PART 1 WHAT IS PAIN? Does pain have a purpose? Chronic Pain Pain is normally the body s natural way of signalling something is wrong. It therefore serves a useful purpose when you are injured. Some people are born without the capacity to feel pain and this can be dangerous. These people are never able to identify when tissue damage might be occurring, because the pain is not there. So a broken bone might never be recognised and may heal incorrectly, causing multiple problems for the future. PAIN Helps children learn about the world and what is physically safe. Helps make you take action to remove the source of a pain, like moving your hand away from a flame. Helps stop you causing further damage once injured. However, pain is a complex experience. Although we normally hurt when injured, a pain message sent to your brain can get changed or waylaid by all sorts of physiological and psychological processes. Pain is more than just a simple phone call sent to your brain to tell you something is wrong with your body. Long-lasting Pain When you have a pain well beyond normal healing time, it is difficult to see what sort of positive value this can possibly have. Most injuries heal after a few months. Pain that continues beyond such time is often called chronic pain. There seems to be no effective medical cure for such pain, sometimes despite many attempts. This is often because the physical injury, which gave rise to the pain, has disappeared or healed. Why does pain continue after an injury has healed? Pain may continue because the way the brain interprets the sensory signals has changed; some messages may still be construed as pain messages 1
despite the injury having healed. There are a number of factors that can change how the brain interprets pain signals: The nature of the original pain The fact that the pain has continued for a long time Treatments that have tried to heal the pain A good example of this is phantom limb pain; where pain is still experienced in a limb that has perhaps had to be amputated. Such phantom limb pain suggests that our brain is so powerful that it can create a feeling of the foot still being there and in pain. This is in spite of the sufferer knowing perfectly well that the limb is no longer there. Sometimes pain can be experienced in parts of the body where there was no injury. This is often known as referred pain. This can be particularly common with neck and spinal pain; affecting other parts of our back, arms, hands, legs, and feet. This is because all the nerves to these parts of our body have to pass through the spine at some point and any injury or damage there can easily involve other nerves. What affects the way we experience pain? As we have said, pain is a complex phenomenon and many factors affect our experience of pain. Phantom limb pain demonstrates the powerful role of the brain in this experience. Another example is someone being seriously injured half way through an important football match but the footballer only noticing the pain when the game is over. Again this illustrates the powerful influence of the brain on pain messages. Many factors affect our experience of pain. Here are some examples: 2
1. Individual differences Everyone experiences pain differently and everyone s pain threshold is a little bit different. One person may seem to suffer badly while another with a similar injury hardly seems to notice at all. These differences are hard to explain and may be due to a number of physical, social and psychological reasons. 2. Painwatching You may notice that when you sit and think about your pain very carefully, it seems to hurt more. Similarly, if you switch your mind away from the pain, you notice it less. This could be one of the reasons why many pains seem worse in the evening or at night when there is less distraction available. When you are busy working or having a good laugh with friends, your pain may be less noticeable. We are not suggesting that the pain goes away when you are absorbed in something interesting, but that you may notice it less. 3. Tension Many people have commented that their pain gets worse when they get tense and upset. Of course pain itself makes us tense and upset. So this can be a bit of a vicious circle. 4. Mood It has been noticed that some people with long-term pain can get very depressed. This is hardly surprising if people are feeling helpless and trapped by their pain. We also know that depression can make pain more noticeable and harder to cope with. So again, there is a possible vicious circle. 5. The meaning of pain How you think about your pain can also affect how much pain we experience. For example, in wars, it has been noted that soldiers ask for painkillers far less often than civilians who had similar injuries. It therefore seemed that the meaning of the injury for the soldiers was less significant than for the civilians (possibly due to an expectation of pain resulting from their occupation). All these examples demonstrate the importance of our thoughts and feelings on the experience of pain. They certainly show that the mind has a big effect on how much our pain hurts. They demonstrate how our brain can over-ride, exaggerate, or even delay noticing pain messages. 3
PART 2 CHRONIC PAIN: A LIFE CHANGING EVENT The experience of developing chronic pain can involve making some major changes and adjustments to your life. For some, it can feel like everything has changed. First, write down what has changed: Now, write down what, if anything has changed for the better: Many people find that they go through feelings of grief in response to the losses they have experienced. These feelings can be much like those following bereavement. Sometimes grief is thought of as a process involving different phases or stages: 1. Shock - When we can be in a state of confusion 2. Denial - Where we can make efforts to pretend or underestimate the extent of our loss 3. Distress - Where we can feel very upset, anxious, angry, guilty and frustrated about our loss 4. Acceptance - Where we can find some way of coming to a sense of peace in ourselves about our loss, so that we are able to move on The experience of grief is a process that we all move through in different ways and at different paces. However, over time, it is possible to reach a sense of acceptance so that we focus our energies on making the most of our lives despite our loss. The experience of feeling like you have lost everything can be overwhelming. It also is possible for us to overestimate the extent of our losses. It is important to bear in mind what we still have, what we still can do and what is still possible for us. 4
Write down some of the things that you can still do but in a slightly different way from before (e.g. more slowly, taking more breaks, using aids): Write down some of the things that you hope to be able to do or achieve in the future: So keep in mind the bigger picture. Mourn what you ve lost, but remember what you still have. Strive towards being all that you can be. Health Psychology Service February 2012 Compliments, comments, concerns or complaints? If you have any comments, concerns or complaints and you would like to speak to somebody about them please telephone 01773 525119 Are we accessible to you? This publication is available on request in other formats (for example, large print, easy read, Braille or audio version) and languages. For free translation and/or other format please call 01773 525099 extension 5587, or email us communications@dchs.nhs.uk 5