Podcast: Relieving Pain’s Impact on Our Mental Health
Jenn talks to Dr. Laura Payne about pain and its impact on mental health. Laura explains why some pain is beneficial to us, shares how chronic pain can affect mental health, and talks about how to balance pain management and emotional management.
Laura Payne, PhD, is the director of the Clinical and Translational Pain Research Laboratory at McLean Hospital. Her research focuses on identifying neurobiological, behavioral, and psychological biomarkers related to pain. Dr. Payne is actively involved in professional organizations and serves on several editorial boards, including Pain Medicine’s editorial board.
Jenn: Welcome to Mindful Things.
The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.
Hi folks. So, good morning, good afternoon, or good evening wherever you’re joining us from, whatever time it is where you’re joining us. Thanks for taking an hour of your day to spend with us to better understand pain’s impact on mental well-being.
I’m Jenn Kearney, and I’m a digital communications manager for McLean Hospital. And I’m just going to put it out there, pain is something that we’ll all experience at any time in our lives. Some of it is just to protect our bodies. Understanding our bodies are at its limits or they’re just being stretched to a point of discomfort.
But for some of us, physical pain is acute, it’s ongoing, it can impact our day in and day out. And a lot of folks with chronic pain report anxiety, depression, negative impacts to their emotional well-being and even their quality of life.
So, I’m really excited to have the very aptly named, Dr. Laura Payne with me today to break down the relationship between chronic discomfort and our mental health and answering questions about the intersection of pain and emotional management.
So, if you are unfamiliar with her, Laura Payne, PhD, is the director of the Clinical and Translational Pain Research Laboratory at McLean Hospital. And her research focuses on identifying neuro-biological, behavioral and psychological biomarkers that are related to pain.
So, Laura, hi. I’m super excited for you to join me today. Thank you for taking time out of your schedule to do so.
Laura: Hi Jenn. Thank you. I’m so happy to join.
Jenn: And before I dive into everything else, I just want to ask, can you clarify what chronic pain is?
Laura: Yes. So chronic pain is any pain that lasts for several months or longer. Usually defined as at least three to six months. The pain can be experienced every day or it may be experienced just once in a while and it can be in any location in the body.
So, it’s a pretty loose definition but once it’s been present for at least several months, we would consider it chronic pain.
Jenn: So, what does this chronic pain do to us mentally?
Laura: Chronic pain can have a tremendous impact on our mental well-being. Typically, when we’re experiencing pain, the natural response is to try to protect ourselves. It’s our body’s alarm system signaling, “Hey, something in your body, some tissue could be damaged if you, continue to experience this.” Like if you touch a hot stove, right, it’s normal to have, to experience pain so that you pull your hand away.
The problem is that when we have chronic pain, our minds are signaling that something’s wrong, something’s wrong, something’s wrong, when in fact there may be no clear physical evidence of something that needs to be addressed.
And so, we end up trying to kind of protect ourselves and keep from experiencing pain. And unfortunately, that process in and of itself can have a negative impact over months and months and months.
If somebody isn’t doing the activities they used to do, if they aren’t seeing and spending time with their loved ones or their family, or their friends, all of these kinds of limitations, plus this repeated experience of discomfort can certainly cause significant mental health concerns. Understandably so.
Jenn: So, I feel like you teed me up beautifully to ask, are there some chronic pain conditions that are more mentally impactful than others?
Laura: I don’t really think we could say that. I think it’s such an individual experience that it really doesn’t matter what your type of pain is, in that, how you experience it and how it impacts you is true for you.
And it could be way worse than somebody with the same type of pain condition or not nearly as significant as another person with a different type of pain condition. One of the things that I really want to get across here is that pain is an individual experience.
So, nobody can tell you that your pain isn’t, shouldn’t be as bad as it is or it, that you shouldn’t be feeling the way that you’re feeling, because pain is totally subjective.
And however, we experience it is what our experience is. And that’s why any type of pain condition can affect somebody in many different ways. It can be very impactful.
Jenn: So, is it possible then for chronic physical pain to cause mental illness or is it possible for mental illnesses to cause chronic physical pain?
Laura: I really hesitate to use the word cause because we really haven’t determined that something causes that, either pain causes mental illness or vice versa but we do know that they are very closely associated.
Part of the reason is what I talked a little bit about before, that there are, once pain becomes chronic and we start limiting our lives and we’re less physically active and maybe we’re having trouble sleeping, that, those things can also cause additional stress, can cause muscle tension, can cause more pain.
And certainly, if you’re experiencing repeated pain or pain every day, that’s going to cause anxiety. I mean, think about if you were walking around and somebody was just kind of randomly shocking you and you were experiencing pain, you’re going to feel so anxious about it.
You never know when it’s coming. And that’s what the experience is of many people with chronic pain, that it can come up unexpectedly and that’s a natural way of making us very anxious.
So, it’s completely understandable that we would experience anxiety. And then also depression from not being able to engage in our lives in the way that we want. Now we do also know that pain and anxiety and depression share kind of similar neuro-biological pathways.
And what that means is that sometimes when pain is activated or when like depression is activated, that can also activate the other.
So, I wouldn’t say that pain causes, mental health or that mental health causes pain but there may be kind of similar components that are acting at the same time. And so, it’s very reasonable that they go hand in hand.
Jenn: I know from both personal experience as well as experiences relayed to me that sometimes without a health diagnosis, if you are in chronic pain, if a provider is having a hard time wrapping their heads around it, you can sometimes be told that it’s like “all in our head.”
So how do we be better health advocates for ourselves without getting increasingly more upset and defensive toward our care team?
Laura: Yes. I can completely understand that. And I think many physicians who haven’t had training in pain and even some who have don’t really understand how pain operates in the body and that whatever, as I said before, whatever you are experiencing is real and true, and it is real pain.
So, there isn’t such a thing as like, pain that’s in your head and like real pain. We know this because, people who experience very similar types of injuries or things that we would consider like very medical, like cancer have very different pain experiences.
And that’s because what our experience of pain is, really depends on so many different factors. It depends on our own neurobiology and genetics.
It depends on how much we’ve, are focusing on the pain. It depends on our past experiences with pain and were they scary? Did our parents seem to be anxious when they were in pain?
All of those things come together in our brains and that determines our experience of pain. So, if somebody tries to communicate that it’s all in your head, well, technically all pain is in everyone’s head because it’s all in our brains.
Our brains determine our experience of pain. And if you are dissatisfied with how your provider is helping address your pain concerns, I would highly encourage you to see a pain specialist in the kind of area of pain that you’re dealing with or in a general chronic pain clinic.
You really want somebody who totally understands pain and helps you feel like you have somebody you can rely on that’s going to effectively treat what you’re dealing with because there are effective treatments. And it’s just a matter of being able to access them.
Jenn: So how would we go about finding a pain specialist and depending on the type of pain that we’re experiencing, what kind of questions should we be asking of these providers?
Laura: Yeah. There’s a couple different ways you can look for a pain specialist. One is to look in like a local kind of hospital department of anesthesiology and see if they have a pain medicine clinic.
And you also want to see what are they offering in their pain medicine clinic? Is it just interventional treatments?
And what I mean by that is like specific interventions for pain that would be like nerve blocks or injections or things like that, which are, can be an important component of pain treatment or do they also have like a more comprehensive care?
Do they have physical therapists? Do they have psychologists? Other resources that people who are struggling with chronic pain really benefit from. So, you can look at your local, especially academic hospitals to see what is available.
The other thing that you can do is look in some of the national pain society directories, clinical directories. There’s the U.S. Association for the Study of Pain, which is a newly developed organization that I’m involved with, and they do have some clinical directories.
Or you can look at a professional group that is related to the type of pain you’re experiencing. So, for women, typically, and for some men who experience pelvic pain, there is the International Pelvic Pain Society. They have a clinician directory.
And typically, the physicians and the providers that are affiliated with these pain, professional pain groups are going to be aware of the latest research, the latest, studies and what’s going to be most helpful for your type of pain.
Jenn: So, I know that you had mentioned previously that how we all experience pain differently is kind of like, it’s a huge culmination of a lot of things. Is there any implication that people with higher pain thresholds have better mental wellness or well-being or is it simply just our chemical compositions?
Laura: Yeah, there’s really no, no connection that I’m aware of between having a higher pain threshold and mental well-being, because we’re still trying to understand the relationship between acute pain, which would be like a pain threshold, what we’re testing, like how much pain can somebody tolerate in kind of one instance.
In my lab, we do tests like putting your hand in very cold water. That’s a very common pain test that’s been used in research for decades. But we’re not really sure exactly how that relates to chronic pain.
Generally, people who are already in, who have chronic pain might have lower pain thresholds but in terms of the development of chronic pain, we’re not entirely sure. So, I think the relationship between that type of pain experience and mental health is not clear.
And I would say people experience chronic pain in very different ways. And so, it’s not a guarantee that if you have chronic pain, you’re also going to have anxiety and depression. People learn very healthy ways of coping with pain.
And even if we can’t eliminate pain, we can reduce its impact. And that can have a very positive impact on mental health and mental well-being.
So, we really are just teaching better coping strategies and so that you can live a full life with pain and that will really have a positive impact on mental well-being.
Jenn: So, in terms of chronic pain and mental well-being, I know that there’s a lot of folks who experience chronic pain don’t want it to be something that actually impacts their day-to-day life. They want to be full-time employees.
They want to be high functioning members of society. They want to be like fully present parents. What’s the line of knowing when we should back off from this versus beating ourselves up about, “not being enough?”
Laura: Yeah. This is a tough one. And it’s a specific skill that we teach as part of like cognitive behavioral therapy for pain and it’s called activity pacing.
Because what we know is that people who, for people who experience chronic pain, if they have a day, they’re feeling a lot better, they want to go out and experience the day and like do a million things.
‘Cause they don’t know when they’re going to feel that much better again. And so, what can often happen though is that during that day they might overdo it or over the next couple of days, they might overdo it and they become exhausted, their muscles aren’t used to that much activity.
So, it can cause some muscle pain and it can send them into like a kind of pain spiral after that. And so, you get this kind of constant up and down of like feeling better and then like overdoing it.
So, we really have to practice this activity pacing which is, not avoiding things completely but trying to get a better sense for yourself of like what’s pushing it just enough but that you’re not overdoing it.
And that takes quite a bit of practice because, we don’t always, we’re not always aware of how our bodies are functioning.
And so, learning to be aware, learning to kind of scale back when you need to scale back, like if you know you have a big day coming up in a week, don’t overdo it with exercise up until then because you know that day is going to take a lot out of you and you want to be able to have some reserve to be able to cope.
So, it’s a practice, it’s a learned skill. And, ideally working with, most often psychologists, pain psychologists help teach this skill. And perhaps in physical therapies too, can help you learn to kind of scale what’s appropriate for you.
Jenn: We had somebody write and I know that being attuned to your body and kind of like turning inward can be really challenging but achievable through mindfulness.
And someone wrote in saying that they’ve read stories about monks that were able to change how they felt physically strictly through meditation.
Do you know if there’s any evidence where meditation or mindfulness exercises can help with chronic pain?
Laura: Yes, we do know that mindfulness meditation does help with chronic pain. It is, I think an important skill that requires some practice.
And, I think there has been, I can’t recall the exact details, but there was a study looking at kind of brain imaging of monks who’ve been practicing meditation for long periods of time and how their brain processed painful information was different.
And so, they were able to change how their brain is processing that information. And ultimately, that is what we’re trying to do.
With chronic pain, we, the brain is continuing to signal pain, pain, pain when either the damaged tissue from an injury has healed or when there’s no longer some kind of physical evidence of some damage.
And so, we are helping the brain kind of calm itself down and say, “Hey, it’s time to stop signaling pain because there’s nothing that we need to attend to in the body right at this time.”
So, meditation, mindfulness can really help with that. And you can start really small and build your skills but it definitely will.
And it has additional benefits of relaxing because when we have chronic pain, we often have chronic muscle tension because if we’re in pain all the time, it’s so uncomfortable and our muscles tense up.
And so, helping to relax will also help pain. It has like a very kind of positive effect. And it’s definitely a skill that I do teach because I think it is really important.
Jenn: Could you talk a little bit about the impact of diet as it relates to physical pain?
Laura: Yes. I can talk a little bit about that. I am not as familiar with the literature on that. I can say that for some people that it does have a clear relationship.
And I think, as we learn more about what we would call complementary and alternative medicine approaches and nutrition or dietary changes is one of those, as is psychology or yoga, meditation, we’re getting more evidence about how these different approaches work.
And the reality is that we need these approaches for chronic pain. Medicine by itself is not going to do it. There’s not going to be a medication or a procedure that solves completely the pain.
So, we need to look at these other areas and say, “Hey, what is going to be beneficial for you? Do dietary changes work for you? Does it help reduce inflammation?” Because for some people that’s a really important benefit of dietary changes and it helps with pain.
There have been some specific diets looked at for specific pain conditions like irritable bowel syndrome or inflammatory bowel disease. And I think there has been some benefit of those diets but it’s not entirely clear.
And again, it’s unlikely that any one thing is going to be the answer. And so, and this is what can be so hard and so exhausting is that it does require trying some different approaches to see what really works for you.
Jenn: So as a provider, how should we approach clients that are facing mental health challenges due to their physical pain?
Laura: So, from a provider’s perspective, and I’m not sure if you’re meaning physician or psychologist but I’ll just speak for a physician or nurse or kind of related field. I would say, it’s important that we encourage clients to get involved in other methods of care.
That could be physical therapy. That’s a really common one. It’s important to keep those muscles strong because the more weak the muscles get from inactivity, the more pain that’s going to cause.
We want to just enhance this, trying to have a healthy diet, reducing smoking, being active, all of those things. And I think validate, that it’s completely understandable that a person in their position would feel the way that they feel.
It’s scary to have a very uncomfortable painful condition and not either have an answer or have a plan or know what to do. There are ways to get those plans and to figure out what to do, but it does require a bit of work.
And so really validating that experience and encouraging them to get connected with other therapies and possible pain support groups ‘cause that can be very validating as well. A lot of those are offered through kind of local hospitals.
And even though that may not provide the specific medical information, it can be emotional support, which is such an important component too.
Jenn: So, I know we’ve mentioned a couple times so far that folks who experience chronic pain are more inclined to feel either depressed or anxious or suffer from those conditions as well.
So how do we tell if someone who’s in chronic pain is developing depression or anxiety?
Laura: Well, there’s some questionnaires that you can give your clients if you’re a provider. Some really short ones. There’s something called the Patient Health Questionnaire, that nine item version that can just give a general sense of how somebody is feeling.
You can also just ask some questions of, have you been holding back or avoiding activities, how many social activities do you end up doing every week or every month? Do you feel kind of down and hopeless about your condition?
Do you find that you’re worrying a lot and maybe you’re having trouble sleeping because you’re worrying? All of those kinds of questions can help key in to somebody who may be really struggling.
And of course, we want to be able to address those concerns as well, because, I think when we start to feel so depressed and down and hopeless, it can be hard to engage then in the treatments that are going to help the pain.
And so, we want to be able to help somebody’s kind of whole experience.
Jenn: So, what are some of the more popular treatments that are out there for folks experiencing both mental health conditions and physical pain?
Are there any that are like a one-stop shop or is this something that’s more case specific and requiring a care team?
Laura: Well, in terms of the mental health and pain kind of together, I think a first-line treatment is cognitive behavioral therapy. And so, in this type of treatment, you are learning more about pain and how it affects your mental health and vice versa.
You’re starting to recognize triggers and cues that may kind of cause you to experience more pain or cause you to feel anxious and how those things interact. You’re learning new skills for helping challenge anxious or negative thoughts or negative thoughts associated with pain.
Like I’ll never be able to, go out and do a bike ride again because of my pain. And so, we learn how to challenge those thoughts not with positive thinking. This is not positive thinking.
This is realistic thinking and having more balanced thoughts. And then we really work on relaxation skills, ways of, preventing the pain from kind of getting worse.
And sometimes that can be like distraction, distraction activities, and then behavioral changes that we’d want to make. And all of those skills apply to both pain and mental health. I do think that typically, just a psychologist is probably not quite enough.
You do want to have a physician who specializes in pain or your type of pain on board as well, because that’s an important component too.
And medications, including, what we think of as SSRIs that would be like Prozac and Paxil, or other medications, Cymbalta, those can be helpful in addressing both as well.
And you would want to talk to your doctor about that. Is there a medication that can help me with both of these things?
Jenn: So, it seems like some folks that live with chronic pain have been able to, for a lack of better word, be accepting of their pain and can find it challenging to have a more positive outlook.
Are there any specific types of therapies that might be most helpful in helping patients change their mindsets?
Laura: Well, I mean, the cognitive behavioral therapy, really is the first line of treatment but kind of an offshoot of that is the acceptance and commitment therapy or known as ACT.
It’s a type of cognitive behavioral therapy and it has been used with chronic pain successfully too.
The slight difference here is that the ACT or acceptance and commitment therapy approach, doesn’t focus on changing the pain experience, it instead focuses on, kind of trying to put it in the background and instead focus on what is important to you in your life.
And how can you begin to engage in those activities even if it’s not to the full extent that you want it to be but how can you bring those things into your life that bring you joy, that bring you satisfaction, even if they do sometimes cause a little bit of pain.
But really focusing on making commitment to those important things, knowing that the pain is going to go up and down. And for some people it’s just, it’s a management issue and it will be to some degree for the, for the good part of their lives, kind of like any other medical condition like diabetes.
It’s going to have to be managed with some days really hard, some days much easier, but really focusing on those things that matter to you. And so that actually can have a positive impact on your mindset.
Similarly, with cognitive behavioral therapy, when we focus on, which is kind of the same, doing activities, changing our responses to pain that signals to our brain, “Hey, look, I can actually do some things even when I’m in pain. Or look, I know how to scale back on something so this doesn’t trigger a huge pain response. And I know how to practice relaxation and that eases some of my pain.” And that gives you confidence and also changes your mindset.
Jenn: So aside from mindfulness, are there any other coping skills that you would generally recommend for folks with chronic pain?
Laura: Yes. I mean, I think any kind of relaxation strategies would be really good. There’s certain practices called progressive muscle relaxation that involves like tightening and kind of releasing your muscles and it kind of triggers this relaxation response in your body.
Even just practicing like a diaphragmatic breathing or kind of a deep breathing can be very helpful.
And then interestingly, some of the tools that have been used in therapies for anxiety and depression, I’m thinking of one in particular from dialectical behavior therapy, such as like putting ice on your forehead can produce a kind of relaxation response.
It’s actually called the dive response. So, you put ice or kind of something cold on your forehead and hold your breath. And it kind of reduces physiological responding very quickly. That can be very helpful.
But most importantly, it does involve kind of a trial and error on your part because each person is different. And what works for somebody is not necessarily going to work for someone else.
But if you’re trying something, I encourage you to give it a good try of at least like a week to really see how it works for you. And then you can start to hone in on the things like, “Okay, I know these are the couple of things that are going to help me if I’m kind of in a pain crisis.”
Jenn: So, I know different treatments are better for different people, folks respond to everything differently, but we have had a few questions in terms of, not necessarily, I would say “traditional forms of treatment for pain.”
So, I wanted to know if there was any evidence about these being helpful. Hypnosis for treatment of chronic pain, is that useful?
Laura: Yes, so there are actually some published data on this. Again, this goes to the complementary and alternative approaches. People have found hypnosis very helpful, and that ability to kind of engage your mind in this, kind of, imaginative place of relaxation, developing that, it’s...
Don’t get discouraged if you can’t do it at first, this is a skill like anything else and it requires practice. That has been shown to be helpful. Yoga.
Although I would caution to see somebody who understands pain, not just go to your regular old, kind of yoga studio, because you want somebody who really is going to understand the movements and what’s going to be appropriate for you.
Tai chi is one of those things that has been shown to be helpful for pain. Acupuncture for some people. So, there is some evidence for these approaches for sure.
Jenn: About CBD or marijuana, is there any evidence that that’s helpful?
Laura: I think, so one of the colleagues here at McLean is looking at CBD and marijuana, and I think there is some evidence now emerging that at least I think that the THC component can be effective. Now, I don’t know anything about the doses or, what brand or anything.
So, I, and I wouldn’t know exactly where to get that information, but I would, especially if you’re seeing a pain specialist, I would ask about that because we’ve got to use these tools to help ourselves and help what is going to support our individual bodies in recovering.
Jenn: And a shameless plug. I did ask that question in a session a couple of weeks ago called “Ask Me Anything About Marijuana, CBD and Mental Health.”
So, we do have some resources with Dr. Staci Gruber available on the website. So, if you want to find out more about that, you can head there.
Laura: Yeah. And I do believe she told me recently they just finished a study on CBD for anxiety. And it does help. Again, I don’t know what dose or how they used it, but these things are worth exploring.
But again, you don’t just want to go pick up something at the store without really knowing, you want to talk to your doctor or your provider about this and the dosing and kind of what would be recommended.
Jenn: I’m curious because sometimes, I know I’m taking a complete 180 in terms of questions, but sometimes patients with chronic pain get almost offended by the idea that their chronic pain is playing a big role in their mental health.
Like they don’t want to hear that their anger or anxiety or depressive symptoms have anything to do with their pain though, to the provider, there’s really clearly a link there.
Do you have any advice for how to tie together these connections for patients who might seem a little resistant to connecting the dots?
Laura: Yeah. Well, and I think, trying to understand the nature of the resistance would be an important first step. There may be, and this often happens, like a lack of awareness of that connection.
And so sometimes just monitoring those experiences daily, how much pain was I in today? What happened today? Oh, I did experience like a couple of stressors and I got into an argument with a coworker and my pain was higher.
So just like starting to monitor day to day can shed some light on that. For other people, maybe there’s other factors going on that’s contributing to that resistance. Maybe they, they feel that somehow that makes their pain not real if it’s connected to how anxious they felt or how angry they felt.
And again, I think it’s just going back over this model of pain. There is no pain that is not real. It just isn’t a thing. So, this dichotomy that we created decades ago, which is like real pain and not real pain, it just doesn’t exist.
And really understanding that when we feel anxious, when we feel angry, when we feel sad, that sets off physiological changes in our body and that can activate pain. And so, it’s perfectly normal and understandable that those things are connected.
And I wouldn’t, get into an argument about it, but we have, there’s so much evidence about this. It’s just really kind of overwhelming. And so, I would encourage the client just to observe that and to see if there is a connection, that gives us more opportunities to treat this pain.
Like if we can help manage your anxiety or help manage anger or sadness, what if that has a positive impact on your pain too? And we would expect that it would.
Jenn: Is there any specific support available for adults particularly older adults that are struggling with chronic pain?
Laura: Well, it depends on, if you’re thinking about support groups, I’m sure there are. We often see chronic pain in older adults in part because of difficulties with mobility and occasionally other health issues too.
So that makes sense that there would be more chronic pain. And I don’t know of any specific support groups but I do know that they’re available. And again, I would look through your local pain medicine clinic or department of anesthesiology and see what’s available there.
There may also be a lot of online support groups and you can reach out to local clinicians and see if they have, knowledge of some support groups as well. I think, especially with older adults, we really want to try to stay as active as we can, even though it is more challenging.
But that activity, that getting out of the house is going to allow for positive social interactions. Even if they’re just kind of like once a day, that can have a really positive impact.
I will also say, I did want to bring this up because women’s specific pain issues are something that’s important to me and my research, something I’m very passionate about. And for women, menopause can also be a time of a big transition and a vulnerability to chronic pain.
So, some women do develop chronic pain, during and after menopause. And, so being able to talk to, your provider, your gynecologist about that and see if there’s any support around that could also be another way of getting some support.
Jenn: For folks that are struggling with chronic pain, how can we be supportive and encourage them to take small steps forward while also not pushing them to do too much?
Laura: Yeah. I mean, this can be, this can be challenging, I think, especially if you’re a family member. It’s really hard to kind of push your family members to do certain things because of just the nature of the relationship. Like it’s not, just a therapeutic relationship.
Like there’s so many other dynamics there and, a family member may be frustrated that the person isn’t able to do as much and that can come up.
And, so, I would encourage trying to get a provider on board, maybe physical therapist, psychologist, other therapist, doctor, to encourage them to take those small steps. And also, you can present it as like, let’s just see.
Let’s just see what happens if you do a couple things and don’t overdo it, and we make modifications for you so that it’s manageable. That can reduce some of the anxiety around doing that.
And can also help to challenge some of those anxious thoughts of like, “I can’t do anything,” or, “I’ll never be able to last all day.” Whereas, making an adaptive environment so that they can achieve that goal.
Yeah, maybe they can’t stand all day, which I think would be pretty hard for many people but like how could, how can you modify it so that they can get closer to that goal?
Jenn: We had someone write in asking, “Aside from CBT and relaxation techniques, is there any more research or new suggestions for folks that are struggling specifically with fibromyalgia?”
Laura: With fibromyalgia, well, in terms of like interventional approaches, I don’t, in terms of medical interventions, I am not aware of that. But the cognitive behavioral therapy is a first-line treatment for fibromyalgia and kind of various offshoots of that.
I know there has been other types of therapies developed around that. There’s one called emotion awareness and acceptance therapy that I have used and can be really helpful identifying how stressors play a role in pain. But generally, the things that are appropriate for fibromyalgia are usually appropriate for most other types of pain conditions as well.
Jenn: So, I’m curious because you have so much research that’s women’s specific. How can women specific chronic pain conditions evolve over our lifetimes?
And how as women, can we be aware of what might be a chronic pain symptom in terms of reproductive health as we continue to age?
Laura: Yeah. Well, and this is what, kind of my research and I think many other people’s research is focusing on right now. Like how can we potentially spot the early warning signs because it’s not going to be, it’s not going to be necessarily as clear cut.
So, one of the potential risk factors for women’s specific kind of pelvic pain could be menstrual pain. And so, this is something that I study in adolescents to try to look and see how that changes a person’s pain experience over time.
But we know not everybody with menstrual pain is going to develop chronic pain because menstrual pain is very, very common and not all women go on to develop a chronic pelvic pain.
But for women who have chronic pelvic pain, almost all of them have had menstrual pain. So, we’re trying to better understand that relationship.
There’s also this idea that having kind of repeated or chronic experiences of pain is part of what changes how the brain is processing that information. Almost sensitizes it almost like an allergy in a way.
Like it just where the brain starts to react really strongly to pain. And so, I would say, if you begin to experience pain, if you notice that it’s kind of coming back and maybe you’ve had some low back pain for a month or two, not really sure what’s going on, physical therapist is like, “Well, you’re doing all the exercises.”
You want to see a pain specialist at that point. You want to try to treat that pain earlier on because we don’t want those pathways to become more developed in the brain. That’s going to start signaling pain.
So, trying to treat the pain as early on as you can, staying active, those things are going to be really important. But we’re still looking at prevention, identification of those at risk and prevention of chronic pain. And we don’t have all the answers yet but we’re getting there.
Jenn: I know a lot of times folks just want to take a pill and have their pain go away. Just a quick fix.
Do you have any recommendations for how to help people be more open to trying the strategies that you and I have talked about?
Laura: Yes. I would say, look at how that is working for you. And there may be, it may be working in terms of like reducing your pain temporarily but is it a long-term solution?
And do you find that that process is causing other challenges such as being anxious about, where are your pills? Are they close by? What happens if you have breakthrough pain?
And this is a situation, typically with chronic pain where the medication is just one component of the treatment. Because again, it’s, the problem is more in how the brain is processing that information.
So, we need these other tools to be able to help the brain change how it’s responding. And, of course it is, it’s very attractive to get relief right away. And that may be an important component of your ongoing treatment, but there’s going to be other strategies that are going to help you also in the long-term.
And that’s really what we want, where you’re able to function pretty well most of the time without having to rely on that for immediate relief.
Jenn: We had someone write in who said that their pain is most pronounced at night which leads to them having difficulty both falling asleep and staying asleep and to date their specialists haven’t really been helpful.
Do you have any suggestions or resources for someone like them?
Laura: Yes. This is so common and we know that sleep also then, can exacerbate pain or can make it worse.
So, if you’re not getting restful sleep, which again, totally understandable because who can sleep through experiencing significant pain, especially if it is more pronounced at night. But this is going to really have a, a way of kind of making the pain worse.
So, there is a cognitive behavioral treatment for sleep and it’s called the CBT for insomnia. And it is one of the most effective sleep interventions possibly even more so than sleep medication but it helps people get off sleep medication.
There are many providers who do it. It’s a relatively short-term treatment. You can do it if the provider offers tele-health.
It can be a really powerful tool, also because once your anxiety about sleep, which is again, naturally develops when you’re having trouble getting good sleep, if we can manage that as well, that’s going to help pain and help you have some other coping strategies for dealing with it.
But certainly, sleep is really important. And if you’re having trouble sleeping, and you haven’t talked to your provider about it, be sure to talk to them about it and also look at some of these potential other resources because it doesn’t just have to be sleep medication.
‘Cause that really just, it doesn’t work for everybody. So, this other approach can be really powerful.
Jenn: We had someone write in saying that their son who’s been in chronic pain for five years just started a new job and didn’t disclose his pain in fear that he wouldn’t get the job.
Now he’s worried he’ll lose the job because he’s having difficulty concentrating and he feels like he’s failing. Do you have any suggestions around discussing chronic pain in the workplace?
Laura: I don’t think I can make any specific recommendations because each workplace is a little bit different.
Obviously chronic pain is a medical issue and hopefully there is no discrimination for medical issues but I would encourage him to either, work with a physical therapist or a psychologist that can help guide that.
And either, and again, I’m not sure what the kind of disability laws are, but help him work through that because he should not feel that his job is threatened because of his, natural consequences of being in chronic pain, including trouble concentrating, thinking clearly.
I mean, these are very understandable side effects of chronic pain.
Jenn: I’d love to ask you one of my favorite questions that the audience asks. Any books that you often recommend about chronic pain?
Laura: Oh goodness. Yes. So, and again, I think it would depend on, there are certain types of pain, like so for women who have pain, there are a lot of great pelvic pain books that are going to deal more specific with reproductive pain, including things like vulvodynia or vaginismus.
And you want to get something that is, that is specific to that. And I’m trying to see if I have on my bookshelf here some examples of one of the workbooks that I might use. There’s one called... Oh goodness, what is it called?
Let me see here. Maybe I don’t have it here. There are a lot of pain workbooks that focus on acceptance and commitment therapy. I think those can be very helpful. I tend to use one that is published by, it’s published, it’s part of the Treatments That Work series, it’s called, I think “Managing Chronic Pain.”
It comes with a workbook and a therapist guide. So, you typically use it in, as part of working with a psychologist.
And then, goodness, I don’t know if I can think of the, I don’t think I can think of names of other specific workbooks right off the top of my head but I’d be glad to send them to you once I can take a look and maybe you can include them.
Jenn: So how do we cope with feeling more vulnerable from our pain? ‘Cause oftentimes with chronic pain, you might feel weaker than other people, feel just generally different.
And a lot of times that translates to having less self-worth. Any suggestions?
Laura: Yeah, and you know, this is really, this is a really unfortunate kind of aspect of our society where we don’t talk about pain maybe as often as we should be. There are these often like gender role expectations in how we manage pain and what pain means.
And this is just so unfortunate because it has nothing to do with, gender roles or identity, like we’re all different and we experience pain differently.
So, I would encourage trying to get support, from other people who are going through the same thing or have been through the same thing, that will help normalize it.
And just trying to, challenge some of those beliefs because this is your life and it’s, how you treat this pain is going to affect how you live your life and, adhering to this idea that pain means I’m weak or I’m not as good as everyone else is going to limit your ability to deal with the pain.
Pain we want to think of is just like any other medical condition. It requires treatment and it doesn’t mean anything about you as a person. Like if you have, again, I’ll use the example, diabetes that doesn’t mean you’re weak in some way.
It’s just, it’s a condition that you have. And we need to be able to treat it effectively. So, I hope the stigma around pain, particularly, well I think in different ways for men and women.
For women, often reproductive pain, menstrual pain is not considered very significant or important and that’s absolutely not true. And for men having chronic pain can be seen as, that they’re not as strong as some others, but that’s absolutely not true.
We want to make sure your pain is treated. And I will say, if your provider isn’t providing the care that you need, isn’t working with you on a plan to address your pain, then you may need to see another provider.
You may need to see a few providers before you find the right person because you having that relationship is a big, important step to recovery.
Jenn: I’m curious because I know you’ve talked a little bit about conditions that are gender specific. So, depending on your reproductive organs, people, folks will get endometriosis where chronic pain is a symptom.
How do we learn more about gender specific conditions where chronic pain may be a symptom? Do you have any advice on where we should get started, whether it’s for men or women?
Laura: Yeah, I mean, typically, we see some gender specific types of pain often around pelvic pain. So obviously given that that’s where the genital organs are.
So, I think looking into, again, I mentioned the International Pelvic Pain Society is a group that I’m really involved with, some fabulous providers, psychologists and the researchers at the top of the field are getting some, have a lot of information on their website.
You can learn about the different types of pain. And certainly, for women, if you’re having pain with intercourse or regular pelvic pain throughout the month, all of those things can be addressed.
And, it’s just a matter of, I think exploring a little bit more and then finding out who’s going to be the best person to provide your care. And it may take a little bit of trial and error there.
Jenn: Do you have any advice for folks, and I swear, this is the last question, because we are at the hour, do you have any advice for folks where they might have a hard time accessing some of the types of care that you’ve mentioned, whether it’s an accessibility issue or they live in a rural area?
Laura: Yes. So, I mean, for one of the benefits of the pandemic is that so many providers are now offering tele-health and that usually means that you could potentially see anyone in your state typically, because it’s the states that provide the license to the providers.
And so, you may be able to see somebody who’s normally three hours away for you but you can see them regularly. I know that physical therapists even are doing this. Although I don’t know exactly how.
So, there could even be an option there. I think you can reach out to providers, even the ones that are not in your area and ask for recommendations that are closer to you or how they would be able to provide care to you potentially.
This is a big issue and it’s something that is being addressed in, in a lot of the research studies that we know not everybody has access to a huge hospital with a pain medicine clinic. We know that that’s the case.
And so, we’re trying to explore these other methods of treatment delivery so that we can increase access to more diverse groups in more diverse areas of the country for sure. And I think the pandemic has kind of pushed us in a big way toward that.
Jenn: I know I said I had one question. I lied. I promise just one more, so... And thank you for the extra time.
What would be in your advice the number one way that we can support those that we care about who are living in chronic pain?
Laura: I would say validate the pain. Validate it, acknowledge that it’s real, that it’s true, that they’re suffering. They’re not doing this on purpose or in any way, shape or form, or they’re not, not trying.
So, validate and support that is actually going to probably be the most motivating thing for them to get the help that they need rather than criticism or like, “Oh, it’s not that big of a deal.” That is not helpful.
And, so if you can, if you can validate their experience and acknowledge their suffering, that might actually help the most.
Jenn: I think that’s a really wonderful way to wrap up the session. So, Laura, thank you for the extra couple of minutes of your time and thank you to everybody who joined.
This actually concludes our session on chronic pain and mental well-being. Thank you so much, Laura for joining and thank you to all of you. Until next time, be nice to yourself and be nice to one another. Take care.
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