Do you occasionally suffer from physical pain such as headache or back pain and do not know a clear cause? You may have tried many prescriptions and painkillers that are supposed to relieve the pain, but the feeling is still there. It is an invisible pain, difficult to explain to those around you, and often surrounded by a stigma that makes it more difficult to cope with, your doctor cannot determine its source, others constantly tell you that it is not real pain, and the magic pill is no longer so, what to do then? This report will not describe to you the latest painkillers and medications that you have not tried yet, but rather will present you with the experience of pain from the perspective of psychology and explain the close relationship between it and mental health, and will tell you about the most important tools that will help you in adapting to this type of pain and relieving it.
What is chronic pain? What is the difference between it and acute pain?
First, it is important to clarify the difference between chronic pain and acute pain. Undoubtedly, pain acts as a warning to you if you are physically harmed, such as the pain you feel when you have an accident, or if you suffer from an internal problem that your brain alerts you to by sending signals that will make you feel that something is wrong. This pain is known as acute pain that It goes away automatically as soon as its causes are treated, and it usually does not last longer than three months, in contrast to chronic pain that continues to exist even after the damaged tissue of your body has healed in the event that you suffer an injury, and in many cases a clear organic cause is not known, but rather occurs as a result of the development of some Neurons – responsible for your feeling of pain – to memory that memorize this pain and repeat it continuously, examples of which are migraine pain or what is known as migraine, muscle and back pain, and chronic muscle tissue pain.
The effect of chronic pain is not limited to the physical aspect only, as hundreds of studies support its association with a decreased quality of life, and the person’s disability from performing his daily functions, and is also linked to increased rates of depression and chronic anxiety, but some studies tell us about deeper effects of it, linking it with a distorted identity The individual or even his loss of it, for example: “My constant and frequent feeling of headache affects my performance of the tasks I perform to maintain my position in society, and is reflected in my sense of self and my confidence in my ability to work and achieve my future plans” (1).
In addition, the nature of the experience of pain is more subjective than objective. Each has his own experience and feeling; This means that those who suffer from pain may face doubts from their surroundings about the reality of what they are going through, this feeling extends even among doctors and health care providers, where studies find them more likely to feel negatively towards patients who complain of pain whose causes are not clear to them, so they become, for example, less sympathetic With the patient and less inclined to provide care (2)(3). “What creates a subject that is not recognized, its experience of sufferings whose existence is fundamentally unbelievable” (4)
Interestingly, research indicates that the relationship between chronic pain and mental health is a two-way relationship, meaning that a person who suffers from chronic physical pain becomes more likely to develop mental disorders, including depression and anxiety in particular, and the presence of a history of psychological disorder in the individual Increases susceptibility to long-term chronic physical pain (5).
Why do we feel pain?
For a long period of time, the relationship between the feeling of pain and the presence of an organic cause was considered a direct linear relationship, without taking into account the influence of any other factors, and in the best cases, factors such as social and psychological were placed in secondary and indirect contexts, and accordingly, medical interventions in chronic pain were Aimed at relieving symptoms through prescription medications, injections, and surgical interventions; On the other hand, however, we find that less than half of patients feel better after these treatments, not to mention that pharmacological interventions in particular may carry high risks (6) (7), and their long-term benefits – if any – are very limited.
Despite the emergence of many theories and models that have attempted to explain pain and its causes, the biopsychosocial model is the most realistic and useful model among them, in terms of its approach to the experience of pain and methods of dealing with it, as it is viewed through a multidimensional framework that takes into account physical, psychological and social factors. And the interaction between them, and this interaction – according to the model – is very important in the process of assessing pain and searching for ways to deal with it and finding mechanisms that help to adapt to its symptoms, rather than focusing on its biological aspect only (8). Accordingly, the idea of using psychological tools to help cope with chronic physical pain arose, as the role of psychosocial components in understanding pain experience and its contexts has become increasingly clear in recent decades.
How do I cope with the pain? How can I mitigate it?
- 1- Understand the true nature of your pain:
Perhaps the last thing you want to hear about your pain is statements such as: “The pain is not real” or “It is all just in your head.” But that is not true. Much of the suffering of pain stems from the belief that feeling it necessarily means that there is damage that must be treated, and then you may spend a long time switching between this drug and that prescription and that doctor, and you may end up falling into a mixture of feelings of frustration, helplessness, sadness and even Anger, because of your inability to heal this pain, and may even exacerbate suffering and feeling it (9), and here we find that many studies of chronic pain focus on the importance of the patient’s awareness of his pain, its causes and its role in influencing the results of treatment.
The following two stories are true, and may help you put your pain in a more logical context:
In a hospital emergency room, a construction worker after a 15 cm nail was pierced in his foot while on the job, was admitted in unbearable pain; Which led to him being put under anesthesia until the nail was removed, but the surprise was after the worker’s shoes were taken off, as doctors found that the nail passed between his toes without penetrating any part of them! The worker did not suffer any injuries, but his pain was real! In another incident, another construction worker was using a nail-shooting pistol in one of his workshops, and by mistake the gun fired several nails in the worker’s face, but fortunately they did not hit him, and within several days, due to his feeling of pain in his teeth, the worker consulted a doctor Teeth, only to discover that a nail hit him and lodged inside his head! Although this injury put him at risk to his life, he continued to perform his daily functions and continue his life normally, because his brain did not send signals that put him on alert or stimulate pain receptors (10). The two construction workers were under the influence of acute pain, which alerts you to the presence of actual physical damage, but what happened with them shows us that there is indeed a cognitive and psychological component that plays a role in our feeling pain in all cases, then, your awareness of the fact that you feel it does not mean that you have a defect Or a disease, gives you more power and control over it than you think.
- 2- Do meditation exercises:
Evidence is constantly growing about the effectiveness of meditation exercises in helping to cope with chronic pain, and we find that there are many studies looking at changes that occur at the anatomical and physiological level of the nerves associated with practicing meditation and relieving pain. The main goal of practicing meditation is to develop an open mindset and create a kind of acceptance of pain in the patient, rather than focusing on attempts to reject or treat it, which often do not bring results (11). If you don’t know where to start, at the end of the report you can find examples of mobile apps that offer guided meditation sessions.
- 3- Visit a psychologist:
Cognitive Behavioral Therapy is one of the most important forms of psychotherapy that aims to focus on your thoughts and actions as the source and cause of the problem you feel, so that this type of therapy provides you with skills and tools that help you change the way you think and feel about the problem or event, and then How you behave towards her. In the context of chronic physical pain, cognitive therapy changes how you see and perceive pain, and how you process how you feel. Examples include:
Rheumatoid arthritis is one of the health symptoms most closely related to chronic pain, and many studies have found that non-pharmacological treatment programs, the most important of which is the use of cognitive-behavioral therapy techniques, have proven their effectiveness in alleviating pain and lowering the accompanying mood, and raising the functional performance of those who have rheumatoid arthritis. Suffer from rheumatoid arthritis (12) (13). In a study conducted on a total of 90 patients suffering from it, with the aim of evaluating the effect of CBT compared to traditional medical interventions, the behavioral therapy group received periodic weekly sessions, and analysis of the results showed that there was a significant improvement in their ability to walk and bend, in addition to lower levels of stress and higher status. Moods compared to the control group (ie, those who received conventional treatment only) (14).
It is worth noting that not only behavioral therapy can help in coping with pain, but there are other interventions that have proven effective, such as: Mindfulness Based Stress Reduction, Hypno-analgesia, and biofeedback ( Biofeedback (15); When you consult a psychologist, you can discuss and find the right treatment for you.
- 4. Do activities that keep you from thinking about the pain:
Although this advice may sound very counterintuitive, we often overlook its importance and its ability to relieve pain. Researchers have found that areas of the brain that are highly activated during episodes of pain can be calmed down and deactivated when the person’s focus is on other activity (16). Try recalling times when pain was less present, as a result of watching TV or sitting with your friends, for example, and use it to reinforce the fact that pain is experienced more intensely when you focus on it alone, and less intensely when you occupy yourself with other activities. That knowledge of doing activities you enjoy, and discovering new ones, of course it may take time and effort to get used to the skill of distracting focus from pain, but it is not impossible.
- 5- Do sports activities:
Perhaps one of the most important misconceptions about chronic pain is the association between the presence of pain and your need to stop engaging in activities that require physical effort. You go to the gym or go out for a walk, and you stay in your bed all day to help your muscles regain their health, but lying at home didn’t relieve it, but it got you into an endless cycle of pain, decreased movement rate and physical fitness, and negative feelings about not being You can accomplish anything, and in this context, the sport aims to break this cycle of chronic pain. Research shows that regular exercise relieves pain in the long term, as it increases muscle flexibility and strength, in addition to stimulating the secretion of endorphins, which in itself is a natural pain reliever, and reduces stress and anxiety levels (17). But it is important to remember here that it is best before starting to consult your doctor or a physiotherapist to determine the type and quantity of exercises that are appropriate for you, so that you begin to gradually increase the rate over time after you gain the necessary strength and flexibility, and remember that finding the appropriate activity and reaching tangible differences will require time, so The important thing is not to rush results and to stick to continuity.
- Restructuring Thoughts Worksheet (18 .)
- Meditation apps
- Balance application: Tawazun app provides short sessions in Arabic that you can listen to while you meditate.
- Waking Up App: Philosopher and neuroscientist Sam Harris offers guided meditation sessions on a variety of topics and situations, including meditation during pain.
- Five coping skills everyone with chronic pain needs (19): Through his experience in the field of pain management, psychotherapist Ted Jones tells you about the five most important skills that a chronic pain sufferer must master in order to be most effective in dealing with it:
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- Akhlaghi M, Faezi ST, Paragomi P, et al. Investigating the short-term impact of cognitive-behavioral therapy (CBT) on quality of life in Persian patients with rheumatoid arthritis: the heterogeneous impact on Arthritis Impact Measurement Scales (AIMS-2).
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