Mind/Body—Active Coping for Chronic Pain

By Carol Krucoff

It’s a common scenario: Someone with a terrible backache watches a movie and afterwards finds that her pain has decreased.

This doesn’t mean her pain isn’t real or is “all in her head,” says psychologist Dennis Turk, PhD, a professor of anesthesiology and pain research at the University of Washington School of Medicine in Seattle. “It simply illustrates that the brain has a finite capacity to process information. When you’re distracted by a movie, you’re not paying as much attention to how bad you feel.”

New research into how the brain modulates pain suggests that simple strategies—such as diverting your attention and relaxation techniques—can profoundly influence the perception of pain, notes Turk, who is past president of the American Pain Society. “Every time you think or talk about your pain, muscles in that area tense. Our research shows that muscle activity increases up to 1,300 percent as you talk about your pain.”

That’s why Turk encourages people with chronic pain to adopt active coping skills that can reduce symptoms and dramatically improve their quality of life. Most important, he says, “is a perspective shift. Stop thinking of yourself as a patient—it’s very demoralizing and relinquishes all the power to others. Instead, recognize that you are a person with a chronic condition that you must learn how to manage.”

Based on his work with thousands of people with chronic pain over more than 25 years, Turk developed a 10-step program of self-management strategies, which he outlines in The Pain Survival Guide: How to Reclaim Your Life (American Psychological Association, 2006) co-authored with Dutch pain expert Frits Winter, PhD. “Stop looking for a magic cure,” says Turk. “Find ways to put your pain in the background, instead of the foreground so that you can get on with your life.” Key strategies include:

Relaxation Techniques. People with chronic pain often feel as if they are waging a battle with their body all day, which can intensify pain by creating stress and interfering with sleep. But learning to relax—despite your level of pain at any given moment—can help break this vicious cycle of stress, sleeplessness, and despair. Relaxation skills can be learned, and it’s important to find a technique that suits your personality, then schedule it in your daily routine.

One of the most effective techniques, controlled breathing, involves switching from shallow “chest breathing” to deep diaphragmatic breathing. To learn this calming skill, lie on your back and place your hand on your stomach, just below the navel. Take a slow deep breath through your nose and completely fill your lungs, so that the hand on your abdomen gently rises as you inhale and falls as you exhale.

Next, visualize a balloon in your abdomen. Each time you breathe in, imagine the balloon filling with air. As you breathe out, imagine the balloon collapsing. Inhale slowly and deeply through your nose and let your abdomen rise as you breathe in to the count of four. Then slowly exhale through your mouth to the count of four, feeling your abdomen sink as you do so. Try practicing 10 breaths, three to four times a day. When you have mastered this, with each slow breath in, focus on a word such as “calm.” On the out-breath think of a related word, such as “relax.” You may also substitute a word from your religious faith or spiritual practice if you prefer.

Other useful relaxation techniques include meditation and prayer, guided imagery, listening to music, enjoying nature, and being with other people.

Changing Thoughts and Feelings. Negative thoughts and feelings open the pain gate, while realistic thinking can help you feel less distressed and more in control. For example, instead of thinking “My pain is terrible, I can’t bear it,” shift the focus to “The pain is back again, but I know it’s only temporary.” For help in transforming negative patterns of thought and behavior, consider learning cognitive behavioral therapy techniques from a qualified psychologist.

Activity, Rest, and Pacing. Pain often leads to reduced mobility, which in turn causes reduced fitness—leading to increased pain. Break this cycle by finding your own personal balance between appropriate activity and rest, so you build strength and endurance to help relieve pain. First, find an activity or type of movement that you enjoy—such as walking, swimming, or dancing. Then, schedule this activity into your week, being sure to pace yourself so that you maintain a reasonable, consistent amount of appropriate exercise. Be sure to start your activity slowly and progress gradually, altering between periods of movement and rest. Yoga can be a particularly helpful form of activity for people with chronic pain, since it relies on deep, diaphragmatic breathing and teaches us how to balance effort and relaxation.

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