Understanding Pain is the First Step in Controlling It
BY ARLENE HARDER, MA, MFT
Recognizing the physical and emotional components of pain can make a significant difference in managing pain and discomfort.
During a discussion on the existential implications of pain, Charlie Brown ends by telling Linus, "Pain hurts." When we are hurting we just want it to go away. If we are in pain, we want to simply shut down our nervous system and prevent the pain sensation from reaching our brain. When we aren't in pain, however, we need our nervous system to signal us in case something goes wrong -- so we can do something about it. One of the reasons leprosy was greatly feared, before a cure was found, was due, in part, to disfiguration caused by missing fingers and limbs. Since the disease creates numbness, when a person would place her hand on a hot stove, she would not notice and so wouldn't move it until it was badly burned, often creating a situation in which gangrene would develop.
So pain is helpful, as long as it signals you to pay attention to what needs to be repaired. Pain is definitely NOT welcome, however, when you've done all you can to fix the underlying problem (such as cancer) and you still have to deal with pain and discomfort
Therefore, the first step in controlling pain is to understand what causes it. It is very important you discuss your pain with your doctor and/or pain specialist to determine if the pain is caused by a new problem or by something that has been taken care of. In the latter case, you may only need time to heal and some way to relieve the pain.
Also, cancer pain can require differ kinds of treatment at different points in time. At first, patients may have pain from the pressure of a growing tumor or from tumor cells that infiltrate other organs. It can also be the result of chemotherapy or radiation, which can cause an accumulation of fluid and swelling (called edema) and can irritate healthy tissue and make nerve endings more sensitive. When treatment is over, a long-term survivor might even have some residual, chronic pain.
The Physical Component of Pain
Part of our problem with pain is the fact that it is complex. Yes, "pain hurts," but what do we mean when we say that? Are we talking about the neurological sensation of burning, throbbing, stabbing pinching, pressing, and cramping that we call "having pain" or do we mean the emotional distress we experience because those sensations don't feel good, something we may also refer to as "being in pain"?
Another step in controlling pain is to understand there are two components to pain: physical and emotional. There are also two types of pain: acute and chronic
Acute pain is immediate and intense. Like banging your shin on the sharp edge of a desk, it can come on strong and fade quickly. For cancer patients, acute pain can be the result of surgery, a broken bone or some type of obstruction. Sometimes, the pain is a side effect of treatment, such as a sore mouth from chemotherapy, post surgical pain or skin irritation after radiation.
Chronic pain, on the other hand, may or may not be as intense, but it's usually just there in the background. The level rises and falls, but it never seems to go away. It just keeps nagging and throbbing. Many factors can contribute to chronic pain. Most pain experts now believe that almost all unexplained chronic pain is rooted in a physical problem, such as damaged or inflamed nerves, blood vessels, and other tissues, or other sources which can't be easily explained. Such pain may also simply be the cumulative effects of a prolonged illness.
Unfortunately, chronic pain often leads to inactivity, causing the muscles to become weakened. The weaker you become, the more difficult it is to take part in exercises that could strengthen the muscles. Chronic pain also interferes with sleep, leaving you depressed and lowering your pain threshold. It can be a vicious cycle. Fortunately, there are many ways to deal with chronic pain, both medically and emotionally.
The Emotional Component of Pain
Once pain signals make their way to the brain, connections with the cerebral cortex and limbic system give "meaning" to the pain message. The mind thus creates a conscious and emotional experience, evaluating how "bad" the sensation feels and deciding what can be done to relieve this thing it considers "pain." For example, although two people may have similar injuries or take part in identical medical procedures, many factors determine why one person will have greater distress than another
To begin with, culture and family help form beliefs concerning how we "should" experience pain. For example, cultures like the American Indians teach tolerance of pain. These individuals will be aware of the physical sensation of pain, but not be particularly bothered by it. Others learn to "bear the pain" without complaining, because they have been raised in families where their needs were ignored and thus they never that others could help lessen their suffering. On the other hand, there are children who are only given attention when they get sick and as adults they may feel, quite unconsciously, that they won't get taken care of unless they make a big fuss
The personality, coping style, beliefs and past experience of a patient can, therefore, greatly affect the physiological process in which the brain sends electrical and chemical signals to open or close pain "gates" in the central nervous system. For example, if a medical procedure caused a lot of pain the last time you had it, when you again need to go through that procedure, as soon as you begin to feel some discomfort your fear of "potential" pain may cause you to tense your muscles involuntarily. This can set the stage for opening the pain gate and cause pain levels to flare. If you had relaxed, it is quite possible your discomfort would not have seemed unbearable.
Ordinary stresses of life, such as problems at work or in relationships, decrease the ability to withstand discomfort and pain. Therefore, if you can resolve those problems to the greatest extent possible, you will be better able to manage any discomfort and pain you might experience. In fact, people who see themselves as having influence, if not always control, over their bodies (and over their small corner of the world) tend to handle pain and discomfort more easily because the "locus of control" comes from within the person.
Nevertheless, there is a great latitude in different people's ability and willingness to tolerate pain. You don't get a good conduct medal for withstanding pain and there is no shame in needing medication. Every patient has the right to have his needs attended to.
On the other hand, you can make better use of pain medication if you use abdominal breathing, stress reduction and imagery techniques along with the medication. So be sure to read the related material at the top of this page. They can help you solve issues that can add stress to a difficult situation.
© Copyright 1998, Arlene Harder, MA, MFT |
