Automatic Thoughts and Pain

Kevin hurts all the time since his accident. After learning how thoughts become automatic, he’s noticing that his pain gets worse with certain ways of thinking. Because this surprises and baffles him, he’s trying to pay attention to the relationship between his thoughts and his pain.

So far he’s identified several instances that result in a pain flare:
    - When he dreads an upcoming situation.
    - When he gets down on himself—for not doing enough or for handling a situation poorly.
    - When he feels like a victim—if someone can’t fix his pain or doesn’t do what they promise.

Dr. Buenaver, a researcher at Johns Hopkins, believes we can reduce our pain when we understand the relationship between thinking, feelings, and behaviors. “It may sound simple, but you can change the way you feel by changing the way you think,” he says. (click to read)

Many of us with chronic pain hurt the worst when we’re upset or fearful, and Kevin is beginning to connect some of his thought patterns to negative filters. During a recent phone call with his case manager, his fears boiled up and quickly turned into: I can’t go back to work until the doctor releases me…what if I don’t get better?...I’ll lose my job…I won’t be able to pay the mortgage or car payment…I’ll lose everything!...What if my wife decides I’m not worth the trouble?...  His pain skyrocketed in a matter of seconds.

With a smile in his voice, Kevin proudly relates how he stopped that freight train. “The fear blinded me for a minute, and then I realized this was how catastrophizing works. I thought back to what started it—a simple statement by my case worker that I would need a doctor’s release before I could return to work. I slowed down and decided to ask when I could get an appointment so the doctor could sign off on my progress, and my pain level dropped about 3 levels!”

We all have ways of thinking that impede our progress.  Do you recognize any of these and how they make you feel?

Negative mental filter

How it looks:  Filtering every activity/thought through something that bothers me. 
Thinking:  My pain was bad today, so learning pain management isn’t helping.  
Feelings:  I feel let down, hopeless, cynical.

Catastrophizing

How it looks:  Exaggerating the consequences (it’s the worst that could happen). 
Thinking:  My spouse is so tired of my pain that he will probably leave me…I will be destitute…I will have to raise the kids alone…I will die alone. 
Feelings:  I feel fearful, worried, tense, anxious.

“Should” statements

How it looks:  Trying to motivate ourselves or directing at others.  
Thinking:  I should have gotten more done today.  Or…  I should have known you’d forget to call me. 
Feelings:  I feel guilty, pressured, disappointed.

Arguing with reality

How it looks:  Focusing on not wanting something to be what it really is. 
Thinking:  If I didn’t have pain, I would be happy. 
Feelings:  I feel disappointed, sad, hopeless.

Filtering

How it looks:  Ruminating excessively on the negative part of a situation or disqualifying the good aspects of something. 
Thinking:  Even though I forgot about my pain while the kids were opening their presents, my life is still all about the pain.
Feelings:  I feel cynical, doubtful, hopeless.

 

If you live with pain, a Coach can help you discover strategies to manage or reduce your pain...read more. Or, Coaching may be the perfect avocation for you to help others. TCC®U trains coaches and prepares students for national certification...read more.

 *Names have been changed.

Dee Emmerson

Dee is a writer who puts her word-smithing and communications to work for Take Courage Coaching™  writing website and brochure copy, lessons, and newsletters. This is what she considers the “perfect job”—writing and sharing life-saving skills with those in chronic pain—with time around the edges to be her kitties’ human, tend flowers, sew or crochet, clean the house (micro-manage the Roomba), or help a neighbor. She lives in Colorado with her hubby of 40 years and counting.

Rethinking Pain Management

JUST WATCH A FEW videos on the origins of human flight and you get a pretty good idea about our efforts to control chronic pain today. An enterprising young man with makeshift wings attached to his arms flaps wildly as he jumps off a tower onto a stack of mattresses. Or we can see some other nut leaping off of a bridge in similar attire. Still another nearly decapitates himself when the steam powered gyroscopic whirligig he captains starts falling apart. We laugh at these videos because we easily recognize the mistakes they are making: all of these men needed a major paradigm shift when it came to achieving flight.

We face the same problem in the world of pain management today: we have the science, but we struggle to apply it in a way that actually works. Read this short article to see how the paradigm is shifting...

Stress--Friend or Foe?

 
StressGraphic.jpg

Each of us has been stressed out, maybe even had moments of crisis, anxiety, panic or rage that seem simply uncontrollable.

We’ve been given the impression that stress is the problem — something we have to eliminate or control. But stress reactions are a vital source of personal safety that need to be understood and valued. 

It’s when the brain’s alarm becomes hyperactive or mismatched to the level of real danger that our overreaction harms relationships and jobs. The problem with the resulting stress is that most of us don’t know how to turn the false alarms down.

We tend to avoid what stresses us until we absolu­tely have to deal with it. Or we try to ignore how we feel when we’re stressed (watch TV, play Internet games, put in the earbuds and zone to music). Instead of learning to use stress as a teacher, we try to hide from it.

When our stomachs growl, we eat. When we feel sleepy, we know it’s time to go to bed. So why don’t we think of body or emotional stress reactions as a sign to pay attention to the triggers or find better ways of coping?

Many stress management approaches focus on diverting one’s attention or calming the body, when what we need is to become aware or what triggered the meltdown, and provide our body/mind with what it’s calling for: safety and security

Clinical psychologist and Professor of Psychiatry, Julian Ford, explains in his book, Hijacked By Your Brain{1), that support, counseling and medications can help in the short term, but may not teach individuals the skills to improve their responses.

When our brains are alarmed, our ability to think clearly is reduced; and so is our sense of personal control. It’s common for people who have just experienced a meltdown, rage, or panic attack to report not knowing what happened or what they said. Clear thinking was hijacked by the brain’s belief that fighting or freezing was the most important response. 

The brain’s alarm is like a two-year-old who feels insecure. You can’t reason or argue with it.  The only way to calm down your brain in the middle of a survival reaction is to give it what it wants — confidence that everything will be OK.

The brain’s librarian (the hippocampus) files every experience we have as a memory. In the midst of trauma or stress, our brain can misfile memories. It’s a big part of what happens when a person develops post-traumatic stress disorder. Dr. Ford explains that in the chaos and confusion, memories get filed in the section of information we need often—like how to drive a car or talk to a spouse—when they belong in the section accessed only in an emergency. Does this explain why we can easily snap when another driver cuts us off or a family member’s comment sends us over the edge?

We all have an alarm that can send us into a panic or contribute to depression, but most of us don’t know how to access clear thinking that resets the alarm to a lower level.

Amazingly, our brain has a perfect system in place to handle stress. The alarm, set off by the survival brain, needs the learning brain to focus on an experience that is better than whatever is causing the feeling of stress. The key to managing stress? Anytime we focus on something truly important to us, we’re activating the thinking center to intentionally focus on what’s most important in this moment.

What we need when feeling stressed is to be able to switch our attention from false or unhelpful perceptions of danger to thoughts and memories that enable us to regain a sense of calm and personal control.

Memories that can ground us include our love for a particular person, an activity we enjoy, a favorite pet, or particular goal we’re working towards.

The major barrier to calm and intentional behavior is not a broken brain.  It is the brain in which survival and learning have become enemies rather than partners, says Dr. Ford.

Danger or Stress? Checking in on our sense of personal control and stress level at times we are not in real danger can give us a baseline of how it feels to be calm and capable of thinking clearly. 

Use a 1-10 scale to measure both your sense of personal control and your feeling of stress.  Personal control is seldom a 10, and stress is seldom a 1, because we are individuals, and our stress reactions strike us at different levels.

With a little practice, you will learn where your breaking point is—

  • personal control lower than: ____
  • stress higher than: ____

Triggers: Next, think about situations that seem to trigger depression, anxiety, panic, frustration, or a meltdown for you.

Focus: Now identify people, things, and activities that are important to you. What is it about each of these that is valuable to you (make it specific)? This list becomes your point of focus when your personal control feels low and stress is high — the point at which one of your triggers is likely to set off an alarm reaction.

How to Use These Tools to Manage Stress: 

  • When you feel a level of stress (not a real danger) that threatens to up-end you, name the trigger. 
  • Then take a second to identify your level of personal control and level of stress. 
  • Now choose one of your values and identify the most important thing to you at this moment. This becomes your focus. Maybe in the middle of an argument with your spouse, you focus on how much you love him/her and your goal of improving communications. In the evening rush hour, when you feel tense and agitated, perhaps you think of how your dog or cat is at home waiting for your affection. 
  • Finally, assess your level of personal control and your stress level.   

What did you just do? You have assessed the situation and recognized a stressful event that used to push you over the edge (trigger). Then you used your thinking brain to re-categorize the stress as a non-physical danger and think about something important to you (focus). 

By acknowledging the trigger or stress reaction, you responded to your brain’s alarm — not ignored it — which tends to quiet the alarm. Then you put your thinking brain to work on something that matters to you — increasing your level of personal control.   

by Dee Emmerson

 
 

(1) Ford, J., Wortmann, J.  Hijacked by Your Brain−How to Free Yourself When Stress Takes Over. Sourcebooks. Naperville, IL. 2013.

 

Dee Emmerson

Dee is a writer who puts her word-smithing and communications to work for Take Courage Coaching™  writing website and brochure copy, lessons, and newsletters. This is what she considers the “perfect job”—writing and sharing life-saving skills with those in chronic pain—with time around the edges to be her kitties’ human, tend flowers, sew or crochet, clean the house (micro-manage the Roomba), or help a neighbor. She lives in Colorado with her hubby of 40 years and counting.

...and the winner IS!

by Dee Emmerson, TCC Writer

Q?  What do pain, stress, anxiety, and depression have in common?
A?  Me, the car accident, my medical diagnosis, exercise.

Anxiety, depression, or a lack of concentration makes life more challenging. People who live with chronic pain often experience all three…every day. Think how much more rewarding life could be if all these conditions, plus chronic pain, could be reduced—even eliminated—by ONE THING.

Drum roll:  Open the envelope, please. And the w-i-n-n-e-r  i-s . . . EXERCISE! 

Science and thousands of people make it increasingly apparent that aerobic exercise can improve more than our physical shape. Exercise may be your brain's best medicine. According to John Ratey, Harvard Medical School professor of psychiatry and author of several books, exercise has nine benefits that slow and improve the aging process. They also improve our pain.

Aerobic exercise | Why it Helps Pain

Strengthens the cardiovascular system. A strong heart and lungs reduce resting blood pressure. During exercise muscles release growth factors that promote neurogenesis and expanded vascular networks.  Blood vessels expand and blood flow increases. | Fatigue increases pain. An efficient cardiovascular system reduces fatigue.

Regulates fuel. It increases levels of insulin-like growth factor (IGF-1) which regulates insulin and improves brain function. Pain sets us up for inefficiency.  We tend to stop or restrict certain activities, get sluggish when we're depressed, and fail to take care of ourselves. | Balanced blood sugar levels ensure that brain cells can function optimally. A healthy brain is easier to retrain than a sluggish brain.

TCC Pain-management Coach and TCCU Coach Trainer, Alice, in her first 5k after going through TCC's program.

Reduces obesity. The physical chaos caused by obesity doesn’t just affect the cardiovascular and metabolic systems.  It increases the chances of developing dementia. Moderate exercise burns calories and reduces appetite—a two-for-one benefit. |  A healthy and balanced body protects us from the ravages of pain.

Elevates our stress threshold by making proteins that fix the damage of too much cortisol, excess glucose, free radicals, and over-dominance of the nervous system’s fight-or-flight response—ultimately delaying the aging process. Pain creates enough stress on the body, so increasing our ability to withstand stress can only improve our pain experience.

Lifts our mood. Being active and maintaining social connections go a long way in reducing depression.  But more than that, exercise sets a body-mind sequence into action that ensures the release of neurotransmitters—the body’s very own “happy pills.” | "Happy pills" may help us feel our pain less, but isn't it great that we don't have to go to the drug store for these!

Boosts the immune system. While stress and age depress the immune response, exercise strengthens it. Even moderate activity rallies antibodies and lymphocytes (T cells)—the immune system fighters. Prevention is a huge task for the immune system; repair is, too, when tissue is damaged or inflammation sets in.  Chronic inflammation is a risk factor for cardiovascular disease and Alzheimers. Exercise allows the immune system to fix inflammation and fight disease. | A healthy immune system keeps us strong—lessening the drag of chronic pain to the body.

How will you give your pain the gift of exercise?

Dee Emmerson

Dee is a writer who puts her word-smithing and communications to work for Take Courage Coaching™  writing website and brochure copy, lessons, and newsletters. This is what she considers the “perfect job”—writing and sharing life-saving skills with those in chronic pain—with time around the edges to be her kitties’ human, tend flowers, sew or crochet, clean the house (micro-manage the Roomba), or help a neighbor. She lives in Colorado with her hubby of 40 years and counting.

Aromatherapy and Its Use in Chronic Pain

by Blaire Morriss, ANP-BC, RN
If you’ve ever smelled lavender and felt calmed, or had the perfume of a freshly peeled orange brighten a moment, you’ve directly experienced the powerful effects of scent. Aromatherapy, the therapeutic use of essential oils, has experienced renewed popularity in recent years as a tool on the journey of health and wellness. While many people are familiar with aromatherapy as something that smells good, the therapeutic effects of essential oils make aromatherapy much more than just a scent. In this article we explore aromatherapy as another tool in the chronic pain toolbox.

A quick search of “aromatherapy and pain” on PubMed will return pages dedicated to trials studying the effects of aromatherapy on pain. An expert in the field, Dr. Jane Buckle, cites several factors that may be behind the pain-moderating effects of scent: the effect of essential oils on the brain, analgesic (pain-relieving) components in essential oils, and the relaxant effect aromatherapy has on the nervous system (Buckle, 2003). In essence, aromatherapy has the potential to affect us not only through our mind and emotions but also through our body. An example of this is aromatherapeutic massage, which can initiate a deep relaxation effect that not only influences pain perception, but also has the potential to improve mood. 

Traditionally a number of essential oils have been used for their analgesic effect.  Some essential oils thought to be helpful in both acute and chronic pain include: 

Lavender (Lavendula angustifolia)
Traditional use: analgesic and antispasmodic. Studied in small clinical trials for its calming and sedating activity and ability to reduce the perception of pain when inhaled.

Peppermint (Mentha piperita)
Traditional use: analgesic and antispasmodic. Studied in clinical trials for its analgesic effect on headache and ability to reduce colon spasm.

Ginger (Zingiber officinale)
Traditional use: analgesic and anti-inflammatory. Studied in small clinical trials for its ability to reduce pain in arthritis and knee pain.

Marjoram (Origanum majorana)
Traditional use: analgesic and antispasmodic.  Shown in small clinical trials (when used in an essential oil blend) to produce an analgesic effect in low back pain and arthritis.

Geranium (Pelargonium graveolens)
Traditional use: antispasmodic and for stress-related conditions. Shown in clinical trial to produce a significant reduction in neuropathic pain.

Clary Sage (Salvia sclaria)
Traditional use: antispasmodic and relaxant. Shown in small clinical trials (when used in an essential oil blend) to reduce pain.

Black Pepper (Piper nigrum) 
Traditional use: antispasmodic and relaxant. Shown in small clinical trials to decrease arthritis pain.

Lemongrass (Cymbopogan citrates)
Traditional use: analgesic. Thought to help with muscle pain.

Roman Chamomile (Chamaemelum nobile) 
Traditional use: anti-spasmodic, analgesic, and relaxant.  

Essential oils can be used in many ways, but topical application and inhalation are generally the most effective for chronic pain. For specific pain complaints such as an achy knee or sore muscles, topical applications (applying directly to skin) of essential oils may be most beneficial. Essential oils can also be applied topically by adding them to massage oil or body lotion, dispersing in an aromatic bath, or adding to a warm or cool compress. 

Inhalation is an effective method for affecting both the physical and psychological realms—by sniffing a bottle of oil, adding a drop to a cotton ball and inhaling, using a specialized aromatic inhaler (aromastick), or inhaling the steam from a bowl of hot water after adding a couple of drops of essential oil.  

The majority of essential oils are safe and do not have adverse effects when inhaled or diluted and used topically. One of the great benefits of essential oils are their relatively low risk of harm and high potential for benefit. Despite this fact, if you have hypertension, seizures, sensitive skin or are taking multiple medications, it is advisable to discuss using essential oils with a knowledgeable healthcare provider prior to use.


Recipes:

Sore Muscle Blend
(Results in a 5% dilution)

1 oz Organic Sweet Almond Oil
12 drops Lavender (Lavendula angustifolia)
10 drops Marjoram (Origanum majorana)
8 drops Lemongrass (Cymbopogan citratus)

Shake well and apply up to three times daily to sore muscles. Wash hands well after use


Uplifting Spritzer
(Makes a spritzer with a 2-3% dilution)

In a 1 oz metal or glass spritzer bottle add:
1 oz distilled or purified Water
12-18 drops Bergamot (Citrus Bergamia) -or- Grapefruit (Citrus paridisii)

Spray in room as needed. Avoid spraying on furniture as essential oils can discolor wood and fabrics. If sprayed on body avoid direct sunlight for 12 hours.


Blaire Morriss is a Nurse Practitioner at the Vanderbilt Center for Integrative Health and an Instructor in Clinical Nursing at the Vanderbilt University School of Nursing. Blaire has completed two certification programs in Aromatherapy and has been working with essential oils for the past 15 years.  She received her graduate degree in nursing from Vanderbilt University and completed the Fellowship in Integrative Medicine at the University of Arizona in 2012. Blaire is also a Certified Professional Health Coach. 

Dee Emmerson

Dee is a writer who puts her word-smithing and communications to work for Take Courage Coaching™  writing website and brochure copy, lessons, and newsletters. This is what she considers the “perfect job”—writing and sharing life-saving skills with those in chronic pain—with time around the edges to be her kitties’ human, tend flowers, sew or crochet, clean the house (micro-manage the Roomba), or help a neighbor. She lives in Colorado with her hubby of 40 years and counting.