•  Humor Therapy •  Interview: Dr James Gordon and Mind-Body Medicine •  Pain Behavior Tool •  Pain Management 101, Part 2: Self-Care Options •  Pain Management 101, Part 3: Alternative Therapies •  Questions to Ask Your Doctor About Pain •  Special Report: New Thinking About Chronic Pain

Chronic pain sufferers are members of a pretty big club. According to the American Pain Foundation, pain is a daily companion for at least 50 million Americans. And one third of U.S. adults lose more than 20 hours of sleep each month due to pain.

Chronic pain is easy to recognize, but the medical community doesn't always agree on how to define it. One definition of chronic pain is "intermittent or constant pain that lasts for at least three months." Many experts prefer to use looser definitions, such as pain that persists longer than expected for healing. Chronic pain can be caused by conditions like arthritis, shingles, persistent back problems, or cancer. Sometimes pain has no apparent physical cause at all.

When pain is the number one thing on your mind, it can color your whole outlook on life. You may become depressed and unable to work effectively or get a good night's sleep. This becomes a cycle that pain specialists call the "terrible triad" -- suffering, sleeplessness, and sadness. Though it may sound challenging, if you can change the way you think about your pain, it’s possible to gain a sense of control and actually decrease the amount of pain you feel.

What can you do to find relief? Pain takes a physical and mental toll, and it could be the sign of a brewing problem, so your first stop should be your doctor's office. Treating yourself with over-the-counter drugs is fine for a few days, but your doctor should sign off on any long-term strategy for dealing with chronic pain. Before you go, print out our Questions to Ask Your Doctor About Pain so you can get the most out of your appointment.

To start with, realize that you are in the driver's seat. The American Pain Foundation has come up with a Pain Care Bill of Rights that says that as a person with pain, you have the right to:

•Have your pain taken seriously and be treated with dignity and respect by health-care professionals

•Have your pain thoroughly assessed and promptly treated

•Receive information from your health-care provider about possible causes of your pain, as well as potential treatments and the benefits, risks, and costs of each

•Be an active participant in decisions about how to manage your pain

•Have your pain reassessed regularly and your treatment adjusted as necessary to ease your pain

•Get a referral to a pain specialist if your regular health-care provider can't relieve your pain

•Receive answers to your questions

•Have enough time to make decisions about your options

•Refuse a treatment if you choose

Let this bill of rights serve as a reminder that you do have choices when you're in pain. You might not be able to rid your body of pain entirely, but you can often lessen its severity and improve your quality of life.

While pain relievers are very valuable in managing chronic pain, they do have downsides. In high dosages or over a period of time, ibuprofen and other anti-inflammatory medications can cause gastritis or gastrointestinal bleeding. Your body can also build up a tolerance to painkillers, so you might need increasingly larger doses or stronger medications (like codeine or other opiates), which have additional side effects and can be addictive.

Ultimately, we experience pain in our brains, so there is a lot of research on ways to convince our brains to perceive less of it. These alternative pain control methods can range from adopting a positive outlook and getting regular exercise, to trying acupuncture and practicing biofeedback. Depending on the type and level of your pain, these strategies might help you reduce your dependence on drugs and regain a feeling of control. Here are a few ways you can tap your brain to take charge of your pain:

1. Alter your expectations

Having realistic expectations is important. It's good not to be overly optimistic because that's a recipe for frustration. But it's also important to have faith that things will get better.

Research has shown that, in fact, negative thinking can actually make pain worse. In a 2006 study conducted at Wake Forest University in Winston-Salem, North Carolina, researchers taught volunteers to expect mild, moderate, or severe pain at regular, specific intervals, using a miniature heat pump controlled by computer to stimulate the sensation of pain. Then they switched the actual level of painful heat that was delivered so that a third of the time a study participant was expecting one temperature, but actually received a lower or higher temperature instead.

The researchers found that most of the time people who expected mild pain perceived just that -- mild pain -- regardless of the level of painful heat they actually received. In other words, the volunteers tended to experience the level of pain they anticipated, not necessarily the level of pain that was actually delivered to them. Not only that, but MRI scans of the volunteers' brains reflected their experience of pain to be what they reported, not what they actually received: Researchers saw activity decrease in the parts of the brain central to the processing of pain by the senses and the emotions.

What does this mean? Dr. Robert Coghill, one of the study's researchers, concluded, "The brain can powerfully shape pain, and we need to exploit its power….Expectations about pain can affect its intensity at a level of pain reduction that is comparable to that of a normal dose of the painkiller morphine." In other words, if you expect to feel less pain, you may actually experience the kind of pain relief you would get from a dose of morphine. This suggests that our mind has the painkilling power of a potent narcotic -- if we can learn how to harness it.

2. Have a good laugh

That's a joke, right? Not really. Studies suggest that laughter can actually provide some relief from pain, possibly due to the feel-good hormones called endorphins that are released in your brain when you laugh. (According to the American Pain Foundation, the word "endorphin" actually means the "morphine within.") Some cancer treatment centers even offer humor therapy to their patients. So, read an amusing book or watch a funny movie and you just might find yourself feeling better.

3. Practice positive thinking

Pain can be demoralizing. When you're in pain day after day, you may feel depressed and, understandably, you may tend to view things in a negative light. You may think, "What's the use of exercising? It may ease my arthritis pain for a little while, but it’s just going to roar right back." If these negative thoughts snowball, before you know it everything will seem bleak. You may feel hopeless and view everything in terms of extremes, like "I'll never feel better," or "This pain is unbearable." Pain researchers call this "catastrophizing," and have found in studies that it actually makes pain worse.

You might think, "My pain is a catastrophe, so of course I'm going to look at it like that."

Nobody can know your pain or how difficult it is for you to bear, but trying to maintain a positive outlook can make a big difference in the long run. It may take some work to turn your negative thoughts around, but it's worth the effort.

How can you tell whether you’re engaging in negative self-talk or just being realistic about living with pain? There are a few characteristics common to negative messages we give ourselves:

•They’re usually all-or-nothing messages, like, "I’ll never find any relief from this pain." The reality is, you should be able to find some degree of relief -- even if you have to learn to live with some pain.

•They tend to be automatic responses, like, " I can’t do anything because of this pain. I’m totally useless." If you find yourself reacting like this when you try to do something that causes you pain, stop for a minute and think about it. There may be a way to break the task down into manageable pieces, or you could try again when your pain is less severe.

Exercise: Think about the messages you tell yourself about your pain. Use our Pain Behavior Tool to write down the negative messages you think, and then see if you can find a more positive way to look at things. For instance, instead of this:

"What's the use of exercising? It may ease my arthritis pain for a little while, but it will be back."

Maybe you could change it to this:

"I know it can't cure my arthritis, but exercise strengthens the muscles around my sore joints and helps me stay strong and mobile. It will also ease my pain in the long run."

Negative thoughts aren't "bad" or "wrong," but they're unproductive and what's worse, they may intensify your pain. So it's worth a shot to try to give yourself some positive messages.

4. Distract yourself

Another way to put your brain to work for you is to distract yourself from your pain with an interesting or pleasurable activity. It makes sense that the more you think about your pain, the more you'll be aware of it. In a small Korean study, burn patients who were allowed to choose music to listen to while their dressings were changed reported feeling less pain than patients who didn't listen to music.

Researchers in Seattle have gone a step further. They have developed a virtual reality program called SnowWorld that allows people to float down an icy canyon and throw snowballs. In their study of burn victims (whose pain could not be fully managed by medications), the patients who used SnowWorld reported a 30 percent reduction in their worst pain, and a 44 percent drop in the time they spent thinking about it. Brain scans confirmed that activity in the pain-related areas in the brain was reduced by 50 to 97 percent.

Exercise: Use the Pain Behavior Tool to jot down some activities you can use to distract yourself when your pain flares up. Maybe you could listen to music, read a book, or do a favorite hobby. It can't hurt, and it might help.

What to do next:

Your brain can be a powerful ally in managing your pain. Before the next class, use the Pain Behavior Tool to work on turning negative thoughts into positive messages. Write down some distracting behaviors and try them the next time your pain is particularly troublesome.

In the next class, we'll cover ways to manage your pain with over-the-counter drugs heat and cold, exercise, and relaxation techniques.

Further Resources

American Chronic Pain Association
PO Box 850, Rocklin, CA 95677
Phone: 1-800-533-3231
http://www.theacpa.org/

American Pain Foundation
201 North Charles Street, Suite 710
Baltimore, Maryland 21201-4111

Phone: 1-800-615-PAIN (7246)
http://www.painfoundation.org

References

First published June 14, 2006
Last updated May 14, 2008
Copyright © 2006 Consumer Health Interactive

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