Updated: Jun 9, 2022
- Teresa Jacobson, DBH, LPCC-S, NCC
May 20,, 2022
Unending pain takes pain to a whole-new level. Unless one experiences pain with chronicity, it is not something that is easy to understand. Like grief, each person's experience with pain is unique.
Sometimes a patient with chronic pain hears people say, "you just can't handle pain." Others may have the misguided thought or hear comments like, "it's all in your head." They may even struggle with that worry, especially if medical staff cannot find the source of pain from a test or x-ray. But just because it isn't visible to others, does not mean it isn't real.
The Pain Hard Truth of it All
Chronic pain is often defined as pain that lasts more than 3 to 6 months, or longer than what is referred to as normal tissue healing time. "Chronic pain is a frequent condition, affecting an estimated 20% of people worldwide and accounting for 15% to 20% of physician visits" (Treede et al., 2015). Chronic pain causes suffering to people, and makes an impact on many levels.
"Chronic pain should receive greater attention as a global health priority because adequate pain treatment is a human right, and it is the duty of any health care system to provide it" according to a review by the International Association for the Study of Pain. This organization was instrumental in the additions to the ICD-11 (International Classification of Diseases version 11) published February, 2022, which included categories for chronic pain and clinically relevant disorders divided into 7 groups:
chronic primary pain
chronic cancer pain
chronic posttraumatic and postsurgical pain
chronic neuropathic pain
chronic headaches and oral facial pain
chronic visceral pain, and
chronic musculoskeletal pain
A description of chronic pain in the ICD-11 reads: "Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." Pain is one of the most universal forms of stress.
Pain is also "one of the earliest suffering of humankind" (Lima, Alves, & Turato, 2014). "Considered as an integral part of life, pain has always been present throughout the development of the human being, exerting a protective function on the body. Associated with diseases, inflammatory processes, accidents, and medical or surgical procedures, pain functions as a warning sign indicating that something is not well." Sadly, chronic pain does not allow us to feel that relief is in sight, which impacts us deeply.
Adding Salt To the Wound
Unfortunately people who experience chronic pain may also experience higher levels of distress due to losses in life, love, work, motility, functioning, sadness, and intense worry. Thoughts might commonly be: "Will I ever be without pain?" or "Is there really no hope for me?"
Naturally, or "concomitant with the high prevalence of both conditions, epidemiological and functional imaging studies suggest that a bidirectional relationship exists between chronic pain and mental health disorders" (Hooten, 2016). "This is relevant to clinical practice because this bidirectional relationship may be partly mediated by shared neural mechanisms, which, in turn, may necessitate the use of targeted pharmacological and behavioral interventions aimed at treating both conditions." The study shares that adults with chronic pain are also at higher risk for suicide, cigarette smoking, and have history of sexual trauma. Insomnia is reported with chronic pain 50-80% of the time, as is social isolation and social rejection (Tick et al., 2018).
One fact has become clear, and that is for providers to consider the biopsychosocial model of pain due to the high prevalence of chronic pain and psychiatric conditions comorbidities, such as Post Traumatic Stress Disorder, Depression, Anxiety, Grief, and sometimes Substance Use disorders.
"Chronic pain is multifactorial: biological, psychological and social factors contribute to the pain syndrome." While the ICD-11 validates many different sources of pain and the need for it to have its own classification, the jury is still out on exactly how to obtain healing.
One promising answer includes the integrated physical and mental health care models across the nation. In these settings, providers are identifying those suffering with this condition and trying to help patients in a more collaborative, patient-centered, trauma-informed, and holistic way, a way that normalizes help for mental health disorders that contribute to the pain experience.
Where there's Help there's Hope
The helping professions are becoming more skillful in evidence-based practices to utilize to best help chronic pain sufferers. Some of these modalities include: Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Mindfulness, Somatic Release and Vagal Toning. In the experience I have with clients, Existential interventions are also helpful to promote meaning from suffering, and cultivate hope.
Here are a handful of ways these strategies can help:
Enhance health through the use of Cognitive Behavioral Therapy (CBT) by ensuring your thought-patterns and core beliefs are accurate, healthy and helpful. "CBT has been shown to have a positive impact on pain intensity, pain-related interference, health-related quality of life, and depression among individuals with chronic pain" (Wegener, Wolfman, & Haythornthwaite, 2011).
Start your healing journey "from where you are, not from where you would like to be...ACT (Acceptance and Commitment Therapy) works to promote the ability to: (a) be in the present moment in life; (b) be accepting of and detached from unwanted, distressing experiences such as painful emotions, intrusive memories, or self-critical thoughts; and (c) act in ways that reflect personal values." (Strosahl & Robinson, 2017).
Apply Mindfulness to "uncouple the somatic sensations from all the thoughts and emotions" to form a healthier response and decrease suffering (Kabat-Zinn, 2022). "Reclaim your body, even the parts of the body that hurt and you don't want to deal with." An example can be as simple as focusing on breathing, just breathing. Should you get distracted, just notice it and bring yourself back to your breath, nonjudgmentally.
Use Somatic Release and Vagal Toning to lower depression, anxiety, inflammation, and overall stimulation of the parasympathetic nervous system which in turn reduces our neurophysiological experience of stress. It reduces heart rate and blood pressure, aids the limbic system in our brain, stimulates digestion and creates an increased feeling of well-being. Loud gargling, singing, or humming can activate our vocal cords and stimulate the vagus nerve, as does cold water face immersion. Deep diaphragmatic breathing, gentle or firm touch, and laughter are examples of other ways to stimulate the vagus nerve which in turn "sends a message to our bodies that it is time to relax and destress" (Horeis, M, 2020).
Understand and affirm your story from a phenomenological point of view and find support to help. "The body that hurts is an individual constituted by the world that surrounds him/her, influences him/her, and is influenced by him/her at every moment, and it has unique characteristics–which, without attention, may limit therapeutic intervention" (Lima, Alves & Turato, 2014).
Each experience of pain is absolutely unique. Our story is an important one, one that is sometimes hard to hear, and often hard to understand.
Regardless of the level of pain, and how it has impacted your life; pain does not define you.
You are more than your pain.
Your life is more than pain.
Your worth is more than your experience of pain.
Though you may feel alone, 1 in 5 of us experience some form of chronic pain. Let your story be heard; you may help a fellow sufferer.
When we turn pain into purpose we take the power back from the pain. When we do, the pain is no longer in vain.
Teresa Jacobson is a Doctor of Behavioral Health and Licensed Professional Clinical Counselor Supervisor who is counseling Ohio and Kentucky adults of all ages and life experiences via secure Telehealth/Video visits. A strength-based, person-centered multi-cultural counselor, with an existential philosophy, Teresa can be reached by emailing email@example.com, calling (513) 206-3026, or visiting https://www.steppingtowardserenity.org
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