Chronic pain, whether from injury, headaches, back pain or conditions such as fibromyalgia, can interfere with activities of daily living: in the home, workplace and community. All too often, treatment for pain is ineffective and leads to a downward spiral of decreased functioning, stress, anger and isolation. When pain persists, a person may avoid activities for fear of further pain or injury, which leads to decreased activity levels and physical deconditioning.. Further, as the pain persists, negative beliefs about the pain experience and negative thoughts about themselves often develop. For some, chronic pain leads to the loss of social and occupational responsibilities and status. Combined with social withdrawal, these substantive changes in one’s life can harbor profound demoralization and resentment. These kinds of beliefs and thoughts, along with diminished participation in enjoyable activities, contribute to feelings of depression and anxiety. All of these things can exacerbate and maintain the pain cycle. Those most impacted feel like they are ‘prisoners of pain’.
The figure below (adapted from Cooper, 2003) illustrates how the pain cycle can be a vicious roller coaster ride that alternates between highs and lows of activity and pain. An unfortunate consequence of the pain cycle is that if it is not broken, or at least contained, the individual physical and psychological cycles actually strengthen one another.
Adapted from (Cooper, Booker and Spanswick, 2003)
Contain Your Pain: The Coping Cycle
The pain cycle can be broken by using a number of methodologies and strategies to ‘Contain Your Pain’. Managing your pain begins with education, by understanding that chronic pain actually isn’t actually a result of further “harm” or damage being caused by activity. Chronic pain is a “message” that is not useful in the sense that acute pain is. Touching a hot stove top, you feel pain – this pain is acute and it is useful, it protects you from harm – chronic pain, however does not prevent any further harm, it just hurts.
Going through a pain management program like Brainworks’ Contain Your Pain program, patients learn why it is safe to resume normal activity. Incrementally, as participation increases, as muscle strength and endurance start to return the avoidance, the fear and distress that accompanies chronic pain begins to diminish. This is the start of the coping cycle which with patience, perseverance and practice begins to replace the pain cycle.
Pain Coping Cycle
With confidence, negative beliefs are being replaced by adaptive thoughts as one sees that it is now possible to increase physical activity, step by step. In conjunction with increasing exercise and activity participation you can learn strategies to “Contain Your Pain” that include breathing exercises, relaxation, meditation and imagery. You begin to relax, feel comfortable, move more normally, and develop the confidence needed to resume more and more activities. This leads to improved mood, happiness, enjoyment with one’s life and less pain.
Once you start containing your pain you are no longer a prisoner to it.
The bottom line: Don’t let yourself form a vicious pain cycle. Contain Your Pain.
Cooper RG, Booker CK, Spanswick C. What is pain management, and what is its relevance to the rheumatologist? Rheumatology 2003;42:1133–7.