Thursday, August 08, 2019

Self Care for Chronic Pain: A Therapeutic Approach

Pain is an incredibly personal experience and when we discuss our own pain problems we have to remember to hold off on judging ourselves against anyone else's pain experiences. Our own pain problems come from our own expectations, our thoughts when pain occurs, our feelings linked to pain and our early experiences of pain. Here is an illustration of pain as I know it and this image resonated with me when I saw it. The pain flares red, it shocks, it strikes, it tenses, it upsets and it stops the person in their tracks. However, our attitudes to pain come from many different places and can affect the way we handle our own pain.

Let's untangle this a little as we all approach pain differently. I will give examples of three fictional members of a fictional Pain Management group which I hope will explain more easily.

EXPECTATION: I always have pelvic pain. I am always in pain. If I move it hurts. If I stay still and rest I will prevent new pain
THOUGHTS: I'm fed up and nothing will help. My life is over.
FEELINGS: I'm anxious, sad and worried and depressed.
EARLY EXPERIENCES: I had to rest when I hurt myself and it always caused a huge fuss if I hurt myself. I was discouraged to take risks.

EXPECTATION: I have pelvic pain. I am usually in pain. I ignore it when I want to do something else. If I move I will loosen my tight muscles and nerves to prevent new pain.
THOUGHTS: I'm fed up. I need to fight this. I won't let the pain win.
FEELINGS: I'm sad that my life has changed. I want to go back to who I once was.
EARLY EXPERIENCES: I had to keep going until I couldn't do any more. I didn't let pain stop me.

EXPECTATION: I have pelvic pain. I am usually in pain. Activity increases pain so I have to decide when to do just it anyway regardless of the consequences, when to change the activity to fit the new me (such as use my chair or do less) and when to opt out.
THOUGHTS: I can take some risks. Some activity is a trade off and I'll have to rest afterwards.
FEELINGS: I worry about the pain I'll feel later.
EARLY EXPERIENCES: When I hurt myself, I either did activities differently or just did them later. No bug fuss made.

This session was a particularly difficult one as we were encouraged to open up and discuss our pain problems, our attitudes to our pain and our own early experiences of pain. As you can imagine, the ten members of the group all came from very different places. Everyone had different pain problems, different diagnoses, different feelings about pain and early experiences had formed quite concrete attitudes about what being in pain meant. Persons A, B and C may have different conditions and similar levels of pain but Person A is ruled by their pain while Person C is managing their pain more holistically.

It was then that the notion of compassion based therapy was introduced.

We are all made up of the above systems: Drive System, Threat System and Soothing System.

Threat System
This system is one of our earliest responses and kicks in immediately when it detects a threat - namely pain in this situation. We decide to fight, flight or freeze. This adrenalin and cortisol led - early human hormonal responses to keep us safe.

Drive System
This system ensures survival and progress. This is largely motivation, goal setting and our achievements. These may be goals we set in the past or present and often our desire to achieve our goals can be unrealistic as our drive system can overide common sense. We talked about those inner voices, those gremlins who say things like 'You were able to do this once so now you're failing' which can then inflame that desire to push ourselves to achieve regardless of how realistic it is to push towards this goal.
We discussed ways that we push through to achieve unrealistic goals - personally when the pain became severe I would take painkillers washed down with a few drinks and then manage to get through the evening or event. However the payback would be days or sometimes weeks. I wan't on my own here. Many of us struggle to accept new limitations and when we fail to achieve our goal our threat system fires up and the two systems fire each other up. We need to set realistic, manageable goals which when achieved still fire up up dopamine, the happy hormone.

We all agreed that these two systems were prevalent in our lives and when these systems were at war with  each other, pain increased.

Therefore, we need to introduce a third system that is within us but often over looked. All three systems need to be in balance in order to meet our various needs.

Soothing System
Often called self compassion or self care, this system often remains untapped due to us underrating its importance and not giving ourselves permission and time to look after ourselves. How often have we put ourselves last? How often have we cancelled time we'd carved out for ourselves in order to do something for someone else, do something else on the the work/home to do list?
We often suppress this important system within us as it has traditionally been viewed as selfish, self-indulgent behaviour yet it is vital to our wellbeing and mental health.
By increasing self awareness and listening to our own bodies we start to realise we need time for exercise, mindfulness, meditation, creativity and rest in which ever ways these manifest themselves.
In discussion, these methods were disclosed which were helping self soothe:
learning a musical instrument
listening to music
watching films
tai chi /xi gong
square breathing

All these can reduce adrenalin, cortisol and dopamine hormones in our bodies which then enables the body to increase oxytocin levels and calm from within. We also need to ensure we make environmental changes to help self soothe. Creating spaces or ensuring we can visit spaces where we can be quiet and uncluttered, outside with nature and relaxed will increase the chances self soothing can occur. 

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