Living a Healthy Life with Chronic Pain (8 page)

The following common symptoms are discussed in this chapter:

• Pain (
  page 44
  )
  

• Ineffective breathing (
  page 48
  )
  

• Fatigue (
  page 50
  )
  

• Sleep problems (
  page 52
  )
  

• Depression (
  page 57
  )
  

• Anger (
  page 63
  )
  

• Stress (
  page 65
  )
  

• Memory problems (
  page 69
  )
  

Pain or physical discomfort is
the
universal problem shared by all people with chronic pain conditions. As with most symptoms, pain can have many causes. We discussed reasons why chronic pain develops in
Chapters 1
,
pages 5
–
16
. You might want to revisit that material before reading the next section. What follows is a brief description of some of the most common causes of pain:

• The pain condition or disease itself.
  Pain can come from inflammation, damage in or around joints and tissues, insufficient blood supply to muscles or organs, and an irritated nervous system, to name just a few sources. In some cases, there is no known cause for the pain. Whatever the initial cause, the ultimate result is a malfunctioning or disturbance of a complex interactive network of nerve cells in the spinal cord and the brain—in other words, chronic pain.
  

• Tense muscles.
  When something hurts, the muscles in that area become tense. This is your body’s natural reaction to pain—to try to protect the area that hurts. Stress can also cause you to tense your muscles. Chronic muscle tension can lead to increased soreness or pain.
  

• Muscle deconditioning.
  With chronic pain, it is common to become less active. This leads to a weakening of the muscles, or muscle deconditioning. When a muscle is weak, it tends to complain anytime it is used. This is not because it is damaged but because it has not been used in a while.
  

• Lack of sleep or poor-quality sleep.
  Pain often interferes with your ability to get either enough sleep or good-quality sleep. Poor sleep can also make pain worse, and it can lessen your ability to cope with it.
  

• Stress, anxiety, and emotions such as anger, fear, frustration, and depression.
  These feelings are all normal responses to living with a condition like chronic pain, and they can amplify the experience of pain. This does not mean that the pain is not real. It is all too real. It just means that emotions such as stress and fear and other symptoms such as depression can make a painful situation worse.
  

• Medications.
  The medicines you are taking can sometimes cause pain, weakness, changes in your thinking, or abdominal or other physical or emotional discomfort. Ask your doctor or pharmacist about the potential side effects of all your medication.
  

We are not helpless in the face of pain. The brain can regulate the flow of pain messages by sending signals that open and close “pain gates” along nerve pathways in the spinal cord and in the brain itself (see the material on the Gate Control Theory
Chapters 1
,
pages 6
–
7
).

For example, the brain can release powerful opiate-like chemicals such as endorphins that effectively block or reduce the pain we feel. For example, when people are seriously injured, they sometimes experience little pain while they are focused on survival. How you focus your attention, your mood, and the way you view
your situation—your thoughts and feelings—can open or close the gates.

Your day-to-day pain level is based on how your mind and body respond to pain. Here are four ways in which the mind and body interact when you are experiencing pain.

• Inactivity.
  Because of pain, you tend to avoid physical activity. This avoidance in turn causes you to lose strength and flexibility. The weaker and more out of condition you become, the more frustrated and depressed you feel. These negative emotions can open the gates and cause pain levels to rise.
  

• Overdoing.
  You may be determined to prove that you can still be active, so you overexert and push yourself to finish a task. At the same time, you ignore the signals your body sends about its need for rest. Pushing yourself only leads to more pain, which leads to more inactivity, more depression, and more pain.
  

• Misunderstanding.
  Your friends, family, boss, and coworkers may not understand that you are suffering and may dismiss your pain as “not real.” This can evoke anger or depression.
  

• Overprotection.
  On the other hand, friends, family, and coworkers might coddle you and make excuses for you. This can lead you to feel and act more dependent and disabled.
  

Fortunately, you can interrupt this down-accept it and manage it. It can be a new beginning. You can learn techniques such that retrain the brain and calm your nervous system such as:

• Redirecting your attention to control pain
  

• Challenging negative thoughts that support pain
  

• Cultivating more positive emotions
  

• Developing relaxation techniques
  

• Slowly increasing your activity and reconditioning yourself
  

• Learning pacing techniques to balance activity and rest
  

Here’s an example of how one of these techniques might work. If you find yourself waking up in pain and thinking, “I’m going to be miserable all day; I won’t get anything done,” challenge this negative thinking or self-talk with more positive thoughts. Tell yourself instead, “I’ve got some pain this morning, so I’ll start with some relaxation and stretching exercises. Then I’ll do some of the less demanding things I want to get done today.” Use your mind to counteract the negative thinking. You will find more about positive thinking, relaxation, imagery, visualization, distraction, meditation, and other ways to use your mind in
Chapters 16
.

For localized pain in an area such as the neck, back, or knee, the application of heat, cold, and massage have all been found to be helpful. These ward spiral of negative mind-body interaction. three tools work by stimulating the skin and If you’ve been told you have to live with pain, it other tissues surrounding the painful area. Heat doesn’t mean you cannot have a happy, fulfilling and massage increase the blood flow to these life. Learning to live with pain means learning to areas, while cold makes the area feel numb. All three methods can close the gate and change the way the brain interprets body sensations.

Apply heat with a heating pad or a warm bath or shower (with the water flow directed at the painful area). You can improvise a heating pad by placing uncooked rice or dry beans in a sock, knotting the top of the sock, and heating it in a microwave oven for three to four minutes. Before use, be sure to test the heat so you don’t burn yourself. Do not use popcorn!

Some people prefer cold for soothing pain, especially if the pain is accompanied by inflammation. A bag of frozen peas or corn makes an inexpensive, reusable cold pack. Whether using heat or cold, place a towel between the source and your skin. Also, limit the application to 15 or 20 minutes at a time (longer can burn or freeze the skin).

Massage is one of the oldest forms of pain management. Hippocrates (c. 460–380 b.c.e.) said, “Physicians must be experienced in many things, but assuredly also in the rubbing that can bind a joint that is loose and loosen a joint that is too hard.” Self-massage is a simple procedure
that you can perform with little practice or preparation. Simply rubbing or stretching the painful area with a little applied pressure stimulates the skin, underlying tissues, and muscles. Always use a nonirritating skin cream or oil to provide lubrication. If you prefer a cooling effect, use a mentholated cream.

There are three basic approaches to self-massage:

• Stroking.
  Place your hand on the muscle you want to massage. When you slightly cup the hand, the palm and fingers will glide over the muscle as you massage. A slow, rhythmic movement repeated over the tense or sore area works best. Experiment with different pressures. If you have an affliction such as complex regional pain syndrome, try putting your hand in a bath of warm water and then firmly stroking the painful area with your warmed hand.
  

• Kneading.
  If you ever reached up and squeezed your tense neck or shoulder muscles, you were kneading. Grasp the muscle between the palm and fingers or between the thumb and fingers as if you were kneading dough. Then slightly lift and squeeze it. Don’t pinch the skin; work more deeply into the muscle. A slow, rhythmic squeeze and release works best. Don’t knead one spot for more than 15 or 20 seconds.
  

• Deep circular movement.
  To create soothing heat (friction) that penetrates into muscle, make small circular movements with the tips of the fingers, the thumb, or the heel of the hand, depending on how large an area you are massaging. Keeping the fingers, thumb, or palm in one place, begin lightly making small circles and slowly increase the pressure. Don’t overdo it. After 10 seconds, move to another spot and repeat.
  

Massage is not appropriate for all cases of pain. Do not use self-massage for a “hot” joint (one that is red, swollen, and hot to the touch) or an infected area. Avoid massage if you are suffering from phlebitis (inflammation of a vein), thrombophlebitis (a blood clot in a vein), or any kind of skin bite or eruption.

Medications and other treatments can also be useful to manage localized pain. These are discussed in
Chapters 16
.

Managing chronic pain is a complex task. Like mastering all new tasks, it requires knowledge, practice, and patience. Sometimes you can’t manage pain directly unless you use medications or other treatments your doctor might recommend. (These topics are discussed in detail in
Chapters 16
.) But often, without medication or medical intervention, you can self-manage other symptoms that are related to chronic pain, such as stress, poor sleep, and depression. If you can address even a couple of these symptoms, you will feel more in control of your pain. The rest of this chapter and
Chapter 5
are about how to self-manage common symptoms.

In addition to managing common symptoms, you can make important lifestyle choices that will positively influence your pain, your health, and your life. These include making physical activity and exercise a regular part of your week, eating healthy, managing your stress, improving your family and partner relationships, working
with your health care providers, and planning to use to manage chronic pain. Just as you can-for the future. That’s what the rest of this book is not build a house with one tool, you often need about. Taken together, these are all tools for you many tools to manage chronic pain.

Shallow or labored breathing prevents your body from getting the oxygen it needs. Like other symptoms, it can have several causes.

Pain from weak, tense muscles can lead to ineffective breathing. When an area of the body hurts, the natural response is to tense the muscles in that area. This is so automatic you are often unaware of how much tension you are carrying. Muscle tension can change how you move. You may move more slowly, or your posture may change so that your chest is not as open, leaving less room for your lungs to expand effectively.

Shallow breathing may ultimately result in muscles becoming weak and deconditioned. And this doesn’t only affect your breathing muscles; the core muscles of your abdomen and the small muscles of your back can also be affected. When muscles become deconditioned, they are less efficient at doing what they are supposed to do. They require more energy (and oxygen) to perform activities.

Excess weight can also cause shortness of breath. Additional weight increases the amount of energy you use and therefore the amount of oxygen you need. Weight also increases the workload for the heart. If excess weight is coupled with restricted movement and poor posture, your body struggles to get the oxygen it needs.

Certain chronic pain conditions can directly impact posture and thereby reduce lung capacity. The list includes scoliosis, osteoporosis, and some severe forms of arthritis that attack the bones in the neck and back. Other causes of breathing problems include chronic lung diseases such as emphysema, chronic bronchitis, and asthma. These conditions usually require special medications and sometimes supplemental oxygen in addition to self-management techniques.

Shortness of breath can be frightening, and this fear can cause two additional problems. First, when you are afraid, you release hormones such as epinephrine. This causes more muscle tension and more shortness of breath. Second, you may stop activity altogether for fear it will hurt you. If this happens, you cannot build up the endurance necessary to help manage your chronic pain and breathing issues.

Just as there are many causes of ineffective breathing, there are many things you can do to manage this problem. When you feel short of breath, don’t stop what you are doing or hurry to finish up. Instead, slow down. If shortness of breath continues, stop for a few minutes. If your
doctor has prescribed medication for this problem, then take it.

The basic rule is to take things slowly and gradually. Increase your activity, by not more than 25 percent each week. For example, if you are currently able to garden comfortably for 20 minutes, next week increase your time in the garden by a maximum of 5 minutes. Once you can garden comfortably for 25 minutes, you can again add a few more minutes.
Chapters 6
through
9
discuss ways to increase your physical activity safely.

Finally, it is very important that you don’t smoke. It might seem strange to think that smoking affects chronic pain, but it does. Recent studies have found a 20 percent increased risk of chronic musculoskeletal pain (such as back pain) in smokers.

Since we know that being exposed to secondhand smoke is also a health risk, you may want to avoid smokers as well. This can be difficult because smoking friends may not realize how they may be impacting your health. Your job is to tell them. Explain that you would appreciate it if they would not smoke when you are around. Also, make your house and especially your car “no smoking” zones. At home, ask people to smoke outside. In the car, tell them they can smoke before they get in or after you reach your destination.

There are several tools that can help with better, more effective breathing. Here we describe two effective techniques:

Ineffective breathing can be caused by a deconditioned diaphragm (a large muscle at the bottom of your rib cage) and breathing muscles in the chest, as well as by poor posture. In either case, the lungs are not able to function prop-erly—that is, they do not fill well, nor do they get rid of old air effectively. Most of us mainly use our upper lungs and chest for breathing. But we can breathe more deeply if we use diaphragmatic breathing, called “belly breathing.” When you do this breathing technique properly, the diaphragm moves down into the abdomen and allows your lungs to expand fully with air. Diaphragmatic breathing strengthens the breathing muscles and makes them more efficient, so breathing is easier and more oxygen is available to the body.

Interestingly, babies belly breathe instinctively with little effort. For adults, though, deep breathing requires a little practice to learn to fully expand the lungs. These are the steps to practice diaphragmatic breathing:

1. Lie on your back with pillows under your head and knees.
   
2. Place one hand on your stomach (at the base of your breastbone) and the other hand on your upper chest.
   
3. Breathe in slowly through your nose, allowing your stomach to expand outward. Imagine your lungs filling with fresh air. The hand on your stomach should move upward, and the hand on your chest should not move or should move only slightly.
   
4. Breathe out slowly, through pursed lips. At the same time, use the hand that is on your stomach to gently push inward and upward on your abdomen.
   
5. Practice this technique for 10 minutes, three or four times a day, until it becomes
   automatic. If you begin to feel a little dizzy, rest or breathe out more slowly.
   

You can also practice diaphragmatic breathing while sitting in a chair.

1. Relax your shoulders, arms, hands, and chest. Do not grip the arms of the chair or your knees.
   
2. Think about your posture. Sit straight, gently slide your chin back, and feel your neck lengthen. Imagine the top of your head being gently tugged upward toward the ceiling. You may notice your abdominal muscles tightening just a little.
   
3. Put one hand on your stomach and the other on your chest.
   
4. Breathe in through your nose, filling the area around your waist with air. The hand on your chest should remain still and the hand on your stomach should move.
   
5. Breathe out without force or effort.
   

Once you are comfortable with this technique, you can practice it almost anytime, while lying down, sitting, standing, or walking. Diaphragmatic breathing and paying attention to your posture can help strengthen and improve the coordination and efficiency of the breathing muscles. It also decreases the amount of energy needed to breathe and reduces overall muscle tension in your body. It can be incorporated with any of the relaxation techniques that use the power of your mind to manage your symptoms (see
Chapter 5
).

A second technique, pursed-lip breathing, usually happens naturally for people who have problems emptying their lungs. It can also be used if you are short of breath or breathless.

1. Breathe in, and then purse your lips as if to blow across a flute or into a whistle.
   
2. Using diaphragmatic breathing, breathe out through pursed lips without any force.
   
3. Relax the upper chest, shoulders, arms, and hands while breathing out. Check for tension. Breathing out should take longer than breathing in.
   

By mastering this technique while doing other activities, you will be better able to manage your shortness of breath.