"I just want my life back." This is what I hear from almost every one of my chronic pain patients. Not only do they feel trapped by their pain, they've lost hope. They're stuck. There seems to be no solution. No one believes the depth of their suffering. Their doctors haven't helped but, nonetheless, they go from one to the next – trying one treatment after another.
It doesn't have to be this way. I've developed a chronic pain treatment program called the DOCC (for "Defined, Organized, Comprehensive Care") project that you can do yourself. My book, Back in Control: A Spine Surgeon's Roadmap Out of Chronic Pain, outlines it in detail, but here is a simplified version.
Three Principles for Understanding and Eradicating Pain
Pain is complicated and affected by several variables (outlined below). The solution, however, is relatively simple. There are three basic principles:
- You need to gain an understanding of pain, in general, and your situation in particular.
- You then need to commit to using this knowledge to take complete control of your care – and eventually your life.
- You must put in place a plan to simultaneously – all at once – address each and every one of the variables that (as you've learned) affect your perception of pain.
Surprisingly, this process isn't complicated or difficult – in fact, most of my patients really enjoy it! Not only do they begin to feel in control of their lives but, as they see results, they begin to once again experience their lives as pleasant and rewarding.
Let's get started.
Variables That Affect Pain
The following "variables" affect how much pain you feel:
The Source of Your Pain
There are three separate, potential sources of pain – your pain may result from one, two or all three:
- Structural: There is an identifiable problem (your doctor can usually see it with an imaging test such as an X-ray, CT scan or MRI) and you have symptoms that match the problem.
- Soft-Tissue Inflammation: You've experienced an injury to your muscles, ligaments or other supportive tissues leading to inflammation in that area. This is a very common source of pain and it often cannot be visualized on an imaging test.
- Mind-Body Syndrome: The sensation that you experience as "pain" is actually neurological feedback loop. Sometimes, over time, the nervous system can "short circuit" and get, effectively, stuck repeating the same signals over and over again.
How to take control: Understand whether your pain involves one, two or all three of these components. It's important to realize one key bit of information: Surgery is often only helpful for structural problems. If you have soft tissue inflammation and/or mind-body syndrome (and many people with chronic pain have both) surgery is unlikely to make your pain go away.
The importance of consistent sleep cannot be overstated. Sleep deprivation (less than seven hours of restful sleep/night) will drain your coping skills and cause an increase in the pain you feel.
How to take control: Many patients with severe, unremitting chronic pain benefit from using sleep medications for a period of time to get their pain under control.
It is human nature to first become anxious – then get angry – when a basic human need (such as for air, food or water) is not met. Not having pain is a basic need. Back in the 1970s, John E. Sarno, MD, used the term "rage" to describe the mind-state of a person in chronic pain. My term is "the abyss." It's a desperate condition that words cannot adequately describe. Adding insult to injury, the body responds by producing the hormones adrenaline and cortisol, both of which further amplify the impact of the pain signal.
How to take control: Pain will not go away until you un-link the pathways of anxiety, anger and pain. My book outlines one way to do this, but there are others – all of which involve connecting thoughts with physical sensations. It's a simple process that becomes automatic with repetition.
The pain signals your brain receives are unpleasant – strong, rapid-fire, relentless. Like a heavily-trafficked shortcut, the "pain pathways" to your brain get etched in quickly and firmly, resulting in neurological circuits that get continually reinforced.
How to take control: Fast-acting relief is required to interrupt the feedback loop. Many people need medications for sleep, pain and anxiety for a while – then, as the nervous systems calms down, the need for the medication often resolves. The goal (and it is within reach for the vast majority of patients) is to be pain-free with minimal or no medications.
An injury to muscles, tendons or ligaments can start the cycle of chronic pain. Tight muscles and joint contractures hurt. Every time you reach the limit of your comfortable range of motion, your body sends out pain signals. As you become more protective of these tissues, you move less but experience more pain. As your body becomes weaker, there is also less support for your spinal column.
How to take control: Healing requires that you regain range of motion of your painful joints. Three to five hours of resistance training each week can help accomplish this. Begin with light weights and high repetitions – interestingly, the repetitions also seem to be very calming. Be sure to consult your doctor or trainer to see what exercises will be most beneficial and make sure you are performing them safely.
When you are suffering endlessly, you lose your sense of humor and become socially isolated. You spend much of your life thinking about your pain and eventually, it becomes your center – the essence of life gets swallowed up and these pain pathways become monsters.
How to take control: By addressing all aspects of pain simultaneously you will create a massive shift in your consciousness that brings you back to a full and rich life!
Connect the Dots!
We have found that the essence of the DOCC project is connection. People heal each other. As you shift your perspective back and begin, once again, to enjoy a larger view of life, it is critical to reconnect with your friends and family and learn to really enjoy them.
You will reconnect with the best part of who you are and this painful part of your life will recede into the background. I've seen this happen again and again and again, but, when it works, the credit belongs to you; I've learned that my role is to simply step aside and watch my patients take off. Helping people find their way out of the abyss of pain has become the most rewarding part of my practice.
For more from David Hanscom, MD, visit Back-in-Control.com.