Living a Healthy Life with Chronic Pain (2 page)

Throughout this book we examine ways of of the essential management skills you need to breaking the cycle of chronic pain illustrated in learn in order to live a healthier, more satisfying
Figure 1.2
on
page 13
and overcoming feelings life with your chronic pain condition.
Table 1.1
of physical and emotional helplessness. A first lists these important skills. step in the right direction is becoming aware of the essential management skills you need to learn in order to live a healthier, more satisfying life with your chronic pain condition.
Table 1.1
lists these important skills.

Table 1.1
Self-Management Skills

Perhaps the most important skill of all is learning to respond to your chronic pain on an ongoing basis in order to solve the daily problems associated with your condition. After all, you live with your condition 24 hours a day; your health care provider sees you only a tiny fraction of that time. This means that
you
are primarily responsible for managing your chronic pain. (See
Chapters 4
and
5
.)

Some of the most successful self-managers are people who think of their chronic pain as a journey or a path along life’s way. Sometimes this path is flat and smooth and you can travel along with few problems. At other times the way is rough, and you must slow down to think about your next move or to take a rest.

To negotiate this path one has to use many strategies. Good self-managers are people who have learned three types of skills:

• Skills to deal with chronic pain.
  Chronic pain, like any health condition, requires that you adapt and do new things to deal with it. These may include practicing relaxation and stress reduction techniques regularly, monitoring your pain levels in order to balance activity with rest, and learning specific exercises and developing a physical activity program. Your condition may mean you may have more frequent interactions with your health care providers. You may need to take medications or treatments on a daily
  basis. All chronic pain conditions benefit from day-to-day self-management skills.
  

• Skills to continue a normal life.
  Chronic pain does not mean that life stops. There are still household tasks that need to get done, friendships to maintain, work to perform (whether you have a job or do volunteer work), and important family relationships to nurture. You just may need to learn new skills or adapt the way you do things in order to maintain the things you need and want to do in your life.
  

• Skills to deal with emotions.
  When you are diagnosed as having a chronic pain condition, your future changes. With these changes come changes in plans and changes in emotions. Many of the new emotions are negative. They may include anger (“Why me? It’s not fair”), fear (“I am afraid to move my body in case I hurt myself”), depression (“I can’t do anything anymore, so what’s the use?”), frustration (“No matter what I do, it doesn’t make any difference. I can’t do what I want to do”), or isolation (“No one understands. No one wants to be around someone who is in pain all the time”). Negotiating the path of chronic pain means learning skills to work with these negative emotions.
  

Self-management involves using skills to manage the work of living with your pain condition, continuing to take part in normal daily activities, and successfully dealing with your emotions so you can start enjoying a healthier, happier life.

Pain is a part of being alive. It is nearly universal, something we all share as human beings. At the same time, it is a most personal, individual, and subjective experience. One person’s experience of pain is not the same as another person’s. Throughout human history, pain has been regarded as mysterious and unknowable. Because we can’t see another person’s pain, it seems invisible. But when we feel pain ourselves, it is all too real.

Humans have always tried to understand pain. The ancient Greeks described pain as a “passion of the soul,” an emotion like sadness or grief. This idea of pain as an emotion is called the
affect theory of pain
and this view of pain was prevalent until the seventeenth century.

In 1664, a famous French philosopher and scientist, René Descartes, developed a new concept of pain. He believed that there were special places in the body called pain receptors that sent pain impulses along a pain pathway that went directly to a single pain center in the brain. He also believed that the mind and body were completely separate and that one did not affect the other. According to Descartes, pain was purely physical, and it was a straightforward, simple process. This was called the
specificity theory of pain
, and it persisted for 300 years.

But it wasn’t until the late 1800s that scientists started to use observation and experiments to study pain. Descartes’ idea that pain was purely physical just didn’t fit the facts. But progress was
slow. Then, in 1959, two scientists—Dr. Ronald (MIT) in Cambridge, Massachusetts. Together Melzack from McGill University and Dr. Patrick they developed new ideas about pain that they Wall from Oxford University—set out to unravel called the
gate control theory
. Their ideas revoluthe puzzle of pain. They met while working tionized pain research. at the Massachusetts Institute of Technology (MIT) in Cambridge, Massachusetts. Together they developed new ideas about pain that they called the
gate control theory
. Their ideas revolutionized pain research.

Nerve endings all over our body are sensitive to types of stimuli that can cause us harm and signal danger. Exposure to things like heat, cold, pressure, or chemicals cause particular patterns of nerve or electrical impulses. If the stimuli are strong enough, these nerve impulses travel along the nerves to the spinal cord and up to the brain.

Let’s say you just stubbed your toe. Within nanoseconds, the nerve endings in your toe that respond to pressure send a pattern of nerve impulses along the ‘nerve highway’—the nerves in your toe, foot, leg, buttock and up to the spinal cord in your back. The spinal cord is like a super highway of nerves that connect to your brain. It’s your brain that asks:
“How dangerous is this really?”
It’s only when the brain thinks the pattern of nerve impulses are dangerous that pain is felt. In other words, pain is not in your toe, although it sure feels like that.
Pain is produced by your brain to tell you and your body to take action
. Because this is so important, it bears repeating:
All pain is 100% in the brain
.

Melzack and Wall said that there is a transmission station in the spinal cord that influences the flow of nerve impulses to the brain. They called this transmission station a ‘gate’. Think of it just like a gate you can open or close to get to your backyard. Two things can happen when nerve impulses from your toe reach the gate:

• If the gate is open, the impulses pass through and continue up the spinal cord to the brain. If the brain senses ‘danger’, you experience pain.
  

• If the gate is closed or partially closed, then only some or none of the nerve impulses travel to the brain. The brain might then interpret the signals as a little danger—not enough to worry about—or no danger. So you experience minimal or no pain.
  

The gate can be opened or closed in a number of ways, including by the brain itself. The brain can send electrical messages down nerve pathways to close the gate and shut out or reduce the flow of nerve impulses to the brain, or send messages that do just the opposite. Many factors can open or close the gate.

Some of these factors arise from our mind. They include our past experience, what we have learned about pain from our culture and social environment, our expectation about what might happen, our beliefs about pain, how much attention we direct towards the pain, and our emotions. For example, positive mood, distraction, and deep relaxed breathing can act to close or partially close the gate while strong emotions
like fear, anxiety, and expecting the worst can open the gate.

So research on the
gate control theory
has explained a lot. It tells us that pain results from many interactions and information exchanges at different levels of our nervous system—in billions of nerve cells, the spinal cord and the brain. Our physical bodies, our feelings and emotions, our thoughts and beliefs and other factors are all involved in the experience of pain. And all pain is produced in the brain. The mind and body are completely connected. They influence each other all the time.

But the story does not stop here. The
gate control theory
mostly explained what is happening when nerve impulses travel to the spinal cord. But what is going on within the brain itself? Answers are coming from several sources: advanced brain imaging studies, studies of the link between pain and genetics, research into the immune system and our response to stress, and Dr. Melzack’s latest
neuromatrix theory of pain
.

It turns out that at least seven (and probably more) areas of the brain are active when we experience pain. Some of these brain regions control our emotions, our thinking (or cognitive function), and the processing of body sensations. These body sensations include stimuli that might cause us to feel pain as well as things like light touch, vision, hearing, and other body sensations. These areas of the brain are connected to each other through a complex widespread network of nerve cells and neurochemicals. Dr. Melzack called this network a ‘neuromatrix’. The purpose of the neuromatrix is to organize the huge amount of information coming into the brain so that we experience our body as a single unified whole. How this network gets developed in the first place is mostly due to our genetics. But after that, many things affect how the network changes to influence how we experience our body.

Look at
Figure 1.1
. You can see that information from at least three different sources goes to this network in the brain. Our thoughts and emotions, whether positive or negative, influence network activity. Nerve impulses from all over our body—our skin, muscles, tissues, our eyes, ears, etc.—impact the network. All this information is processed by the network to produce a pattern of nerve impulses. If the brain thinks this pattern means that our body is in “danger”, then a number of things happen.

Figure 1.1
Pain and the Brain

• We experience pain—its location, strength, and how it feels (sharp, dull, burning, miserable, etc).
  

• We take action to protect the body. Think of your stubbed toe. You start hopping around, raise your foot, and rub your toe. You might sit down and decide not to walk on your foot until the pain is better. Often, actions are unconscious like tensing muscles or holding our breath. Movements can even occur during sleep.
  

• Our body releases neurochemicals throughout the nervous system and brain that attempt to regulate the stress caused by pain. These include stress hormones that ready our body for action, hormones from our immune system that fight inflammation, sex-related hormones like estrogen, morphine-like substances such as endorphins that decrease pain, and others.
  

Probably the most difficult thing to understand is that pain is not injury. It’s our brain’s assessment of danger. That’s why there is no exact relationship between how strong a stimulus is, the amount of injury it causes if any, and the amount of pain we feel. So two people can be in the same potentially pain-producing situation but have very different experiences. One person can be in excruciating pain while the other feels little pain or discomfort. Or the same person may experience extreme pain in one situation but not in another even when the amount of damage to body tissues is exactly the same or there is no damage at all. That’s because our central nervous system and brain actively process information and assess the meaning it has for each of us as individuals at this particular time and place—is there ‘danger’ or ‘no danger’?

So, pain is really complex. There is still a lot more research that needs to be done before we have all the answers. But we don’t have to wait until then to take action to manage our pain. Science supports the important role of thoughts, emotions and physical sensations in the experience of pain at all levels of the nervous system and the brain. That’s why this book emphasizes ways to use your mind and your breathing to regulate your thoughts and emotions. These techniques can help close the gate in the spinal cord and influence the complex network of nerve cells in the brain. This book also emphasizes how participating in normal physical activity and exercise does not pose a danger to you. In fact, increasing your activity can change the way your brain processes information about movement and physical sensation. The good news is that you can learn to calm your nervous system, reduce your stress, and re-train your brain so you can live a healthier, happier life.