and being able to leverage the mind-body connection is at the base of applying an integrative approach.

Mind over Matter?

Mind-body oriented health professionals contend that we have more power over our pain than we realize. We know that the brain and central nervous system are connected and constantly talk to each other, sending and receiving signals such as pain messages. Messaging typically results from injury or illness and stop once the body is healed. Mind-body interventions are based on the idea that this messaging system can break down, causing miscommunication between the mind and body.

Pain treatment programs that use mind–body interventions help interrupt these pain messages and reestablish healthy communication within the central nervous system. It is important to bear in mind, however, that because pain is a complex puzzle, no single health care profession holds the “one and only key piece”; rather, each health care professional holds a critical piece that contributes to the completion of the puzzle. Skilled practitioners are trained to see patients as multifaceted, whole systems requiring a multidisciplinary viewpoint and a tailored clinical/ behavioral approach.

Role of Behavior: Thoughts and Emotions

“Emotions = energy in motion” – Cited via addiction and codependency expert John Bradshaw, Ph.D. But, human being can only be aware of just so much on a conscious level. There are many emotional experiences that we have at the subconscious level that we do not tune into, but it is these inner experiences that have the most power over us when they go unidentified over the longer term. Feelings of anxiety, fear, tension, anger, resentment, or depression could cause a disconnection between the mind and body – creating a multitude of problems.

Our brain is designed to respond to such emotions, it is constantly rewiring itself to keep up with the barrage of negative stimuli. As a result, the brain may send erroneous pain messages through the body. When working within a mind-body or integrative treatment framework, a physician or behavior therapist’s first step is to examine behavior and environment in order to identify factors that may be causing or exacerbating the person’s pain reaction. The next step is to develop more productive ways to handle the stressors in order to develop more control over physiological responses to difficult emotions. Over time, difficult emotions are processed or “regulated” more fluidly and distress is better tolerated without getting “held up” in the body. Ultimately, this helps in building the ability to become more stress hardy and resilient against negativity and sickness.

Integrative Approaches

Over the past few decades, an abundance of research has confirmed that mind–body therapies, either alone or with other treatments, may help resolve various types of pain and prevent pain recurrence. Techniques that were once considered complementary or alternative (such as behavioral therapy, biofeedback, cognitive therapy, guided imagery, and hypnosis, acupuncture, acupressure, nutrition, meditation, and relaxation therapy) have now become mainstream. These therapies, along with standard medical care and needed lifestyle changes, can be integrated into a tailored treatment plan, allowing the pieces to be put together towards resolve of chronic pain and restoring a higher quality of life.

Where does one Start?

At Integrated Treatment Solutions, we always start with a comprehensive assessment. An assessment is all about having a quality conversation about the client’s history, health, home/work environment, relationships, important life experiences, world view, and concerns. Therapists generally spend more time with clients over a span of time and are helpful in being able to speak to important factors that may be impacting the client’s health. When there is a health issue at hand, we always work with the client’s primary care doctor and/or refer the client to an Integrative Medicine (IM) or Functional Medicine (FM) doctor who can assess and treat conditions beyond symptoms, getting to the root of a given problem.

Through identifying underlying issues to the problem, we develop an integrated treatment plan with goals and a process to reach them. Many of these goals are behavioral requiring the client to try new ways of living and making changes. Learning new skills is central to making progress. Other resources and interventions are generally included, as it is necessary that the client become an active “learner” in the process and be willing to collaborate in their treatment. Essentially, everyone needs to do their part in order to work towards a solution.

Skill Building: Mindfulness – “What” Skills

The first step in working with any condition worsened by stress is to start with the mind. Our minds can be our best ally or our greatest foe. Being able to distinguish the difference between what is real and what is not is important in being able to gain true control over our comfort, establish confidence and trust in our ability to cope.

It is our nature to judge, that is to interpret what we see and experience, assigning some sort of meaning to it. Judgment is about survival, so we can act out of self-protection and prevent harm. But, the problem with this is that our interpretations are not always accurate. We all bring our personalities, fears, and experiences with us through our lives and they impact the way we see and experience other people and events. In order to reduce stress, tension and to build healthy habits, we must step back and relearn how to view the world. Being “mindful” is at the core of this way of “living in the moment” and noticing changes that take place in slow motion, noting the gradual progression of one moment into another… allowing each moment to be new and residue free from the past.

We can apply moment-to-moment awareness to anything, including our bodies, minds, and emotions. When we tune in and watch and listen closely to our body, we are more apt to also notice the inner dialogue we are having in response to what we think we are experiencing. For instance, a headache; it is easy to want to grab an Advil or aspirin, as our most likely immediate reaction to the pain is “This is bad! Let’s make this go away.” We have become conditioned to just irradiate pain. However, if we would stop, maybe sit in a chair or lie down, get quiet, and mentally scan the body, we may come to identify the tension that is asking us to be released or learn to recognize some other emotion that is lingering. But, if we just silence the pain before getting the information, then we cannot take care of our health in a real way.

Try the attached exercise: Mindfulness: What Skills and read through the steps. Note the breakdown and the importance of keeping it simple and sticking to what is.

We, at Integrated Treatment Solutions, would like to hear from you. Let us know what you discover in using this approach. And, remember, that it is the mind’s habit to rush through or pass over what requires attention. Learning about the mind is the key to all health and contentment.

References and Recommended Reading:

Mindfulness Meditation for Pain Relief
Guided Practices for Reclaiming Your Body and Your Life

Jon Kabat-Zinn

Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness
Jon Kabat-Zinn

Healing Back Pain
John Sarno, MD
YouTube Video: http://www.youtube.com/watch?v=9ymsLSiA2RA&feature=related

The Power of Now
Eckhart Tolle

Paula Tropiano
About the Author

Paula Tropiano is a Licensed Professional Counselor and Addictions Specialist providing holistic – skills based counseling and therapy to adults in West Chester, PA. (610) 692-4995. www.myintegratedtx.com