Practical Steps to Manage Chronic Pain
By Sandy Smith
Chronic pain is familiar to many of those with bleeding disorders. According to research presented by Thomas Kern, PhD, in the hybrid session, What’s Beneath the Surface: Connecting Pain Management and PTSD, some 89 percent of adult patients with hemophilia experienced chronic pain which interfered with activities of daily living. In addition, 39 percent of those surveyed in the United States said their pain was not well treated, and they had turned to alcohol or illicit drugs to manage it.
Kern also shared the realities of post-traumatic stress disorder, an anxiety disorder. PTSD can be related to “something happening to you, or you could be witnessing it happen to someone else,” he said. “That event comes back over and over. There are intrusive thoughts, nightmares, avoidance of activities related to that initial trauma.”
An unpleasant medical appointment can turn into anxiety over other medical appointments. Often people can get irritable or strong headed when they don’t want to do something associated with past trauma.
Eye Movement Desensitization and Reprocessing (EMDR) therapy is “the gold standard treatment for PTSD. It is intense and it takes a real commitment.”
But chronic pain and PTSD can be treated with self-management techniques, particularly early on. The process involves identifying triggers and preparing for them.
Using practical and simple-to-follow tools to manage chronic pain, Kern suggested acceptance as the beginning. “It is an acknowledgement of, ‘Yes, I have this condition.’” But don’t stop there, he said. “We have to do things in different ways.”
Prevention is better than intervention, he suggested, including stress reduction, pacing skills and distraction.
“I want to say, some of these are going to sound very simplistic. Don’t dismiss them because they are simplistic.”
He suggested starting with diaphragmatic breathing, which involves relaxing the abdominal muscles, taking a large gentle breath, opening the mouth and immediately letting the breath fall back out. “Then, we have to repeat this. It’s like one minute of practice that you do 20 times per day,” he said.
Pacing strategies are a way of respecting the body’s limits. “Make a plan with the realities of what the limits are. Plan a stopping point before you begin the task. When you take a break, it is not taking a break from mowing the lawn to weed the flower bed, but taking a moment to breathe and relax.”
Distraction techniques may mean focusing on something else. Literature, art and music work particularly well, but so does virtual reality, especially highly immersive video games. Even an exciting sports event can distract enough to keep the focus off the pain.
Pain can interfere with sleep. For those struggling with falling asleep at night, Kern recommended what he calls “See, Hear, Feel, 5-4-3-2-1.” The technique involves looking around the room and identifying five things. “Then shift your attention to, ‘What can I hear?’ Then shift your attention to, ‘What can I physically feel?’” Follow that same process with four, three, two and one thing.
“What we are doing is systematically activating these different parts of our brain that are not part of the pain processing,” Kern said. “Often people are asleep before they get to that one thing.” ■