Episode #58 

How To Manage Chronic Pain

Do you live with chronic pain?

Do you feel powerless to change it?

Do you struggle to feel positive?

In this episode, Dr Julie shares how you can harness the power of Cognitive Behavioral Therapy to regain control of your pain and your life.

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Full Episode Transcript

Hi, my name is Dr. Julie Osborn. I'm a Doctor of Psychology and a licensed clinical social worker specializing in Cognitive Behavioral Therapy. I'm here to help you bring the power of CBT into your own life.

In this podcast, I'm going to answer some questions and share with you practical ways to apply CBT principles so you can achieve a greater level of happiness and satisfaction in your life in relationships.

So I first wanted to share just a quick little message. I got somebody that reached out to me on my Facebook page, which I really appreciate. And it's a short one, but it's a good one. So she sent a picture of the mind over a book and then it said:

“Your podcast has inspired me to start taking back my life.”

Perfect. All she needed to share. That ‘your podcast has inspired me to start taking back my life.’ Really powerful stuff. And that's what I'm hoping a lot of you are getting from listening to the podcast and how to use CBT in your life as well.

So I always appreciate you guys reaching out and sharing with me how the work that I'm doing is helping you, because that is my intention and that is what I'm hoping to be teaching everybody so that you can be your own therapist and get well.

So in this episode, I'm going to take a closer look at managing chronic pain. There's a big issue for many people.

I'm sure most of us know, at least in the United States, that opiate addiction is the number one addiction out there.

And most people I've talked to that are going through this have started because they had an accident or something happen. Right, or surgery. They had pain. Their doctor prescribed the medicine and then is just kind of been a roller coaster since then. So I want to talk a little bit about pain and the mind body experience and how CBT can help those of you that are dealing with chronic pain, how to manage it better. And if it's not for you, maybe you can share this with somebody who's going through this, because I think most of us know someone that's dealing with some type of chronic pain.

If we look at pain being kind of your body's messenger telling us that things are not right and we want to see how we can make them better. OK, so first of all, estimates based on research indicate that from 10 to 30 percent of the American population suffers from chronic or recurrent physical pain. Pretty high and pain suffers often feel that their doctors aren't able to give them the treatment they need to alleviate their pain. They may have been told that it's on their head.

They feel very alone. And when nobody can seem to give them support from being in their pain, so then people end up feeling helpless and anxiety ridden, depressed, angry, frustrated in a sense of not being in control of your life. So a lot of people with chronic pain often turn to prescription pain medicine, as I mentioned, drugs or alcohol for relief, only to find that these quick fixes can cause more complications and devastation in your life than the actual original pain.

Right. So then that becomes another problem. Pain is actually essential to our survival. So acute pain is temporary, but it can be severe. You know, it tells us that the injury has occurred and we must take action to protect ourselves from further injury and seek comfort to the body can heal. So that's kind of like putting your hand on a hot stove, right? You need to feel that pain. So you take it off of the stove.

No, continue to burn yourself. If these actions occur, healing usually takes place. However, sometimes people don't recover and the pain continues. So this is what they call chronic pain, in which the pain lasts longer than three months is often ill defined regarding its cause and has a heavy impact on all aspects of your life. So let's first talk about the negative cycle with pain. So although the cause of chronic pain, as I mentioned, is usually difficult to pinpoint, most pain experts believe that it's caused by damaged and inflamed nerves, muscles and blood vessels, and that it's very real.

The body becomes locked into a vicious cycle. So you normally limit movement in those painful areas, right? Because it hurts. And then this causes you to lose strength and flexibility. If you try to ignore the pain and increase your activity, the pain can become so severe that you can become an active. Sometimes you unconsciously guard against the pain. And then this leads to muscle tension and spasms so your body can become weak and deconditioned and you begin to feel frustrated, angry and depressed.

So even if we've had short term pain, I think all of us can relate to that, because I can relate to this as well about having the short term pain or coming back, you know, or some kind of injury. So your friends and family a lot of times don't understand and they underestimate its impact on your life because some people that haven't experienced this or have had short term acute pain think, you know, just move through it and go away.

But then the sense of making you feel more angry and depressed because people don't understand. Sometimes, though, they also may even overindulge you and this. Make you feel more dependent and out of control of your own life so these negative emotions can actually perpetuate the pain, and the more negativity we feel, the greater our pain and the greater pain, the more negative emotions we experience. It's kind of like when you get even a paper cut and you focus on it, it hurts more, right?

I think we've all had that. So there's really is a connection between our mind and our physical pain. And again, I'm not saying that you're not having physical pain, but as we talk and you understand more, there definitely is the connection and how we think about what we're feeling physically. But there is good news. The good news is that this negative spiral can be broken. And we're sometimes told that we'll just have to live with their pain, after all, has failed.

But we are far from doomed at this point. The realization that nothing else medically can be done can actually force us to examine the way we have lived and what brought us to the point where pain can play such a dominant role in our lives. And in fact, this may be just the thing that takes to turn one's life around in a very positive and meaningful way. You know, when we get to the point where I have to take control now, I have to do something, I have to look for different help, get out of the box, as I've talked about before, and get some help because the typical doctors I'm going to aren't helping.

So that could be part of the issue. So with good therapeutic support and a commitment to do some hard work and important life issues, chronic pain can be managed really effectively for some people. Mind body strategies have been shown to eliminate pain altogether, even when all else has failed. And people who've been through therapy, which addresses pain, report significantly reduced pain, severity, lessen depression, anxiety and decreased feelings of losing control. They report reductions in the degree in which pain interferes with their daily activities, even though the pain continues to suffer, can experience less distress and emotional suffering and can become an active participant in life again.

So there's several good physical treatments that can alleviate pain. So some forms of acute pain, short term respond well to pain medication ranging from mild to L Genex to strong opium based drugs for most severe cases. But of course, we really need to be careful with that. Right. Some chronic pain responds well to antiinflammatory medicines or even antidepressants. And although narcotic drugs are seldom effective for chronic pain, they may work for the short term acute pain. But since narcotics tend to require ever increasing doses, they become less effective over time.

Not to mention their effect on your sleep, your mood and your ability to think and perform clearly. And we really need to be under good supervision from a doctor so you don't become addicted. Sometimes electrical stimulation provides some relief as well as other medications. Sometimes surgery is needed. Ice heat massage. And I'm a big, huge proponent of acupuncture. I refer my clients all the time and I have some other specialists that are, quote, out of the box that I refer my clients to.

And I've you know, they've told me everything they've been through and they're just not getting much help. You know, I believe in a lot of holistic treatments. So I really encourage you if you have been to try some other type of treatments, like I just mentioned, that maybe there would be something that would make a difference for you. I know. I know it has for me for sure, because of the medical interventions fail. However, that's what it's time to take a hard look into some psychotherapeutic techniques by using CBT that focus on the way we handle our emotions.

Right. And our general way of living, which is what it's all about. Why am I having these emotions? What are my thoughts like? Our thoughts create our emotions a hundred percent and how are we living? That's the behavioral part. What am I doing every day to manage my life and have some control over this pain that's following me around. So I want to talk to you about some techniques for managing the chronic pain and starting to feel like you're regaining control of your life because that is the goal.

So first, you want to become aware of your pain. What I mean by that is the first step in taking charge of chronic pain is to learn more about your experience of pain in a structured way. So when we live daily with pain, we sometimes lose track of just how severe the cycles can be. And we also tend to forget the better periods. We need to increase our awareness of the cycling of the pain throughout the day and what we're doing to manage it.

So being mindful, I talk to my clients that are feeling better and I say, well, what are you doing to make yourself feel better? Because what we're doing, OK, we tend not to stop and think about what we're doing. We're more focused when we're not feeling good. So when things are working, we got to figure out what we're doing to manage it. And we also need to distinguish between actual pain we experience and our emotional stress associated with this pain.

Keeping a pain diary can be really helpful to keep track of this. It can be really important to kind of understand this allows you to record your level of pain at various times throughout the day. Initial pains related to the time of day mood. Your fatigue, your stress. What are you doing? Who are you with? So if you're working on the fossil record, this will be the first column. Where is this situation? Right. Who, what, when and where there will be a place to start.

It also encourages you to become aware of the crucial question of whether the pain is physical or more associated with our subjective experience of the emotional distress. So you can see already there's so many things that you can do to start taking control over this chronic pain that you're having. And that is always the goal, because when you feel like you have control over things, you automatically will feel better. So our lives tend to be taken over by the chronic pain, right?

So our jobs are friends. Enjoyable activities all become secondary to this force that is taking over our lives when we put our lives on hold while we wait for someone, a doctor, drug and insurance company, a friend to come to our rescue, it's just not a good place to be in. And what we forget is that ultimately we need to be in charge of our lives. We need to regain our sense of independence. We want to ask yourself, is this pain in control or am I in control of the pain?

So you want to ask yourself, I'm not going to repeat that is the pain and control or am I in control of the pain? So we need to shift to taking control of the pain. This may take some exploring in therapy of how we see ourselves and how we can allow ourselves to fall into the role of being the victim. It helps to embrace our pain, to acknowledge that it is part of our life and that is there to serve a purpose.

The pain is not the enemy that must be fought off. As long as we hold on to this thought, it becomes very difficult to take control of the pain. Right? So if your thought is my pain is the enemy that must be fought off, how am I going to do that? And I don't have control. I don't know what to do. So now I'm feeling hopeless. Right. And depressed and anxious and all those horrible moods.

It's only when we embrace the pain and take ownership of it that we can truly begin to know how the pain fits into the whole of our life experiences. We can then hear the messages that the pain's trying to send us and we can be both in control of the pain and in control of our own lives. I want to see anyone listening to my podcast that has had long term pain. You might be feeling more pissed off and angry with some of the things I'm saying.

And again, I'm not minimizing that pain is real. I have some long term things that I have to deal with. I've had to change some things up in my life because of some injuries and the pain that it causes. I understand. But when I started seeing what am I going to do about it? What can I replace what I used to like to do and having to give up some things that were affecting my injuries, I started to feel happier and seeing there's other things I can enjoy even if I have to give certain things up.

So please keep that in mind as you're listening. I have a lot of empathy. Again, I've had some things that happen in my life with pain that I've had to manage. So I do understand. But I do also know for a fact that the way I think about it has been what's helped me to take control. And then sometimes there's a secondary gain of pain, which you really have to be honest with yourself and need to examine in depth the cost of your pain in your life and how it decreases your ability to enjoy your previous activities, your family, your friends, your peace of mind.

But it's also helpful to see with hidden benefits, the pain brings you. This is what we mean by secondary gain, the benefits that are not apparent at first glance. So, for example, it may be that the only time you get support and attention is when you're in pain. In fact, there's studies that have shown that those who get support from their pain usually have higher levels of pain and are more disabled than those who do not get the support.

Pain can also be the excuse that a person may use to deal with problems in a relationship. For example, you know, a wife who feels left out of her marriage because of her husband's job with the husband who who's afraid to open up emotionally to his wife. These are difficult issues to face and they can be examined in therapy, especially cognitive behavioral therapy. One goal of pain management is to see how you can meet your goals in a healthy way, rather than relying on being in pain as a way of achieving your needs.

So I know that's a hard pill to swallow, to think like, oh my God, it might try some secondary gain here. But if you can be honest with yourself and look at that, you can really start moving in the right direction. You want to also express your feelings and be assertive about it. So our pain tends to increase when we keep our feelings to ourselves. Of course, it's understandable that we may be reluctant to voice our deepest fears and anxieties, especially when we're in pain.

And we may be anxious about the impact of the pain on our jobs, our relationships, our future plans. And we may harbor a great deal of private anger about being in pain. Why did this happen to me? Why me? Right. And, you know, my other mantra from Dr. Eger is instead of saying, why me? You say, what now? So why did this happen to me? You're probably never going to get. To answer that, you're OK with right or an answer at all.

So instead of you can say what now that gives you the control in the freedom in your life to start making some decisions? We also may feel that we don't want to burden others, especially those with whom we're close or who depend on us. I want to just be like everything's OK and we can manage everything. But learning to express your feelings openly and taking assertive approach to dealing with your life's problems is an important step in reducing your experience pain and in taking control of your life again.

And then you want to start using your CBT tools to change the way you're thinking, because negative thinking can greatly increase a person's experience of felt pain. And when we think that our life is over and we'll never have fun again and our plans for the future destroyed, we're undermining our own sense of control and setting ourselves up to experience more pain. We need to challenge our negative thoughts and ideas and replace them with more balanced thoughts, which is what I've been teaching you guys all along.

Right. It is true you're in pain, but it's also true that there's something you can do about it. And the balance thought would be that although I have this chronic pain that I'm dealing with, there's a lot of things I can do to take control and minimize it. There's your balance, thought a member of the research also shows with CBT that when you start changing the way you think, you change your brain chemistry. So you want to examine your negative thoughts and figure out which ones are hot, the ones that aren't 100 percent true as they're changing them into more balanced thinking with assertive ideas.

What am I going to do about this? Rather than saying, Oh, I'm totally incapacitated, I'll never have pleasure again, a balzar will be. I need to learn what I've done wrong in the past so they can go on to accomplish things in the future they've always wanted to do. That would be an example. These are just a few of the techniques can be explored in dealing with chronic pain. And you're invited obviously, to explore many more alternative ways of dealing with pain.

The therapy also can offer, you know, just to share a couple of my experiences, I would say is I used to go to the gym and be in spin classes all the time. And I had a community there. I end up having friends. I didn't know that was going to come out of going, but I went to the same classes, you know, at the same time. And I still have those friendships today. And then I end up having some injuries that I wasn't able to continue.

I remember the day being on that bike and I was with my husband. I just looked at him. I just said, I have to leave. And, oh, my God, I was so sad and depressed and crying. I just was so upset. It was such a big part of my life. But it wasn't worth the pain and my injury would have only gotten worse. So I end up taking up swimming, which now I love.

I can tell you my husband been bugging me to swim with them for years and like and and now I go swimming. It's really helped with my injuries. I feel much better. And I found something else. And I still have my friendships that I created when I was in spin class that didn't go away. And I just had to monitor and manage the way I was. I could still work out. I just need to do something different so I could have just been, oh, forget this, and just sat at home because I can't go to spin class.

But that wasn't taking control of my situation. Right. And the injuries I have aren't going to go away. I have to manage them. I have to be careful. And I also want to show them I was remember, you know, when they talk about how psychologically your brain really affects how severe your pain is. When I was about seven years old, I was hanging out with some friends in an area I wasn't supposed to be. And there was those called the Rockies.

And you kind of walked up this mountain, I guess, huge hill and up to this shopping center we'd hang out at. Anyways, somebody had knocked down a fence so you could get up it. So me and my best friend and her brother were walking down the Rockies and I fell and I fell like on the fence. It was on the ground. And I got up and I was walking and I didn't feel anything. And then my best friend's brother said, Oh, you should look at your arm.

And I looked at my arm and my arm was ripped open. It was bad. I remember as a kid saying, why is my muscle white when there's all this blood? It was really bad. I was luckily I didn't lose my arm, but when I looked at it is when I started to feel the pain and started to scream. And I'm not saying it wouldn't have hurt, but I always remember thinking that is so interesting that I didn't feel anything when I didn't look at it and didn't even know I had an issue.

And then when I looked, I was literally screaming bloody murder. So luckily I got help. They sewed it up and I'm all good. But I always remembered that as a kid going, that's really weird that it didn't feel anything until I looked at it. So I know and I've learned just from being in this field that, you know, they say eighty percent of the pain is psychological and twenty percent is physical. So it's a real thing.

And when you can start to learn that and take control, you can start feeling a lot better if you're going through chronic pain. So I want to talk about taking care of your body and your mind in. The first thing to do is relaxation. Right. So when you're. Distressed, your pain increases and when you're in pain, you may experience more stress. So to break this cycle by learning one of several common ways to relax, so you want to learn the art of diaphragmatic breathing or what they call abdominal breathing.

This is the way babies breathe. By the time we grow up, we learned to breathe by expanding our chest. And this sets us up for increased tension and the loss of the sense of our own body rhythms. So we do not breathe in as well as we did when we were babies. So you want to practice progressive relaxation, learn how to take quick relaxation breaks throughout the day, learn how to do that informatic really meaning you're taking your breath all the way down to your abdomen.

You want your belly to come out, you want to get enough oxygen to really fully get in your body, not just goes to your chest. Right. Like I said earlier, that by the time we grow up, we're just expanding our chest and we just not get enough oxygen. And so you want to practice breathing techniques. One of my favorites, which I'm sure is shared at some point, but it's called for seven, eight breathing. And you can actually go on YouTube and look up for seven, eight breathing.

And there's a Dr. Andrew Weil that does a short presentation on and it works really well. So that's just a quick referral if you want to. And I know there's tons of stuff on the Internet about deep breathing and diaphragmatic breathing. So that's one thing to do with relaxation. Another thing is exercise. So your pain is likely to decrease once your body is recondition again. And not only does exercise distract you from your pain, but in my release endorphins as well.

Right. Which is the body's natural painkillers. And when your muscles are strengthened, you become more mobile and independent. So seek the advice of a health professional before starting an exercise program geared to your individual condition. Your schedule should be gentle, regular and should increase gradually. Don't just say, you know, I'm going to start working out five days a week. If you haven't been doing anything, just take some baby steps, but just get moving.

You also want to nurture yourself. You need to feel guilty for seeking comfort, especially if it distracts you from pain and increases your level of daily activity. Spend half an hour per day engaging in an activity that gives you some pleasure, taking a walk, listen to music, do something helpful for someone else. These are just some examples and rediscover the joys of incorporating pleasure into your life. Again, meditation. We all talk about meditation. That's always a helpful thing.

You might want to learn one of the calming meditation techniques. The mind is not geared to staying active at all times become problem when one is preoccupied constantly by pain, right? It's always geared in that way. So achieving a state of mindlessness can allow us to experience our bodies, our thoughts and our feelings in different ways. Alternatively, one meditation technique called mindfulness encourage us to stay passively focused on our pain and to simply observe it. This is allows us to distinguish between the existence of the pain and the fact that we are the ones who experience it.

And we get to this point. We know that we control how we experience our pain. And what they want to say with meditation is a lot of people have unrealistic expectations about how quickly they're going to be able to meditate. Well, it takes a lot of practice, but practicing is still good, right? So practice for one or two minutes in the morning. Don't be like, oh, I'm going to meditate for twenty minutes. You know, our brains are always going, remember, we got 80 to 90000 thoughts a day, so we're going to get distracted easily.

So find a place where you can have some peace and quiet and don't beat up yourself. You know what? If you can meditate for thirty seconds, that's great. But it's a great little practice to get into another one. You might want to try as guided imagery. So there's many very powerful techniques one can learn, especially with the help of a trained professional with the imagery which can tap into the ability of the mind to explore methods of examining the pain experience in non logical, nonsequential ways.

And guided imagery is where, you know, you're closing your eyes, doing some breathing. And the image is that you bring up in your mind can help bring you some relaxation. So I hope this is giving you some new tools. So new ways to think about things is always using the mind over my book and learning how to do your thall records. Be aware of what your thoughts are, what your loved ones are, and challenging those. If you're using the mine over my book, I can tell you in Chapter 14 and anxiety near the end, it talks about breathing relaxation.

It talks of breathing techniques. It talks about imagery, talks about progress and most relaxation. So there's some exercises there that you can learn to use as well. And one other excellent, excellent book I want to refer you to is called A Day Without Pain. This is a really great book. And they actually have a treatment center in Las Vegas that teaches people how to use these techniques and gets people off their chronic use of opioids.

It's really phenomenal. So I referred this book to people with chronic pain issues and they've just been thrilled with it. So it's a really good book. And that will be another one that I would recommend.

So that is it for today. I hope this was helpful for you or someone you know and love.

You can share with us if you have a burning therapy question - I'd love to answer it. You can email me at MyCBTPodcast@gmail.com.

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And remember to always make decisions based on what's best for you, not how you feel.