Thursday, 13 January 2011

Coping With Pain

December 2010 is going to be one of those months that I won't wish to remember. I was in hospital twice. The first time was for an eye operation in which I had the vitreous removed from my left eye. The second was an emergency - as I was passing a kidney stone! They say its more painful than childbirth. I don't know about that but it was certainly the worst pain I've ever experienced - by a factor of about THREE!

So this prompted me to write a post about pain.

I want to talk about how to deal with pain. I'm not a medic so I do not claim to be an authority on the physiology of pain. My experience has taught me that some pain can be managed in ways that do not involve drug therapy.

"Pain is the body's smoke alarm," according to Robert Coghill, a neurophysiologist in the USA. There is a rare medical condition known as "congenital analgesia" in which the victim is unable to feel pain. They usually die in their 30's from injuries that they weren't aware of at the time with their bodies severely damaged and bruised. Pain is not only a necessary part of the functioning of your body: its vital.

In my post on psycho-physical unity I explained that our thoughts are intimately and inseparably bound up with our physical bodies. Severe or persistent pain can affect you psychologically, making you angry, anxious or depressed. This process works the other way round: a positive and joyful attitude can actually reduce your perception of pain.

"Pain needs to be treated with more than just pills" says Dr. Coghill. "The brain can powerfully shape pain, and we need to exploit its power."

Well, the pain of passing a kidney stone is more like a ship's foghorn than a smoke alarm! It was 2:00a.m. on Christmas Eve and I had already spent an hour or two limping around the house, gasping in pain and going "arghh...arghh..."! There seemed to be nothing I could do to alleviate the agony. An ambulance was called. While I was waiting for it to arrive, the pain diminished. This was because I knew help was on the way and therefore my mental attitude to the pain was more positive. Getting distressed and fretful about it wasn't actually helping me to deal with it: in fact, the opposite was true.

With my eye operation a few weeks earlier, the initial "glass in the eye" sensation gave way to a more persistent, dull throbbing of the eyeball. This sort of pain wears you out in a different way: it depresses you because its chronic and lasts for days. I consciously chose to adopt a positive mental attitude to help me to deal with the pain. I was kind to myself. I treated myself to lots of hot tea beside a warm fire, watching old episodes Star Trek Next Generation. Marvelous! Before long, my eye was feeling better and the pain had subsided to nothing more than a mild discomfort.

I recently read that up to 90% of the pain we perceive could be due to our emotional response to it. That would partially explain why techniques like hypnotism can be used to alleviate it. I don't want to step on anyone's toes here but there are many alternative therapies for pain that owe their efficacy to this fact.

A recent New York Times article reported that a Stamford University study had shown that feelings of love can relieve pain. I think my wife, Cas, helped me in this respect by looking after me and caring both for and about my suffering.

I also use peer support to help me through difficult illnesses. After my eye surgery, I posted messages on my Twitter and Facebook pages, telling my friends how well the surgery went and how much better my vision was going to be. In return, they sent messages of support and well-wishes which lifted my spirits and thus helped me to deal with the pains. I didn't subsequently post a message to tell them I'd had a setback - a bleed from my retina which obscured my vision completely. That's because I didn't want to create a negative "cloud" around my recovery process. (The blood clot disappeared within a few days and my eyesight is almost normal now - a month after the operation.) I recommend that everyone should send messages of support to their friends when they are ill, even if they don't specifically request it.

Now I want to talk about the sort of pains that the Alexander Technique can help you to deal with.

I refer to musculoskeletal pain. This might be the result of an injury or an underlying pathological cause such as arthritis or spinal stenosis. Regardless of its source, very often the victim of muscle or joint pain suffers a greater severity of pain than is justified by the underlying condition. There are at least two reasons for this.

The first reason is that pain itself induces more pain because our reaction to it is to tense-up the muscles in the area of the pain. This affects not just the motor control muscles but also the deeper, skeletal muscles over which we have little or no direct control. Tightening muscles in response to pain has a similar effect to over-working your muscles in a gym: causing muscle fatigue and still more pain. However, it doesn't stop there.

Pain from tightened muscles itself produces more tightening which in turn intensifies the pain. A positive feedback loop is created which amplifies the level of discomfort. Pain creates more tension which creates more pain and so-on. The muscles can eventually spasm. This is called "hypertonic muscle spasm". In acute conditions, especially with back strains, the tension in the muscles surrounding the trauma can persist weeks or months after the underlying damage has healed.

The second reason that people suffer more pain than they should is that, following trauma, they often repetitively strain the weak, injured area of the body by trying to continue using it in the same way as they did before the injury occurred. This is particularly the case when analgesics are used to mask the pain. In the absence of the smoke alarm people assume its OK to continue using the damaged area as if it wasn't injured. Just like the person with congenital analgesia, they continue to damage themselves in a way that they would not do if they could feel the pain. So, although I would not advise people against taking pain killers, I would offer the warning to take them sparingly and remember that just because you can't feel the pain that doesn't mean the underlying cause has been cured! If you choose to take a pain killer, ideally, do it at the onset of the pain rather than when it has become established.

Using the Alexander Technique can help to break the pain-tension-pain cycle on the "tension" branch of the cycle by teaching you to inhibit your reaction to the pain. It requires a positive attitude of mind, even though you may not feel very positive. You need to accept that you have a pain and consciously say "no" to responding to it by tightening the muscles around the affected area.

One step beyond having a positive attitude to your pain is to use your body in a way that protects the injured area from further abuse. Be extra-specially kind to it and above all, leave it alone and DON'T go trying to stretch or work the affected muscles just so you can see if they're getting any better! Choose massage over exercise and remember that most injuries can take 2-3 weeks or more to heal naturally, so give it time before you try to go back to normal activity.

Whilst developing his technique, Mr. Alexander uncovered a fundamental truth about personal health and well-being which he expressed as "use affects functioning", in other words: how you use your body directly affects the way it works and also the amount of pain you experience.

It wasn't until 2008 that the results of a formal medical study into the effects of AT on chronic lower back pain vindicated his assertion. The following link opens short article containing a video from the British Medical Journal

From my personal experience of pupils with chronic musculoskeletal pain, I have yet to work with someone whose levels of pain cannot be reduced by applying the Alexander Technique. With back pain, it is often difficult to avoid repetitive strain to an existing injury, as most people only know one way of using their backs: their habitual way.

Author's Note
Nothing in this article is intended as medical advice. Always seek help from a qualified medical practitioner if you are suffering unexplained, chronic or persistent pain.

Further Reading
Headaches which are caused by bad posture.

The effect of the mind on pain
US National Institute of Neurological Disorders and Srokes