- Amy Calmann LCSW
Managing Chronic Pain in the Time of Coronavirus
(Based on a discussion with Dr. Ziv Peled on April 3, 2020)
I have had chronic pain for many years. I know how devastating it can feel, and how disruptive it can be to your life. When someone with chronic pain comes to see me, I’m always inspired by the courage it takes to face what you are going through. It is not easy to take that first step and seek out support.
Most people with chronic pain have gone through months or years – or decades – of hoping that the next treatment or medication will be helpful. It can be disheartening when each new potential remedy doesn’t alleviate your pain. There can be feelings of disappointment, despair, and even thoughts of suicide.
I find myself awed by the strength of many people I see, who are suffering from various pain issues, some of which are wholly debilitating. Even though they may be depressed, and they may have had to give up many things in their life, they are still here and they are still surviving.
Right now, we have an unprecedented pandemic that is causing us to alter many parts of our lives. This is a very stressful time for most of us. But when you are already feeling pain, this additional stress can exacerbate the pain, and make you feel even worse.
It might be helpful to take the time now, to learn new mechanisms for coping better with your pain. Over time, it can reduce the impact that pain has on your life. These methods can be used and practiced during this global Covid-19 crisis. And once this difficult time has ameliorated, you can continue to build and use these skills on a daily basis, in your everyday life.
In some sense, people with chronic pain have been preparing for the coronavirus quarantine for a long while. They have become great modifiers for life experiences. When you have pain, you often can’t do the things you had hoped to do, and it can become isolating and lonely. You may have had to give up your usual exercise regimen and instead do light exercise from home, on days when you aren’t in as much pain. You may have already figured out ways to meet people or stay in touch with friends through online apps and groups. Those at home who are social distancing and quarantining may be able to turn to you for help now.
There was a theory developed in the 1950s and 1960s, called the Gate Control Theory. If we briefly examine this theory, it might help to understand the importance of the mind in one’s experience of pain. If you are injured, a pain signal travels from the injury through nerves to the spinal cord, and then to the brain. The brain interprets the pain signal and you then feel the pain. The Gate Control Theory explains that there is a gate in the spinal cord that can open or close, based on input given by someone’s brain or body. The gate determines how much info is sent to the brain from the injured area.
Negative thoughts open the gate, which lets more painful information through to the brain. Positive thoughts close the gate, and so less painful information can get to the brain. When we are paying attention to the pain, it tends to keep the gates open, so we feel more pain. If you notice that you feel less pain when you are involved in doing something enjoyable or when you’re busy and distracted, your pain may be decreasing because your focus is not solely on your pain.
When you are expecting pain, or you are living with frequent or constant pain, it is of course hard to relax and to remove your focus from the pain. The pain causes you to feel stressed and that stress causes your body to go into a mode known as “fight or flight”. Fight or flight originated back when our ancestors were faced with danger in their environment and they had to either fight or flee, to escape the threat.
At times, the fight or flight response is helpful to us. If we encounter someone dangerous in a dark alley, we need our body to tell us to prepare for action so that we can protect ourselves if need be. We get a rush of hormones, our heart rate speeds up, our blood pressure goes up. We become prepared to take action in the face of this danger. Therefore, we need stress in certain circumstances. The same thing can be said of pain. If you feel pain from burning your hand on a hot stove, you know not to keep touching the stove and further injuring yourself. We need pain sometimes, because it can keep us safe and even save our life.
But when pain and stress are not working in the way that they were meant to work in the body, it becomes problematic. Pain and stress are meant to be short lived signals. They tell your body to manage the event that is occurring in that moment. If the signals keep sending messages long after the event has passed, then we are left with pain that lasts longer and feels worse and worse. Essentially, your nervous system and brain – the parts of your body responsible for sending messages to start or stop your pain – are on overdrive.
The constantly stressed and anxious body never feels relaxed. The more anxious and stressed you are, the more pain you are likely to be feeling. You are fearful and anxious about getting the pain, and then you are feeling the pain when it happens, and you are spending almost all other times trying to avoid doing anything that might trigger the pain. All of this anxiety causes more pain that can become further crippling to your life. Pain, stress and anxiety end up flowing in an endless cycle.
Our brains are complex, and the pain we feel is coming from multiple sources. There is the pain signal being sent to our brain, and there is also our psychological interpretation of that pain signal. The psychological component includes whether we are anxious or depressed. It can include our past experiences with our pain. It also involves our expectations for what the pain is going to feel like.
Learning better ways to break this cycle can come, in part, from acknowledging how you may be feeling. You likely have experienced loss in many different areas of life due to your pain. Maybe your job changed or you are unable to work because the pain interfered. Your friendships may have become more distant because it’s been hard to keep plans. Or maybe the role you used to play in your family has been altered because you couldn’t do certain activities any longer. Once you can identify the losses you may have experienced, you can learn ways to cope with the feelings that you’re experiencing.
For example, it is known that when you are angry or frustrated, you often have tightened muscles due to tension, which increases your pain. And if you’re already experiencing pain, your threshold for tolerating things that make you angry can be lower. Therefore, you may become angered more easily.
For some people, expressing anger and frustration can be helpful. For others, you can get stuck in those feelings and you don’t find relief from repeatedly expressing them. Either way, it would be helpful to work towards acknowledging and then ultimately accepting those feelings. Even the Dalai Lama has said he gets angry sometimes!
If we can grow to accept our feelings, then they have less of a hold on us. That doesn’t mean that we don’t and won’t get angry or frustrated. It means that we accept that we are going to feel angry and frustrated. But instead of fighting these feelings or placing judgment on ourselves for having these feelings, we take a kinder approach. If you can remind yourself that these feelings will pass and that you are human and that moods and emotions are part of being human, your feelings may pass more quickly. And if you can be free of the anger and frustration more quickly, you might alleviate your pain faster too.
Here is an introduction to some of the tools that might be helpful to keep in your chronic pain toolbox. You may have tried some of these already, and some may not have worked as well as you had hoped. But if you can find one or two practices that work well for you, then it will remind you that you are armed with the skills to manage your pain when it arises.
I will complete this section later today.
Progressive Muscle relaxation -
Diaphragmatic Breathing –
Distraction techniques –
Visual Imagery –
Better Sleep Habits –
Socializing and Entertainment - Right now, consider using FaceTime to reach out to a friend that you haven't spoken with in a long while. Take a cooking class online, either by yourself or with friends. Organize a book club on Zoom or one of those multi-user apps. Start a journal to document your activities, thoughts or feelings, or use your journal to jot down poetry or sketches. Start a blog about a topic that interests you. Complete a puzzle or learn how to play new games like Sudoku or Poker. Work on clean-up projects that you've been dreaming of completing for years. Check out adult coloring books that can relieve stress and bring you back to your childhood. Go through all of your photos, print out your favorites, and create a photo album. Make a list of all the things you would like to do when the quarantine ends, such as museums you want to visit or concerts you plan to attend. Take a typing course to speed up your typing skills. Learn how to knit or crochet.
Pacing – This involves taking breaks when doing activities, in order to reduce the chance of your pain worsening. Sometimes it’s hard to slow down, because you feel like you won’t finish the task if you take breaks. You might worry that if you take breaks, then the task becomes longer. Instead, you plow through the task, even when you are feeling pain. The result is that your pain becomes greater and greater. If you end up finishing the task, you might be out of commission for hours or days, because the pain that developed has become debilitating.
Pacing teaches you to use time as an indicator for completing activities, rather than using pain as an indicator. You can think of something you do on a regular basis, that often causes you pain. Then estimate the length of time you think it will take to complete the task, without causing your pain to flare. The time should be at least a few minutes before you believe the onset of pain will occur. Secondly, estimate how much time you will require to rest before resuming the task again.
Sometimes your pacing estimates are not accurate. You can keep a log to see how long it took you to feel your pain, and if the amount of time that you rested was sufficient enough to keep you from getting pain. Then you can adjust your pacing, based on your findings.
Pleasant activities – When you experience pain, just like with anxiety and depression, you tend to withdraw from things you used to enjoy. First, make a list of things you enjoy. This list can include activities you have always wanted to try, or things you used to do in the past that you liked. The list doesn’t only have to include activities that require physical movement. It should contain things that you believe will increase positive feelings. Right now, while we are mostly staying indoors, the list could include things like “join a meetup group”, “make someone laugh”, “take an online cooking class”, or “keep a journal”.
When a person survives with unbearable pain, it shows the capacity of the human spirit to overcome enormous difficulties. My hope is that building your pain management skills can help you to find a greater sense of peace that you may not have been able to imagine or feel in the past. Personally, I have worked and continue to work on building my repertoire of coping mechanisms for pain. And I feel privileged to be a part of someone else’s journey as they heal and work towards leading a more fulfilling life.
I like and recommend these books:
How to Live Well with Chronic Illness and Pain – by Toni Bernhard
You are Not Your Pain – by Vidyamala Burch and Danny Penman
The Brain’s Way of Healing – Norman Doidge
Groups for Chronic Pain:
Chronic Pain Anonymous – This is a group of people that come together to support each other and share their experiences of chronic pain. In addition to in-person meetings, they have both online and phone meetings.
The Amercian Chronic Pain Association has a list of support groups. You can check to see if there is one in your area. They will also guide you, if you would like to set up your own support group.
Learn more about Dr. Ziv Peled of Peled Migraine