What Is The Best Way To Cope With Pain?

Pain is defined as being an experience of both physiological and psychological discomforts marked by unpleasant or uncomfortable sensory symptoms resulting from some sort of damage or injury (Gurung, 2014). The origin of pain can come from a variety of sources and there are numerous ways that individuals can cope with pain, consisting of either psychological or biological interventions. Certain pain management therapies may work better than others depending on the source and duration of pain, as well as an individual’s tolerance or threshold for the pain. According to Gurung (2014), there are three primary classifications of effectively managing pain: physiological treatment, psychological treatment, and self-management techniques.

Physiological techniques for managing pain, for instance, often involve the use of pharmacological or chemical management methods, traditional or holistic treatments (e.g. acupuncture), and surgical interventions. Medicinal therapies are generally one of the first approaches used for pain management, particularly if the ailment is caused by acute pain triggers (e.g. broken bones, sprains, illnesses, etc.), and generally comprise of pharmaceuticals called nonopioid, opioids, and adjuvants. Adjuvants are medications that are prescribed to manage pain but are not solely listed for that purpose. These medications are used primarily because they have shown some effect in helping to manage pain, although they may elicit different physiological responses. Some common example of adjuvants includes benzodiazepines, corticosteroids, antidepressants, and local anesthetics (Gurung, 2014). Nonopioids, on the other hand, include many of the over-the-counter pain relievers, such as ibuprofen, aspirin, or acetaminophen. According to Gurung (2014), “these medications act locally, often at the site of pain” (p. 291) and provide quick-acting, short-term relief in milder forms of acute pain. However, nonopioid drugs are generally not recommended for continued use due to the many long-term side effects associated with these drugs and their inability to maintain pain relief over time.

A stronger category of medication, known as opioids or narcotics, are much better suited for more severe pain management, particularly for those undergoing a surgical procedure, have suffered a severe illness or injury, or are living with a chronic or debilitating illness. Some well-known examples of opioids include oxycodone, codeine, morphine, and methadone. Opioids are the drug of choice for moderate to severe pain, given their level of effectiveness. Morphine, for example, works by binding to the “receptors in the periaqueductal gray area of the midbrain and produces pronounced analgesia and pleasant moods” and mimics the body’s natural response to coping with pain (Gurung, 2014, p. 291). However, opioids come with their own set of side-effects that are often much more severe than nonopioid medications. For instance, there is a much higher risk factor for overdose or addiction, and individuals who take opioids for chronic pain management often build up a large tolerance to these types of medications. Therefore, in order to gain the same benefit, patients also need to increase the dosage of the drug which places them even further at risk for the potential of overdose or addiction. Nonetheless, the controversy over the effects of long-term opioid use is a hot topic of debate in both the medical and chronic illness communities.

Still, there are a number of physiological techniques, outside of medications, that also assist with pain management strategies. Some examples include acupuncture, surgical interventions, and the use of either hot and cold compresses (and even alternating the two). Acupuncture, for example, works to manage pain by releasing blocked energy associated with pain and has been used in Traditional Chinse Medicine for years (Gurung, 2014). Alternately, surgical treatments can also help in decreasing levels of pain by removing the conduction of many of nerve fibers throughout the body that directly or indirectly transmit pain signals to the brain. However, while surgical approaches typically provide relief of pain for a period of time, improvement does not seem to provide a long-term cure since nerve fibers’ have the ability to regenerate. Still, while the majority physiological techniques offer relatively good methods in managing acute forms of pain, psychological strategies for the management of pain are likely to be more effective for handling chronic forms of pain.

Research into various psychological techniques shows that many of the pain pathways found within the human body are directly linked to the brain, ensuring that pain is very much a psychological process in addition to being a physiological one as well. A person’s mood can greatly impact how individual’s cope with or experience pain and altering one’s cognitions about chronic pain is, therefore, detrimental to obtaining control of individual levels of pain. For instance, when a person is undergoing chronic stress or is depressed, they are likely to feel more pain. According to Gurung (2014), “negative mood states can lead to biased forms of thinking. These cognitive biases can accentuate the feelings of pain and need to be modified” (p. 294).  Often, these behavioral modifications come from the use of psychological techniques (e.g. hypnosis, distraction methods, and relaxation techniques) in a similar manner to the practices associated with coping skills for dealing with stress. Distraction techniques, for example, are helpful in handling pain because it diverts attention away from the problem, similar to stress management techniques, and includes the use of some common practices like guided imagery, meditation, or watching television, reading a book, or talking with a friend over the phone. Likewise, biofeedback is also helpful in identifying pain triggers through observing physiological responses to pain through the use of machines or computers and then teaching relaxation techniques in order to assist individuals in gaining control of their physiological reactions to pain.

Although both psychological and physiological approaches to pain management procedures are helpful in their own ways, neither necessarily define the “best method” for handling pain—at least, not alone. Essentially, the primary problem in defining a standard method of pain management is the fact that the experience of pain is mostly subject. Although tests are available to measure specific fragments of pain, currently there is no exam available that can objectively measure pain with any amount of accuracy. Also, since both physiological and psychological factors influence the involvement of pain, it’s hard to distinguish which variables are positively or negatively altering elements of pain and individual levels of pain can change day-by-day. Given the number of factors involved, perhaps a better method for managing pain is to utilize a dual approach by combining both psychological and physiological techniques.

One way to combine both pain management strategies is through a technique known as self-management, which has been particularly supportive of individual’s living with chronic episodes of pain. Self-management programs are defined as “treatments for pain relief that make the patient with chronic pain the one with the most responsibility for making the change rather than the doctor or the health professional staff” (Gurung, 2014, p. 452). Self-management programs for chronic pain are effective because they focus on the emotional aspects of pain, outside of the physiological response, by teaching patients to change their thoughts or behaviors to better cope with their pain – mainly by focusing on various strategies to improve one’s overall quality of life. According to Gurung (2014), the main goals of self-management programs are to:

  1. Provide skill training to divert attention away from pain;
  2. Improve physical condition (via physical reconditioning);
  3. Increase daily physical activity;
  4. Provide ways to cope more effectively with episodes of intense pain (without medication);
  5. Provide skills to manage depression, anger, and aggression; and
  6. Decrease tension, anxiety, stressful life demands, and interpersonal conflict. (p. 297).

Gender Bias of Pain:

It’s important to point out a very significant problem currently plaguing patients across the country — the gender bias in medicine. Although this problem is not exclusive to pain management, the gender bias in medicine is alarming because many women are often left without the proper care essential to maintaining a good quality of life.

It’s become far too common that women’s complaints of pain or illness are minimalized by the medical professionals they turn to for help, often implying that women are overly dramatic in their interpretations of pain. Doctors often label many of the pain symptoms found in women as being psychosomatic or “all in their head” when a diagnosis is not easily obtained. This bias becomes even more evident in women who have chronic pain, who continue being called a “drug-seeker” when asking for pain relief. “Women are more likely to have chronic pain conditions that are more difficult to diagnose and treat (TMJ Disorder, fibromyalgia), and in many cases, these are treated as mental or hormonal rather than as a disease or disorder” (Stacey, 2012). Likewise, many doctors still foster the ideology of the gender bias by suggesting that women are affected by pain harder than men.

According to Gurung (2014), “women reported significantly higher pain in most categories with the most significant differences in patients of the musculoskeletal, circulatory, respiratory and digestive systems, followed by infectious diseases, and injury and poisoning” and “men report less pain, cope better with pain, and respond to treatment for pain differently than women” (p. 274) However, at least in their initial presentation, these statements are somewhat misleading. At best, research is relatively and widely varied. Recently, an article I came across by Dusenbery (2015) called Is Medicine’s Gender Bias Killing Young Women? described this phenomenon in detail:

This pervasive bias may simply be easier to see in the especially high-stakes context of a heart attack, in which the true cause usually becomes crystal clear—too often tragically—in a matter of hours or days. When it comes to less acute problems, the effect of such medical gaslighting is harder to quantify, as many women either accept misdiagnoses or persist until they find a health care provider who believes their symptoms aren’t just in their head. But it can be observed indirectly: In the ever-increasing numbers of women prescribed anti-anxiety meds and anti-depressants. In the fact that women make up the majority of the 100 million Americans suffering from (often under-treated) chronic pain. In the fact that it takes nearly five years and five doctors, on average, for patients with autoimmune diseases, more than 75 percent of whom are women, to receive a proper diagnosis, and that half report being labeled “chronic complainers” in the early stages of their illness. Then there are the diseases, like chronic fatigue syndrome and fibromyalgia, that exist so squarely at the overlap of the Venn diagrams of “affects mostly women” and “unknown etiology” that they’ve only recently begun to be recognized as “real” diseases at all.  (para. 20)

There are some valid explanations for why pain across gender is inconsistent. In a study by Hamberg, Risberg, Johansson, & Westman (2004), for instance, it was found that “proposals of nonspecific somatic diagnoses, psychosocial questions, drug prescriptions, and the expressed need of diagnostic support from a physiotherapist and an orthopedist were more common with females” (para. 3). However, laboratory tests, physical examinations, diagnostic testing, and pain management were offered to men more often than it was for women patients. Additionally, the differences offered in treatment could result in the many inconsistencies demonstrated throughout the literature as to how men and women are different when it comes to pain. Furthermore, the gender difference may be the direct result of our modern culture expect men and women to experience pain. We often encourage women to express their feelings about pain, yet make them feel like they are crazy or are behaving like a hypochondriac in following the expectation. Alternately, society tells men to hide their emotions. So of course, it’s easy for “science” to say that women have more reported pain than men because females are more likely to confess about their experiences of pain, skewing the results and furthering the gender bias. At the end of the day, I do believe that Dusenbery (2015) stated it best by saying, “call me crazy—hysterical, even—but I don’t think you should have to feel that empowered just to receive proper medical treatment” (para. 20).

References

Dusenbery, M. (2015). Is Medicine’s Gender Bias Killing Young Women? Retrieved on Feb 16, 2016, from http://www.psmag.com/health-and-behavior/is-medicines-gender-bias-killing-young-women.

Gurung, R. A. (2014). Health Psychology: A Cultural Approach (3rd ed.). Belmont, CA: Wadsworth.

Hamberg, K., Risberg, G., Johansson, E.E., & Westman, G. (2004).  Gender bias in physician’s management of neck pain. Journal of Women’s Health & Gender-Based Medicine, 11(7): 653-666. doi: 10.1089/152460902760360595.

Stacey (2012). Is There Gender Bias in Pain Management? Retrieved on February 16, 2016, from http://www.tmjhope.org/gender-bias-pain-management/


To find out how you can receive FREE online therapy to manage chronic pain, please visit the following article on the Better Health website:

https://www.betterhelp.com/advice/therapy/get-free-online-therapy-should-you-use-free-counseling/

“I don’t go to therapy to find out if I’m a freak…”

I’m not exactly sure why I went back to therapy, really. My anxiety has been under control, no panic attacks since I can’t even remember when.  I’ve been pretty stable, despite all that is going on. I told myself it was to stay ahead of the game, to ensure I keep my anxiety in check. I wanted to learn to make decisions without doubting every detail. I wanted to learn to be a self-advocate. To gain self-confidence. To be more assertive, especially with my doctors. I wanted to GAIN CONTROL of my life back. But to be truthful, I think I was depressed.

Well, I think I was depressed anyway. I’ve never been depressed before. Definitely pessimistic, but never depressed. From when my symptoms first came on, it was always suggested that anxiety and depression must be the cause of my abdominal pains. I know my body, maybe too well, and I knew it was not being caused mentally. It was absolutely, positively, without a doubt, not depression or anxiety. Although, after a few years and test after test coming back as “normal”, I thought well maybe I am crazy. Maybe this is all in my head. I do have stress, life is stressful. I must be making myself sick. But after a year of therapy, only talking about wedding planning and drama, my counselor didn’t really think I needed it anymore – unless, of course, I wanted to keep going. It was a long drive and life is busy, so I opted to stop treatment instead. 

But fast forward to the last few weeks, here I am again. I just felt really defeated by everything going on. At first I felt very angry, like the kind of raging anger that rushes through every vein in your body kind of anger. Full of hate and spite. And then I got really sad. Why doesn’t anyone believe me? Why do I always have to prove how sick I really am. It’s visible now, I can’t hide it anymore, even if I wanted to. I feel like I’m literally going to die. I’m tired of fighting, the struggling, the judgement, and stress. I wanted to give up. To quit life. What was the point? What was I fighting for? Was it worth fighting for? Or living for? That’s when I knew it was time to get help. 

I chose a place closer to home this time because driving all over the state for doctors appointments is getting to be enough and honestly, it’s hard to get very far from home with the current state of my illness. She’s a an actual doctor and has a great resume full of work in medical clinics and hospitals, and even works with law enforcement. As you can tell, I did a lot of googling before deciding to give her a call. Her resume, anyways, made her seem like she would be a good choice in understanding where I am coming from right now. She was able to get me an appointment within a couple days. Great. She takes my insurance. Perfect. Sounds too good to be true…

The first appointment was a get-to-know-you type deal. I filled out paperwork, which by now I can do with my eyes closed and left-handed, while holding my breath, upside down, and juggling fire. I really am that talented. But that’s another topic completely. Anyways, I felt like such a hot mess and was embarrassed of myself, considering this was our first encounter. I hadn’t eaten in days, I hadn’t slept much the night before due to pain, my coordination was off and I kept dropping things, my skin was flaring with this new rash that has decided to come and go from my face recently,  and my thoughts were racing all over the place with all the things I was trying to get done that day. Not the first impression I wanted to make.

Usually, I like to try and look my best when first meeting a new doctor. Doctors are people, after all, and people judge you. So I typically try to put on my best face, neatly groomed, makeup on, fake smile on my face, positive attitude… I want to be taken seriously. However, that didn’t happen that day. It was more of: my body hurts too much to shower today. I can’t wear make-up because this rash is burning my face. My stomach is swollen and painful, so I put on baggy jeans and a t-shirt. I have large, dark bags under my eyes from lack of sleep and nutrition. My hair has decided it doesn’t want to lay flat on the side where I lost a giant patch of hair that is now growing back awkwardly. I can barely fathom putting on any other shoes then flip-flops. I’m chugging a venti Starbuck’s coffee to stay awake. I look like I’m on drugs. Definitely not how I wanted to present myself. She asks me if I’m nervous, I look nervous. I explain I’m just tired and not feeling well today. She’s quiet for a moment. Then came the usual questions. 

  • “So why are you here today?”
    • “Well, I’ve been dealing with some health issues. Life’s been a little stressful lately. I just want to manage everything I’ve got going on. Maybe learn to have less guilt, be more assertive, and be less indecisive…” 

Damn. I can tell she see’s through my generic answer. This lady is smart. I fidget in my chair some more, trying to find a position that doesn’t make me want to vomit. What am I doing? I feel stupid. 

  • “Tell me more about some of these health problems you have going on.”
    • “Well, let’s see.” I list off symptoms: Chronic abdominal pain and nausea, I’m not digesting my food anymore, hypoxemia, livedo reticularis, nevus anemicus, IBS, alopecia, constipation/diarrhea, rectal bleeding, skin rashes, hives, pre-syncope, dysphagia, joint stiffness, asthma, allergies, abnormal menstruation, muscle spasms and twitching, abscesses, swollen lymph nodes, chronic infections, chronic fatigue, foot and height growth… “I’m currently undergoing testing and seeing specialists the last few weeks. It’s been crazy.”
  • “How long have you been sick?”
    • “I’ve had stomach trouble my whole life on and off for periods. Those periods usually didn’t last too long, maybe 6 months to a year. This current bout started 5 years ago, but just never went away. It just keeps getting worse.  Only got extremely bad since right around Christmas, when I started not digesting my food and my hair started to fall out. It’s been downhill ever since.”

I’ve told this story a million times before — to every doctor, to friends, and to family members – and yet it still sounds so ridiculous in my head every time.

  • “Nope, no answers yet.” “Yeah, all the tests are inconclusive or come back as normal.”

I feel crazy. I guess I’m in the right place. She asks about work, I fill her in on my short term disability denial. How I’m tired of always needing to prove that I am sick. She asks about my home life and marriage. My family. What I’m going to school for. Where I grew up. Etc. Etc. The appointment ran five minutes over. She walks me out, there’s another patient in the lobby waiting. I feel guilty for running late. She says that she’ll see me next week. I thank her for her time. 

In my head, I know she think’s I’m a nutcase. How could she not? I SOUND like a nut job. She probably thinks it’s in all in my head too. But she was nice and pleasant about it, at least. And her office was clean and comforting. Maybe she can give me guidance on how to navigate through everything right now. And while I do talk about my illness a lot, considering I’m always at a doctor’s appointment or getting asked about it, it’s kinda nice to have an outside perspective. And if my superhuman powers, like the ones I used for filling out the medical paperwork, are causing all of these crazy symptoms, then she can help me with that too. Plus, I wrote a paper last semester on the prevalence of suicide rates in relation to living at high altitude and one section was on the general risk factor in committing suicide among individuals who are dealing with chronic illness. I figured it couldn’t hurt, I was being proactive. Especially considering a friend committed suicide this past Halloween with no warning signs. So I go to my second appointment.

I felt better prepared this time around. I’m not such a mess. She says I look better this week. I tell her I still feel terrible, but my mind seems to be in a better place. She asks me how things are going? I tell her about all the appointments I’ve attended this week, the endoscopes, the esophageal dilation,  the new PCP appointment i had, and the fiasco with driving an hour and a half away to see the wrong kind of specialist my doctors referred me to for the Nutcracker Syndrome. I explain my usual day of coordinating my care, calling all over the state, scheduling this test or that appointment, dealing with insurance, and fighting with my current PCP to do anything. How I feel about not having a diagnosis. What I’ve experienced with my healthcare.

Oh, and I’m also taking the worst class. Statistics. Usually, I like school but this class is unstructured and a nightmare. I failed a test. But I’m grateful to have this opportunity. I can’t give up, not again. I wish I had more time so I could do better. I’m barely hanging on to a B.

I discuss the short term disability appeal I’m working on and talking to lawyers across the country who are interested in trying to help me win my case. But there’s the cost, not sure if it’s beneficial to hire one or not. Meeting one in Denver next week. I mention the struggles of not working right now. How could I though? Between all I’m doing, I’m barely keeping up. Plus, the symptoms have gotten worse so quickly. I don’t know when I should go back. I don’t have any answers yet, there’s still so many appointments. What if I am still too sick when I go back? I don’t want to lose my job. But there are bills to pay. It’s been almost two months without a paycheck. They offered accommodations that can’t help me in any way. I feel guilty for getting so sick so shortly after starting there, it’s only been 6 months. It’s always been manageable until now.

She is quiet for a moment and then she says she very sorry, she feels bad for me. I don’t want her to feel sorry for me. I don’t want anyone to feel sorry me. I just want people to listen. Simple.

She thinks that everything I’m dealing with right now, coming from the medical environment, is unacceptable.

  • “How do you do this every day?”
    • “I do it because I have to. There’s no choice. If I don’t, no one will. My symptoms will continue to get worse. Nobody will care or notice and I’ll be the one left to suffer the consequences. Plus, I deserve answers. I’ve been a good patient. I’ve been calm and respectful, even when I didn’t receive that in return. I NEED a diagnosis. I can’t accept that there’s no answers for me. My care has been negligent, at best. I’m fighting to get my life back. AND now it’s principal.”
  • “How do you handle all this stress, when anyone else would have broken down by now? You seem to be handling everything really well, considering. Really strong.”
    • “I’ve learned to function in chaos and I’ve been busy my whole life. That’s not the problem. Bad things happen. All the time. That’s normal. Me getting sick, isn’t really the issue either. It’s the lack of empathy, the lack of help and having to fight my way through this process when I shouldn’t have to. I’m on leave from work but I haven’t rested once. Instead of getting better, I’m getting worse because I’m constantly struggling with things beyond my control. Things that are unnecessary…” 

We discuss the time in my life where I learned to live and embrace the chaos, but that’s a story for another time. I barely touched the surface of that part of my life. Her eyes widened,  in shock. Again, she is quiet for a moment and starts to say something but stops. Our time was up anyway. She asks me if I want or need another appointment. I get the sense she was telling me I don’t really have to be in therapy, but she didn’t say it. I schedule for next week and thank her. As I leave, I feel validated. I do feel strong, considering. I’ve overcome a lot. I guess maybe I DO need therapy after all.


If you (or someone you know) are interested in talking with a therapist or counselor about the difficulties associated with living with a chronic or undiagnosed condition, you can visit the Better Help website to learn more on how to get started in online therapy.