Psychological Pain: Understanding the Invisible Continuum of Pain
“The depression started almost as soon as I got home from the hospital. Psychological pain is real, and combined with my physical pain – I felt trapped.”
For those of us living with chronic pain, managing suffering is a constant and ever-changing challenge. While friends and loved ones may be able to comprehend physical suffering associated with a chronic condition, many people do not realize the full impact of living with pain every day.
It can take a significant toll on even the most resilient chronic pain warriors and their families, leading to what we refer to as the invisible continuum of pain. This invisible continuum affects every life domain, including psychological, social, and spiritual pain.
In this article, we will be exploring how living with a chronic pain condition can lead to mental health disorders and psychological pain – or as we know it, Suffering.
If you haven’t already, click here to read part one on our series exploring the Continuum of Pain.
Trauma Induced Psychological Pain
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It is difficult to predict how psychological pain may manifest itself after someone has been diagnosed with a chronic pain condition. However, psychological and emotional suffering can often be linked back to a traumatic incident associated with a medical diagnosis.
Emotional and cognitive deficits sometimes begin long after the onset of pain. Long-term pain may be detrimental to the brain and decrease a person’s ability to marshal internal resources to control their pain and frequently leads to other co-occurring disorders. (Neuroscience: 14: July 2013).
In some cases, this may have started with a tragic accident, such as a motor vehicle accident or sustaining a sports related injury. The swiftness of the events leading up to the impact occurs too rapidly to comprehend at the time. The injured person almost immediately begins bargaining with themselves that everything is going to be okay; that it’s not as bad as it looks.
However, as we have seen with many of the patients at our program, this is often not the case. Their world will be changed forever, even though many continue to cling to a reality that no longer exists.
For others, psychological trauma may stem from a chronic (invisible) illness diagnosis. Receiving a chronic pain or illness diagnosis can be a long, drawn out process.
A confirming a diagnosis is something many nearly celebrate because it validates the symptoms they have been living with for months, sometimes years. However, any celebration that is experienced is short lived as reality sets in; in all likelihood, they will be playing a cat and mouse game of symptom management for the rest of their lives.
Manifestations of Psychological Pain
Here are some of the most common ways psychological pain manifests itself following a chronic pain diagnosis. It is important to note that these manifestations can change over time, and are often not mutually exclusive.
Many times, pain patients face a combination of psychological pain disorders. It has been our experience that one manifestation of psychological pain can influence and/or lead to another.
Depressive disorders can develop quickly following a chronic pain diagnosis, and there is a number of reasons for this.
- Coming to terms with a life changing event
- Processing the fact that pain will become a part of daily living
- Coming to terms with a new standard of comfort or normalcy
- Additional burdens placed on family members or loved ones
- Lost sense of purpose
- Feelings of inadequacy
- Being unable to provide for one’s family
- Limited social exposure and engagement
- Neurobiological changes in the pain system
One of the most common ways people try to minimize pain is by being sedentary. Staying at home and occupying one’s time with movies, books, music, or hobbies might work well at first, but these distractions don’t last for very long.
Many people find themselves being inescapable drawn into negative thinking patterns. When this occurs, depressive symptoms can negatively increase an individual’s perception of pain. Depression can also lead to generalized anxiety and poor sleeping habits.
Chronic pain and anxiety often go hand in hand. Anxiety alone can be incredibly overwhelming, but when combined with chronic pain, it is often paralyzing. In a recent article, we discussed the role anxiety plays in influencing anticipatory pain.
Anticipatory pain is a phenomenon triggered by the fear of doing something you believe will cause you to hurt even more. This anticipated fear triggers an increased perception of pain. To learn how to overcome this fear, please read Moving Beyond Anticipatory Pain. This fear can prevent people from doing even the most basic tasks of daily living such as:
- Getting ready for the day
- Going to work
- Socializing with family or friends
- Preparing dinner
Life with chronic pain means life with significant stressors. Medical bills, dealing with insurance providers, planning activities around your pain, all while trying to manage work, social and family obligations is daunting. Without knowledge of healthy coping skills, how can someone be expected not to have a nervous breakdown?
It is important to learn how to intervene using emotional regulatory techniques that kick anxiety out of the driver’s seat. In each level of care, our patients are exposed to variety of over 25 holistic non-pharmacological modalities to help them better manage symptoms of psychological pain. Learn more about our program options here.
Grief and Loss Over Prior Levels of Function
One of the first major hurdles pain patients must overcome is processing the reality that activities and levels of functioning may become restricted in order to prevent the worsening of pain.
One patient who entered our program was a lifelong athlete. She was a natural born runner and competed in both track and field, as well as numerous 10ks across the US. Each day was an opportunity to push her limits, improving technique and improving her times. Until she was involved in a terrible motor vehicle crash.
Over time her wounds healed but her pain and suffering only seemed to get worse. She was no longer able to run and felt as if the accident had taken away her identity as an athlete. She was no longer able to participate in her favorite past time; walking became a painful chore, as well as other activities of daily living.
Not only did she feel as if she lost her identity as a runner, but that she became a burden to those around her. She could no longer work, and needed assistance with everyday tasks like showering, preparing food; even getting in and out of bed was difficult. Her perceived over reliance on others fueled symptoms of anxiety, depression, and worthlessness.
Her story is not uncommon from other patients who have completed our program; everyone struggled to find a new sense of normalcy around living with a chronic pain condition.
One of the most common co-occurring disorders associated with chronic pain is sleep disorders. Sleep hygiene can be disrupted immediately following a chronic pain diagnosis. The struggle to find a comfortable sleeping position contributed to the difficulty of falling asleep. In addition, as we try to wind down and prepare for sleep, chronic pain sufferers find it almost impossible to escape their ruminating thoughts and turbulent emotions.
For those who developed PTSD, frequent nightmares, and even night terrors, further erode their quality of sleep. Feelings of depression and anxiety can seem inescapable and amplified in darkness and the silence of night. This creates a vicious cycle for people who become hyper fixated on pain, suffering, and the challenges tomorrow may bring. Many of these thoughts and emotions trigger anxiety attacks or lead to depressive episodes. People start feeling even more hopeless and helpless.
Offering Hope and Healing
The biomedical approach to chronic pain management has traditionally focused exclusively on healing the physical wounds of an injury. Often this is enough, but not for those who end up in a chronic cycle of pain and suffering. The biomedical approach alone clearly doesn’t work for this low outcome subset of chronic pain patients who end up over-utilizing the healthcare system and experience disappointing outcomes. (Source: FAIR Health, Inc. White Paper – September 2016)
Change is coming, but it is slower than we like. We recently met with a doctors, physicians, and case managers at St. John’s Regional Medical Center in Oxnard, CA earlier this week, where they told us they are beginning to better understand the mind body connection. However, it will still be some time before we see integrated treatment that addresses the physical and psychological impacts of a chronic pain condition.
Our program will continue to help shift the paradigm of chronic pain management. Pain patients are coming to A Healing Place – The Estates from across the nation because we offer integrated concurrent treatment. We treat the whole person, addressing biological (physical), psychological (emotional), social and spiritual suffering associated with chronic pain. A true Body-Mind-Spirit approach.
Stop suffering and start healing today. Contact us via phone or email to learn more about how our triple diagnosis can help you or a loved one.