Tips For Coping With Chronic Pain

They say women naturally have a higher threshold for chronic pain. This is partly due to the fact that they go through the process of childbirth; which is one of the most painful experiences. But can women truly have a different threshold for pain? Have you ever wondered why our body feels pain? What is the purpose of pain? Why do you get pain sometimes during activities that are not usually painful, such as sitting and working on your laptop?

Purpose Of Chronic Pain

The purpose of chronic pain in a healthy person is to alert the brain and body that potential damage has occurred to the bodily tissues. Pain is a protective reflex response to a physical stimulus (such as trauma). Hence, the bigger the injury, the greater the pain. It was traditionally assumed that all pain is a symptom of an underlying organic cause. The patient will be relieved of this pain once the cause of pain is healed/mended. The patient is presumed to be lying or imaging this pain if the cause of pain is not found.

But we now know that this is not always the case. This is because the chronic pain that we experience sometimes is much more complex and different from the traditional pain where there is a actual tissue injury. We may experience pain suddenly with no apparent reason, does that mean the pain is “bad”? Pain in this scenario no longer serves its traditional purpose of alerting one to tissue damage.

Nociceptive Pain

“Normal” or Nociceptive Pain is pain that is proportionate to the degree of actual tissue damage. A more severe injury results in a pain that is perceived to be greater than that pain caused by a less severe injury. Such pain serves a protective function. Examples of nociceptive pain include acute burns and bone fracture.

Neuropathic Pain

“Abnormal” or Neuropathic Pain occurs through changes in the peripheral nervous system. This is especially so during diseases involving damage/ changes to the nerves (nerve compression/impingement, cancer, or diabetes) that leads to “impulses” being sent to brain that is then perceived as pain.

Likewise, damage to the central nervous system (involving the brain and/or spinal cord) can also cause non-painful sensations from the peripheral nerves to be wrongly interpreted as pain by the brain.

Finally, prolonged or increased exposure to painful stimulus may also cause changes to the central nervous system. This leads to a condition called central sensitisation, where pain is disproportionate to the degree of tissue damage. It can also persists even in the absence of continued tissue damage. Thus, neuropathic pain serves no protective function and provides no benefit to the overall health of the person.

Neuropathic pain patients may experience certain emotions especially when doctors and other healthcare professionals are not able to appropriately diagnose and recognise the cause of their pain. Feeling depressed and thinking that the pain felt is actually “all in the mind” are examples of such emotions. Disappointment may also be felt, when others are not able to empathise with their ordeal; or even defeated when management for pain has been unsuccessful. A person can begin to think they need to ‘resign themselves to a lifetime of pain’.

Personal Coping Strategies For Chronic Pain

Every one’s pain has a different cause; fortunately here are some personal coping strategies you can apply when dealing with chronic pain.

Coping With One’s Mood And Emotions Especially During Pain Exacerbation

• Primary goals is to view pain as a controllable experience and decreasing the use of maladaptive coping strategies.
• Introduced is a new skill for skill development. Patients are to develop and refine the skill during low pain periods, before attempting to implement the coping skill during an actual period of pain exacerbation. The skill is shaped over time as the individual becomes much more proficient in it. This is so that the skill is gradually applied toincreasingly challenging (i.e. painful) episodes. A similar approach is taken to the application of many pain coping skills. This includes cognitive or behavioral distraction, relaxation, pacing of activities, and the appropriate use of social support.
• understanding one’s cycle of pain and anticipating potential aggravating and easing factors/ actions
• being positive and minimise negative thoughts such as “I’ll never get better!”, “Everyday it’s getting worse!” and “I should just give up and suffer the pain!”

Minimising One’s Disability In Terms Of Functional Activities

• start with graded exercise, and breaking an activity into segments to reduce fatigue. Once you have gained confidence in a specific part of activity, for example sitting over the edge of the bed and standing, in this case, having sufficient strength to lift your bottom over the bed, you can try getting out of chairs of different heights or bed of different firmness.
• Every little success is still a success. Start practising with common activities that you frequently do at home, such as washing the dishes, standing and ironing clothes then gradually progress to brisk walking and other gentle sports.

Cultivating Health Behaviours (Exercise, Appropriate Use Of Medications)

• reduce reliance on medications for chronic pain (don’t start popping pills at the first sign of symptoms!). Frequent consumption of painkillers may gradually cause you to develop an increased threshold to its effects which leads you to increase your dosage or have to have a stronger form of medication instead.
• always aim to reduce dosage of medications gradually only after thorough discussion and consent from your GP. For example, having to take painkillers one pill a day.

Coping A Loved One’s Pain

• be supportive of your loved one’s attempts to manage their pain
• trusting that their pain is real and it is truly upsetting even if you do not understand how they may experience such pain of such intensity
• providing a listening ear to their complains may help to settle them down and increasing their confidence in managing their pain