Pain “Catastrophizing” Can Make Chronic Pain Worse

August 26, 2020 / Thomas Cohn, MD

Chronic pain can be a cyclical battle that can be tough to break out of. Pain can leave you feeling discouraged, and this discouragement can have real world implications for your chronic pain treatment. In other words, unless you really focus on beating your chronic pain, it’s only going to get tougher to treat.

Don’t Let Pain Control Your Life

This sentiment was given credibility based on a recent study led by researchers at Penn State. For their study, researchers took a closer look at how people felt about their chronic pain condition and cross-referenced it with whether or not the were physically active later on in the day. In the study that focused on patients with knee osteoarthritis, researchers found that patients who “catastrophized” their pain (classified as feeling an exaggerated sense of helplessness or hopelessness) were less likely to be physically active later in the day. Moreover, this contributed to a domino effect of sedentary behavior followed by even more pain catastrophizing.

So while the results show that it can be hard to break free from chronic pain, it also shines a light on how we can best help patients with chronic pain conditions.

“Reducing daily pain catastrophizing may help older patients to be more active and less sedentary on a daily basis,” said Ruixue Zhaoyang, assistant research professor. “This could help improve their chronic pain condition, physical function, and overall health, and reduce the possibility of hospitalization, institutionalization, and healthcare costs in the long term.”

Nobody looks favorably on their chronic pain condition, but at the same time, if you’re constantly focusing on how the condition is negatively impacting your life, it can lead to pain catastrophizing. Researchers say patients who think that their pain is “terrible and never going away,” or those who say they “can’t stand their pain anymore” may be catastrophizing their condition and subliminally decreasing their likelihood of pursuing active treatment solutions, like exercise and physical therapy.

So if you are struggling with your chronic pain condition, really take a hard look at how you’re viewing your pain condition in your head. Are you constantly negative about your pain, and do you shy away from activity when you’re frustrated by your pain. If so, you’re not alone, and you should know that solutions are right around the corner. We can help change the way you think about your pain condition so you’re more likely to follow through on proven active treatments to help with your condition. For more information, or to learn more about how we can help treat the physical and mental aspects of chronic pain, reach out to Dr. Cohn and his team today.

How Does Chronic Pain Affect A Marriage?

August 19, 2020 / Thomas Cohn, MD

Chronic pain affects many aspects of a person’s life, but it’s not just the individual dealing with the pain condition that has to bear the burden. According to new research, chronic pain can also significantly affect the relationship between a patient and their spouse.

The study published in the European Journal of Pain decided to take a closer look at the impact chronic pain had on households, spousal relationships and marital satisfaction. As you can probably guess, chronic pain can really put some stress on a relationship.

For the study, researchers questioned 114 couples where one spouse was a chronic pain patient at a clinic in Spain. Nearly 60% of participants were female, and the average age was 55 years old. The most frequent locations for chronic pain were the lower back (79.8%), neck (46.5%) and the knee (15.8%).

What Spouses Are Saying

After being asked about their lifestyle and martial satisfaction, here’s what patients and spouses had to say about how chronic pain was impacting their life.

Spouses reported an average of just over 90 minutes of caregiving duties each day.
65.8% of patients reported an occupational change because of their chronic pain, with some going on permanent disability and others quitting without compensation.
Of 24 listed chores, patients said they performed an average of 18 before chronic pain began but were limited to an average of 12 tasks after pain.
On the flip side, spouses said on average that they took on two more chores after their spouse developed chronic pain.
52% of spouses reported a high to severe degree of burden, and roughly 1 in 4 patients and spouses reported having a troubled relationship.

There’s a lot to sort through with these findings, but the main takeaway is that chronic pain can really stress a marriage. Not only can it financially affect the relationship in the form or lost or reduced income, but it can also require the spouse to take on a much bigger caretaker role. Being both a caretaker and a spouse can be stressful and can lead to relationship dissatisfaction, but it doesn’t have to.

There are a number of ways to help mitigate the stress brought on by chronic pain, and we don’t have all the answers here because chronic pain is so unique to the individual. However, one of the best things you can do is talk about your concerns, your fears, your wishes and your goals. Speak up and communicate with your doctor, your care team and your spouse about what concerns you and what you can do to help improve your relationships.

Relationships take work, and relationships involving chronic pain can take even more work, but they are far from doomed. Work to correct your pain issues and to foster an open dialogue between you, your partner and your doctor, and we’re confident your relationship will move in the right direction. And for help with any aspect of your pain care, reach out to Dr. Cohn’s office today.

Why Added Stress Can Make Chronic Pain Worse

August 10, 2020 / Thomas Cohn, MD

stress Everyone is adjusting to the new normal. Life has been turned upside down and inside out, and there is a new agenda every day. Most of us are locked in at home, with the new goal being trying to stay safe and healthy. If you are a parent, now you have to become a teacher alongside all your other responsibilities. If you are a senior citizen, you may think you are young but now you have a new target on your back and the challenge is to stay alive. If you are lucky you still have a job. However, almost everyone is worried about what is next, whether it is financial issues, the ability to obtain food or toilet paper shortages. Beyond these, one still has the regular health concerns and for many their chronic pain is now compounded by added stress.

The normal now is everything is likely to change, and constant change is stressful to most people. Not knowing what tomorrow will bring and the fear of the unknown is common nowadays. Everyone is stressed since life has radically changed. Having chronic pain from any source now can feel worse. It is not a part of your imagination; it is due to the fact that many of the centers in the brain that help transfer pain signals are adjacent to the stress and anxiety centers. Therefore, stress and anxiety can be perceived by the brain through a short circuit caused by added stress. As one becomes stressed about change, pain increases.

Treating The Physical And Emotional Components Of Pain

Treating physical ailments has always been the strength of the medical profession. Recognizing a broken bone or a cervical or lumbar disc issue is relatively easy, since we can see it on an imaging test. The pain a malady causes is more complex since it requires a sensory nerve to be stimulated and the brain to perceive and interpret the signal as an abnormal event. The act of interpreting sensory transmissions is partly based on a person’s experience of similar signals and their emotional responses to those types of sensations in the past.

For many people, the emotional components of pain in the past are neutral in importance. For others, the signals have strong negative stressful associations with traumatic experiences and then pain and stress become linked in the brain as the same events. Recognizing this association of pain and stress becomes vital in the management of controlling chronic pain.

The pain everyone suffers is real. However, most pain has both physical and emotional factors. identifying and treating the physical aspects of pain is much easier. Treating these aspects of pain are in ways the simple “cookbook” parts of management strategies, i.e. if you are having X symptoms, do Y, and so forth. When pain becomes more chronic, understanding and working with the emotional components to pain are often critical to its control. Treating the person’s perceptions and emotions associated with the pain become critical. A person is much more than just a broken bone or spine problem, and treatment often needs to include managing the brain’s perception of sensory signals.

Successful pain management often involves dealing with not only the physical generators of sensory signals, but also how the brain is responding to those signals directly and emotionally. A person is not weak or crazy when there are emotional components to pain. Using cognitive and psychological techniques to treat these parts of pain is challenging but very important in being able to reduce the intensity of signals. When successful treatment of central interpretive components of pain occurs, the relative intensity of signals markedly diminishes.

So as the world seems to be collapsing in the throes of a pandemic and stress and anxiety are increasing, it is common to see those with pain issues having increased intensity of symptoms. The brain is a complex structure, and everything that it perceives is often subject to interpretation. Pain is no different and stress has a large impact on the perception of sensory signals, especially those delivering messages of trauma and inflammation. Treating the brain and how it is interpreting sensory signals often becomes the key necessary to unlock the successful management of pain.

Don’t Be Ashamed Of Your Chronic Pain

July 29, 2020 / Thomas Cohn, MD

There are a lot of emotions that can develop as a result of dealing with a chronic pain condition. There’s sadness, frustration, anger and loneliness to name a few. Eventually we’ll have a blog on how to deal with all of these emotions, but today, we want to touch on another emotion that sometimes develops in chronic pain patients, and that’s shame.

Before we dive into the nuts and bolts of the blog, let us just say this – you should never be ashamed of yourself because of your chronic pain condition. It’s not uncommon for patients to feel a sense of shame, but know that these feelings don’t reflect accurately on yourself. You don’t have to be ashamed for something you can’t control, so don’t be.

Obviously that’s easier said than done, but in today’s blog, we want to dive into some of the reasons why patients may feel ashamed of their chronic pain condition, and what you can do to help free yourself from these feelings.

Avoiding The Shame Of Chronic Pain

Shame can develop for a number of different reasons for those individuals battling a chronic pain condition. They may be ashamed that they can’t do as much physical activity as others, they may be ashamed about cancelling at the last minute because of a flareup, or they may be ashamed about how others perceive them. We understand those feelings, but know that you should not feel ashamed for those reasons.

In our experience, the only reason you should feel genuine shame over your condition is if you are cheating yourself out of the best treatment outcomes. If you’re skipping physical therapy appointments because you don’t want to put in the work, or you ignore your doctor’s instructions, then we understand why you might feel ashamed. The good news about this type of shame is that it starts and ends with you. You control your commitment to your treatment plan, so all you have to do to rid yourself of these feelings is dive head first into your doctor’s recommendations.

But how can you rid yourself of the other reasons for the feelings of shame? Those reasons you can’t control, like missing a movie night because of a flare up or the fear of being viewed as someone with a low pain tolerance by your friends? To do this, we need to begin by changing our mindset. Instead of focusing on how we think others are thinking of us, we need to turn are attention inwards. Because if you are satisfied with what you are doing to control your pain, you’ll often notice these feelings of shame will disappear.

So how can we self reflect on our handling of chronic pain to reduce these feelings of shame? Again, it goes back to what we said above about controlling what you can control. You need to realize what is out of your control, what you can control, and how to manage the controllable aspects of your life. You can’t control whether or not you’re going to have a good day or a bad day, but you can increase your likelihood of having more good days than bad by doing your therapy exercises, increasing your understanding of your condition, reaching out to your doctor if you have questions or concerns, setting attainable goals and recognizing achievements, no matter how small. These controllable aspects add up, and when you make positive strides in all these areas, you’ll find that you are doing everything you can to regain control of your physical health, and once you’ve achieved that, there’s nothing to be ashamed of.

So it doesn’t matter what your mother in law or your coworkers think. If you can say “yes, I’m doing everything I can to take control over my chronic pain condition,” even if it’s not working the way you hoped, you have absolutely nothing to be ashamed of. In fact, you should be proud. It takes a lot of guts to fight back against a chronic pain condition, so you should be commended, not shamed.

If you’re still finding it difficult to deal with some of the feelings associated with your chronic pain condition, let us help you take back control and develop a care plan that suits your needs. For more information, reach out to Dr. Cohn’s office today.

How A Positive Attitude Can Affect Chronic Pain Treatment

July 21, 2020 / Thomas Cohn, MD

When it comes to treating chronic pain patients, we always hope to find patients who are willing to put in the work and have a positive attitude about working towards a solution. And according to a new study out of Boston Medical University, those patients with positive attitudes may actually have a better chance of experiencing positive results from treatment.

For the study, researchers at BMU tracked the progress of nearly 300 individuals who had been diagnosed with chronic low back pain. Individuals were either placed in a therapy group, where they received 12 weeks of physical therapy or yoga, or they were placed in self-care group which involved being given a handbook on self-management strategies for their pain. Not surprisingly, the individuals who pursued active treatment strategies like yoga or physical therapy were more likely to see a decrease in back pain and an increase in function compared to the self care group (42% vs. 23%, respectively).

Looking Forward To Exercise

However, likely the most interesting finding from the study was uncovered when researchers looked into patient motivations. Researchers also tracked a patient’s desire to complete their specific treatment course, and they found that those who looked forward to exercise, or at a minimum, did not fear the activity, generally had a much higher physical response to the treatment.

Of those with less fear of exercise, 53 percent of those in the yoga group had pain decreases and function increases, 42 percent in the physical therapy group responded the same, as did 13 percent in the self care group. Researchers uncovered that regardless of what group they were placed in, those individuals who had a fear of exercise typically had a poor response to pain and function changes.

We understand that exercise or your physical therapy routine may not be something that you look forward to with anticipation, but at the same time, if you generally dislike the activity or are afraid of giving it your all, it can actually have negative effects on your recovery.

It’s obviously easier said than done to change your attitude about therapy, especially when you’re dealing with a chronic condition, but know that your attitude plays a bigger role in your outcomes than you may expect. Focus on your goals and what you hope to gain by working towards a recovery instead of focusing on the discomfort caused by your pain condition. Focusing on your goals instead of your pain can make it easier for you to attack the day and have a positive mindset about your treatment, and that can help you make success a reality!

So if you are struggling to find the motivation or desire to follow through on a chronic pain treatment plan, or if you feel lost and in need of professional guidance, reach out to Dr. Cohn and his experienced medical team today for more information and assistance.