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Escaping the prison

Combination of approaches can revive body, mind

Chronic pain affects more people than cancer, diabetes, heart attack and stroke combined. The Institute of Medicine estimates there are more than 100 million sufferers in the United States, costing the nation as much as $635 billion a year in medical treatment and lost productivity.

It’s even the focus of the new movie “Cake,” starring Jennifer Anniston as a woman struggling with chronic pain.

Chronic pain can be devastating, and a challenge to treat. As a mental-health counselor, I have seen it damage productive lives and tear families apart.

Pain sufferers often are misdiagnosed, misunderstood and miserable. Their friends and family can become worn out from listening to complaints. The afflicted’s identity may be significantly altered because they cannot engage in activities they once enjoyed. Doctors get frustrated by the inability to provide a cure.

I have worked with people who had full, rich lives as corporate leaders, mothers, athletes and professors before their chronic pain. However, by the time I saw them, they were isolated, overmedicated and depressed, and they believed their life was devoid of meaning.

The good news is that chronic pain is treatable with the right blend of approaches. The traditional healing model – take medications, rest, get better – doesn’t work with this illness. But there are ways to reduce pain and rebuild yourself.

I worked with one client who lived with chronic pain for more than 15 years. He was a pilot before his illness. When I met him, he was taking copious amounts of pain medications, but all were useless. The drugs simply made his pain worse while clouding both his mind and mood.

He lived in his easy chair in front of the television. He watched the clock, praying for relief and waiting for his next dose. His three adult children never visited because they were tired of his constant irritability and complaining.

When I asked about his goals, he said, “I want to mow my lawn again,” with tears in his eyes.

After eight months of physical therapy, counseling and weaning off addictive medications, he was able to achieve this everyday task and much more.

Nervous system gets distorted

Usually, people feel acute pain after an illness or injury. If pain lasts beyond the time it takes to heal, or longer than 12 weeks, it’s considered chronic.

Michael Clark, a psychiatrist and director of the pain treatment program at Johns Hopkins Hospital, explains the underlying neurobiology: “The disease of chronic pain is more than just acute pain that lasts longer. It has greater intensity, causes impaired function and can migrate beyond the original pain site. The nervous system becomes distorted. Pain receptors get amplified and internal pain blockers minimized, which can make even the lightest touch be perceived as painful.”

People may work with many medical specialists to find help even as relief remains elusive because they focus only on the pain symptoms.

“Chronic pain is not simply a single symptom or a straightforward experience like acute pain,” Clark says.

Depression is common

Chronic pain frequently is accompanied by depression, which can include fatigue, anxiety and changes in mood, appetite and sleep. Sufferers have some of the lowest reported quality-of-life levels among people with major illnesses. Pain combined with depression can hold sufferers back from engaging in life, which may lead to damaged relationships and loss of employment.

“In my practice, I routinely see clients who have suffered from chronic pain for many years. This can result in isolating behavior – especially toward spouses and immediate family members,” says Melissa Delgado, a gynecologist and obstetrician in Vienna, Virginia, who specializes in treating women with chronic pelvic pain.

“Approximately one-third to three-quarters of people with chronic pain experience moderate to severe depression,” Clark says. “Patients with depression experience increased pain because of overlap in the two affected systems: pain reception and mood regulation. Both depression and chronic pain share some of the same neurotransmitters and nerve pathways. So pain is worse, function is poor, response to pain treatment is diminished and their prognosis is worse until they can get their depression under better control.”

Antidepressant medication can provide considerable relief for some. I have seen amazing improvements in clients who focus on treating their depression in addition to pain reduction.

One woman wanted to have her legs amputated because of the interminable, horrific pain, but once her depression was properly managed, her pain diminished. She wasn’t 100 percent pain-free, but it was manageable. I remember her overwhelming joy when she went with her husband to a concert for the first time since the onset of pain more than six years before. They danced in the aisles.

Drugs can make pain worse

Another well-understood contributor to chronic pain is the extended use of strong, addictive medications such as opioids and benzodiazepines such as Percocet and Valium. If they are taken over many years, they can make pain significantly worse.

These medications block the transmission of pain from the site to the brain, so, over time, nerves send stronger pain signals. It’s as though the nerves turn up the volume to help the brain hear the pain. Higher doses of medication are required to block the louder signals. Pain receptors and processors get so distorted that eventually most stimuli are perceived as pain and these medications no longer work. Additionally, these drugs blur thinking, depress mood and encourage isolating behavior.

“Physicians should take a holistic approach and not just focus on individual symptoms,” Delgado says. “Chronic pain is a complex and debilitating disease, and, as a result, we need the multidisciplinary approach to address the whole person.” Medical doctors, counselors and physical therapists all add valuable pieces to solving the chronic pain puzzle.

Rachel Noble Benner is a mental-health counselor in Bethesda, Maryland.

What you can do to ease your pain

These steps, distilled from research and experience, can help manage chronic pain.

Embrace physical therapy

The more you move, the better you feel. Strategically strengthening and stretching the body – especially parts that are affected by chronic pain – can increase mobility, decrease pain and improve overall mood. Find a physical therapist who is experienced in working with people who have chronic pain.

Socialize

Avoid loneliness by engaging in activities with friends and family members. If you have physical limitations, find accommodations that will allow you to enjoy the company of others. Use your problem-solving skills to create solutions and avoid excuses. The emotional and physical benefit of engaging with others is immeasurable.

Treat depression and anxiety

Depression and anxiety can cause physical pain in addition to psychological distress. Talk with a doctor who treats chronic pain if you are experiencing symptoms such as low mood, significant weight loss or gain, fatigue, trouble sleeping, lack of concentration, hopelessness, lack of interest in activities, agitation, worry, fear or panic.

Treating depression and anxiety can significantly reduce chronic pain.

Practice mindfulness and relaxation

Stress increases pain, so meditation, biofeedback, positive visualization and progressive relaxation all provide powerful tools to decrease stress and discomfort. Each of these techniques can train your body to relax muscles, increase blood flow and reduce chemical stress responses that are harmful to your body. These activities also decrease anxiety, elevate mood and ease pain. A good counselor or relaxation specialist can help you master these skills.

Join a support group

Often, an individual suffering from chronic pain feels as though he is the only person in his or her social circle struggling with this issue. Support groups offer a space for people to share and learn from one another. The American Chronic Pain Association, the American Pain Society and Pain Connection can point you to local resources.

Support groups also can be an excellent place to get contacts for physical therapists and counselors who work with people affected by this life-corroding illness.



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