Psychologist, Tara Brach approaches therapy using mindfulness as the foundation to healing; she does this through a blend of westernized therapy and eastern buddhist practices. Her website www.tarabrach.com, has hundreds of free recorded talks, videos, and articles where she investigates different facets of the human experience; pain being one of them. In the video The Dance with Pain that I attached below, Dr. Brach explores the relationship between emotional and physical sensations when dealing with acute and/or chronic pain and discomfort. Dr. Brach reminds us when humans feel pain - they tend to contract against the pain, they judge the pain, and blame themselves, others, and/or the pain. However, this fight and resistance tends to create more physical and emotional pain/discomfort. Dr. Brach then goes on to clearly teach us ways in which we can mindfully inhabit our bodies and learn how to listen and respond to the pain with awareness and compassion.
There is a lot of debate in the medical literature about which came first, anxiety or chronic pain? It's one of those chicken and egg situations. To me all that matters is that I can tell you, if you have been living with pain for more than 6 months you probably have some anxiety. It is not as important to me to know which came first because you are now living with both. And anxiety increases pain and pain increases anxiety, creating what I can a "death spiral" where without help the person just gets sucked farther and farther down into misery.
So let's assess the problem:
Anxiety is defined as 'A negative reaction of a person to stress, often leading to over arousal'
'An emotional state, similar to fear, associated with arousal an accompanied by feelings of nervousness and apprehension'
What is an anxiety disorder?
Anxiety disorders are a unique group of illnesses that fill people’s lives with persistent, excessive, and unreasonable anxiety, worry, and fear. They include generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder (SAD), and specific phobias. Although anxiety disorders are serious conditions, they are treatable.
What chronic pain conditions and diseases commonly occur with anxiety disorders?
Arthritis —The amount of anxiety and mood disorders (such as depression) is higher in individuals with arthritis than in the general population. Some studies have found anxiety disorders are even more strongly associated with arthritis than is depression.
Fibromyalgia —In a recent study of 336 adults, published in the Journal of Clinical Psychiatry, those with fibromyalgia were almost 7 times more likely to have suffered from an anxiety disorder than those without the disorder.
Migraine —Migraines (and chronic daily headaches) happen a lot in people with anxiety disorders, as well as in those with mood- and substance-abuse disorders. Many studies have found that generalized anxiety disorder and panic disorder are particularly associated with migraines or other types of headaches. As with fibromyalgia, researchers have suggested that there may be a common tendency to develop anxiety disorders, depression, and migraine headaches.
Back Pain —Anxiety disorders and back pain often co-occur; back pain is more common in people with anxiety and mood disorders than in those without them.
Does chronic pain complicate the condition of a person who also has anxiety disorder?
An anxiety disorder and a co-occurring chronic pain disease can make a person’s health more difficult to treat. But a variety of treatments and lifestyle changes can offer relief. Possible health complications are noted below:
Chronic pain sufferers who also have an anxiety disorder may have lower pain tolerance or a lower pain threshold. People with an anxiety disorder may be more sensitive to medication side effects or more fearful of harmful side effects of medication than chronic pain suffers who aren’t anxious, and they may also be more fearful of pain than someone who experiences pain without anxiety.
What treatment considerations are made when someone has co-occurring conditions?
Many treatments for anxiety disorders may also improve chronic pain symptoms. Usually a comprehensive plan with a number of treatment types is necessary. Below is more information about some treatment options for anxiety disorders and chronic pain.
So don't be surprised if you find yourself worrying more, or even feeing symptoms of panic if you have been in pain persistently for six months or more. That is pretty common. But DO take anxiety seriously as it can have detrimental effects to your health (lower immunity, poor quality sleep, increased pain and crabby mood to name a few!). There is treatment for anxiety available so make it a priority. You will be surprised by how much lowering your anxiety level can also lower your pain.
Yours in health,
Adapted from: “Anxiety Disorders and Chronic Pain,” by Anxiety Disorders Association of America. http://www.adaa.org/gettinghelp/MFarchives/MonthlyFeatures(july07).asp
Pain is Distressing….But Distress Can Be Tolerated!
Through Distress Tolerance we learn how to get through difficult moments until they pass.
Through distress tolerance we move to do something that will help us ride through a difficult, but transient, time.
Distress tolerance is about willingness and acceptance…being willing to accept your current situation and then to do something about it.
The purpose and goal of distress tolerance coping skills are to cope with and get through particularly difficult moments until they pass and one is in a better moment.
Thus, these skills are to be used when one is in significant physical and/or emotional pain or distress. Through the use of these skills, we do not fight with our pain. Instead, we accept the pain and the difficult moment, but we empower ourselves to manage the moment.
The trick is to use distress tolerance strategically and deliberately…so you know what to do and you are in control during the most difficult times.
Distract: Through distraction we focus our attention away from our pain and onto something else.
Sensory Distraction: In this process we activate the part of our brain that is more involved with our senses (sight, touch, sound, taste, smell). In doing so, we de-activate the part of our brain involved in physical pain and emotional distress. It will not make the pain go away, but it will quite literally turn down the volume of the pain.
Examples of Sensory Distraction: exercise, holding ice and feeling it melt in our hands, listening to music, tapping our leg with our hand, smelling something strong/odorous, eating something with a powerful taste.
Cognitive Distraction: Here we activate the part of our brain focused on logical and rationale thinking, reflection and imagination. In doing so, again we de-activate the part of our brain involved in physical pain and emotional distress. Our mind can only focus attention on one thing at a time, although our attention can shift quite rapidly and frequently. However, by sustaining our attention on something that is interesting or mentally stimulating, our focus is taken off of our pain and distress.
Examples of Cognitive Distraction: Reading a book, playing a musical instrument, watching a movie, crafts and projects, puzzles, anything that requires or activates focus and attention.
Self-Soothe: This is similar to distraction, but in a soothing, enjoyable and comforting way. Use your senses (vision, touch, hearing, smell and taste) to soothe and bring comfort to yourself. The same activation and de-activation process in distraction occurs, although self-soothing requires a willingness to be soothed.
Examples of Self-Soothing: Watch a sunset, pet a pet, take a hot bubble bath, get a massage, listen to your favorite soothing music, watch a funny movie, listen to the birds, watch children play, eat and savor a favorite food, anything that brings enjoyment and comfort.
Improve the Moment: The idea with Improve the Moment is that you are going to be in pain anyways, so you might as well do something productive. Otherwise, all you have to show for your time is pain and distress. So, tell yourself “I am going to make the best of this difficult time and do something to make my life a little bit better.”
Examples of Improve the Moment: Pay the bills, exercise, do some chores, respond to emails, call a friend, work on your resume, look for job opportunities, wash your car, play with you kids or pets, you get the idea.
It too Shall Pass: This is more of an attitude and an outlook versus an active coping strategy, nonetheless, it can be quite effective. Keep in mind that life is always changing and distressing moments pass. Every moment leads to another, and we know from life experience that the next moment can bring something else and something better.
Use this as a mantra for It Too Shall Pass:
Moments pass, that is the nature of moments. Don’t get stuck in a bad moment - wait for a good moment to come. Remember, a good moment is just around the corner waiting for the bad moment to pass.
Vacation: Take a small vacation from your life and the stress that comes along with it. A weekend, a day, or even an hour away from what you usually do can revive and redirect energy. Vacations recharge and restore us to balance. Be specific and plan it out, or specifically plan not to plan. Treat yourself to something out of the ordinary, something special, something fun. Remember, a good vacation takes some thought and planning.
Try these techniques when you are feeling overwhelmed by your pain (or any upsetting situation). While we can't always make our pain go away we can make riding it out less distressing.
For more information on distress tolerance see this great website: titled DBT Self-help.
The following excerpt was taken from Dr. Andrew Weil's website and is an interesting investigation of things that impact pain tolerance. We have long known that different things increase or decrease pain tolerance such as sleep, mood and social support.
More Friends = Less Pain
The more friends you have, the higher your tolerance for pain, according to a new study from the U.K. Researchers at the University of Oxford wanted to know whether our social networks affect the activity of endorphins in our brains, perhaps enabling these natural compounds to better tamp down pain in people with a wide circle of friends. To test this idea they recruited 101 adults ages 18 through 34 and asked them to respond to a questionnaire on their social contacts. The associations asked about were not limited to the people the participants saw or talked to daily but also those they were in touch less frequently, including once a week and once a month. The respondents also rated their stress levels and fitness and the researchers assessed such traits as “agreeableness.” To determine pain tolerance the researchers asked the volunteers to squat against a wall with their knees at right angles and stay in that uncomfortable position as long as they could. Combining the information about the size of the participants’ social networks and the length of time they were able to squat, the researchers found that those with more friends were better able to tolerate pain, suggesting that our endorphins are positively influenced by how well connected we are to others.
My take? Although the study was somewhat unconventional, this is an interesting finding and plays into my long held view that we haven’t evolved to be alone. We need the intimate support of a family and are meant to be part of larger communities, bands and tribes. In addition, the kind of connectedness you can get by playing a role in your community – working with others for common goals – can give you great satisfaction. There are many rewards to being part of a wide social circle. This study suggests that greater tolerance for pain may be one of them.
-Dr. Krista Jordan, Program Director, Restore FX
Dr. Jordan recommends the following article: http://www.foxnews.com/health/2014/10/21/write-your-way-out-chronic-pain/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+foxnews%2Fhealth+%28Internal+-+Health+-+Text%29
For those of us who work in chronic pain it’s easy to see that patients who have persisting pain for more than 6 months almost always struggle with depression. And research has also shown that those who had depression before they developed pain are much more likely to have that pain become chronic. But the mechanisms linking these two disorders have not always been fully understood.
At Restore Fx we aim to provide the most research-based and current treatments for chronic pain. Our staff constantly reviews medical journals to inform our treatments and improve care for our patients. Just today I came across an interesting article that may help to explain the link between depression and chronic pain on a brain level. Researchers were able to stimulate increased release of serotonin (a neurotransmitter/brain chemical) in mice and found that it significantly reduced their sensitivity to pain. They did this through a clever use of light-sensitive neurons that produce serotonin. For more detailed information on their study please see:
Optogenetic Recruitment of Dorsal Raphe Serotonergic Neurons Acutely Decreases Mechanosensory Responsivity in Behaving MiceGuillaume P. Dugué, Magor L. Lörincz, Eran Lottem, Enrica Audero, Sara Matias, Patricia A. Correia, Clément Léna, Zachary F. MainenResearch Article | published 22 Aug 2014 | PLOS ONE
This may help to explain why taking an antidepressant helps in reducing pain. It’s also good to note that exercise, which is helpful in painful conditions such as arthritis, also reduces depression. So what’s good for your depression is probably also good for your chronic pain.
Stay tuned for more scientific advancements on understanding chronic pain and how to best treat it.
Wishing you well,
Krista Jordan, Ph.D., ABPP
Program Director, Restore Fx
Restoring Functional Life
Krista Jordan, Ph.D., ABPP