Yes, September is Pain Awareness Month. A time to remind myself that other people have no idea what this chronic pain thing is all about.
Drugs only help 58% of chronic pain sufferers.WebMD
I suspect that people without chronic pain might know that Pain is actually the sucky part of chronic pain. The really, really sucky part. But it isn’t actually the only part of chronic pain and that might come as a surprise. As the quote above notes chronic pain isn’t actually easy to treat. Despite common believe we are not all drug addicts addicted to opiates. Most of us are not even on opiates and even if we are they are there to dampen the pain not get us stoned.
The psychological impact of pain
As one might imagine chronic pain is an intense experience. And it is one that doesn’t stop which makes it a very stressful experience on the body and mind.
Often we become limited in how we can function in our lives. In our careers, social lives, our hobbies, activities and any other thing we do. And this naturally affects our mood and self-esteem. If we are unable to work this adds to financial stress. There can be a lot of social isolation and stigma.
We can fear the pain which leads to avoidance of activities even more. We can focus overly on our pain which leads to catastrophizing.
All of this adds to the emotional burden of chronic pain.
Depression and anxiety are extremely common in pain patients, with up to 85% of chronic pain patients being affected. Mood disorders are often comorbid with chronic pain. These mental illnesses can contribute to worsening pain and other symptoms. The emotional impact of chronic pain is so severe that pain patients are at a higher risk of suicide. In fact, chronic pain patients are at least twice as likely to have suicidal thoughts or behaviours than the general population as this study states.Pathways
Chronic pain and the brain
Left in the chronic pain state long enough and it alters the brain in various ways.
One way is that it reduces the gray matter in the brain. Gray matter is the area of the brain important for such things as attention, learning, coordination, thought processes, motor control and memory. And it really comes as no surprise to anyone with chronic pain that we have a problem learning new things, focusing, concentrating, and remembering things. Or even problem solving and finding solutions easily.
Motor control can also be impacted as this study explains. This means that chronic pain patients can struggle to control their motor functions (including day to day activities and movements and more precise movements and coordination).
This study found that chronic pain patients had up to 11% less grey matter than those without chronic pain. This is the same amount of grey matter that would be lost in 10 to 20 years of aging! The study discovered that the longer a person is in chronic pain, the more grey matter they lose, explaining that, “The decreased volume was related to pain duration, indicating a 1.3 cm3 loss of gray matter for every year of chronic pain.”Pathways
I have read similar studies with fibromyalgia that suggest that we have brains that are cognitively aged 20 years. However, there is research to suggest with chronic pain when treated adequately these are reversible results… so not permanent changes to the brain. But the longer we go without effective treatment the longer it will be before it is reversed.
Perpetual loss of sleep
With chronic pain, we call it Painsomnia. And it is a vicious cycle that seems endless. We are in a lot of pain which makes it difficult to get to sleep and stay asleep, which makes pain worse the next day, which makes more pain at night and makes it harder to sleep…. and so on forever.
This study on the impact of impaired sleep patterns explains how seriously this can affect the lives of even healthy people without chronic pain: “Long-term consequences of sleep disruption in otherwise healthy individuals include hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, and colorectal cancer.”Pathways
And it is true that chronic sleep deprivation can lead to comorbid conditions and complications.
There are a Lot of things we have to do to manage our pain. A LOT. And I would say pain management is 99.9% in our hands and .1% medication that may or may not do something. It also takes years and years to find those things that we can do that may help us cope with the pain we have.
However, when we find those things keeping up with them is a problem due to what chronic pain does to the brain. I know I feel immense guilt when I fail to stick to my routine. Or when I am in a flare and Can’t. But sometimes I just have no motivation to and that makes it difficult to get back into it.
Based on evidence accumulated to date, we conclude that chronic pain reduces “wanting” behaviors. Bursts of reward-seeking behavior involve cognitive processes such as attention, working memory, and associative memory retrieval. Patients with chronic pain are sensitized to pain-related information, and pain management occupies their attentional resources [77, 78]. As a result, long-term chronic pain-induced attentional impairment might conflict with reward-seeking behavior, leading to the adaptive reduction of “wanting.” In addition, some studies have shown that chronic pain can decrease “liking” behaviors.
There are more than a few studies showing our reward system is just not functioning that great. So our motivation… sort of lagging and when we do things and achieve goals we do not really get much a punch to the dopamine as we would really expect.
That doesn’t mean we do not over time develop ways to cope and manage our pain- better than we did five years ago or ten years ago or 20 years ago. We do make progress in coping strategies and ways to manage our pain in our daily lives.
Frankly, when you look at all the research on how pain affects our brains all the things we manage to do, at any level, is pretty amazeballs even if We think anything we do is so minimal and non-productive and just Not Enough.
I don’t know. When you are in a crapton of pain what is the measure of Enough anyway? What is the yardstick for that? We keep comparing ourselves to healthy people or our previous healthy selves and that is clearly the wrong measure.
I like to just compare myself to myself yesterday. If I just improve bit by bit in how I cope from my previous self I’m good. If I improve my overall well-being or self-worth or mental health or sense of self or quality of life or some aspect of my life satisfaction… it is all good. Yeah, maybe one day a medication will work and that would be awesome. Maybe one day my pain will be so much more manageable and I will be much more functional. That would be awesome. Maybe not. Either way, I have to deal with the pain I have as it is and live the life I actually have.
And some days, weeks, months and years are going to really suck. And that is just the way that is. We can’t feel guilty about the fact chronic pain gets seriously severe sometimes and our functionality drops. Our fatigue gets extreme. We can’t do much of anything. We have to rest much more. Pace way more. Do what we can when we can.
See: Pain self management strategies from the U.S. Pain Foundation