Mindset Archives - Pain 2 Possibilities

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Understanding Pain – Part 1

Yes, chronic pain is a wildly complicated, complex process.

At Pain 2 Possibilities, we believe that managing your pain means truly understanding your pain.

So just like any good story we are going to take you back to the very beginning…

When you were born, you were equipped with some pretty amazing ‘built ins’. You acquired a body and a brain that combined is a machine that is intuitive, adaptable and responsive. It may not always feel like an amazing machine when you are living day in and day out with persistent pain. But I am here to remind  you just how amazing you and your systems really are! Each and every day your body and brain are going through some pretty complex processes to sustain you. Let’s take a moment to showcase some of those innate features.

When your body temperature rises due to environmental, exercise, hormonal factors and illness, your body instinctively knows what to do to protect your cells. Once your core reaches a certain temperature your body begins to sweat to start the cooling process.

When there is a stimuli (also known as a threat),  perceived or real,  the sympathetic nervous system stimulates the adrenal glands to trigger the release of neurotransmitters (adrenaline). This results in an increase in heart rate, blood pressure, and breathing rate to help get you into fight or flight mode (or sometimes the ‘deer in the headlights’ freeze). This all happens at lightening speed to prepare you for what ever decision you make…to defend, to protect.

Or how about the high speed withdrawal reflex when your hand senses extreme heat on a stove top of which includes a sensory input, central processing, and motor output. This all happens without us even having to think of it nor control it consciously. That’s a highly sophisticated process that happens in a very short period of time and it is meant to protect us from harm. Your limbic system is pretty incredible.

For our last example, I want you to take a moment and think about your favourite meal. Think about what it looks like, what it smells like and finally what it tastes like. Take your time and think of that meal in detail. Now notice what your mouth and salivary glands are doing.  This stimuli and response is incredibly powerful! And it is one of the best examples we have of how your thoughts affect or influence your physical self (which we will address in another post).

Why is this important? Because pain has purpose. Pain is our bodies natural defence mechanism against harm when exposed to a short term stimuli like an injury, damaged tissue, bruises, for real and perceived danger.

Acute Vs Chronic Pain

So our next step in understanding pain is deciphering between Acute and Chronic Pain and how one becomes the other.

Acute pain, as described by webmd.com ‘comes on suddenly and has a limited duration. It's frequently caused by damage to tissue such as bone, muscle, or organs, and it usually disappears when the underlying cause of pain has been treated or has healed.’
Whereas acute pain lasts for days up to 6 months, chronic pain lasts for much longer and is much more complex. It is the pain that stretches beyond the tissue healing.

So how does acute pain become chronic? There is still much to learn about this transition but what we do know is described best by ‘Medpage Today’. They state, ‘acute pain progresses to chronic pain when repeated or continuous nerve stimulation precipitates a series of altered pain pathways, resulting in central sensitization and impaired central nervous system mechanisms.’

Let’s unpack this a little bit. The key concepts in this description are ‘repeated or continuous nerve stimulation’, ‘altered pain pathways’ and ‘impaired central nervous system’.

Nerve stimulation can come from many different sources and can be both physical and emotional in nature. In the world of pain education we call it the Biopsychosocial model, where pain is an intertwining of biological, psychological and sociological factors (stay tuned for more on this). When our nervous system is constantly bombarded with stimulation of pain, worry, fear, stress, trauma, self doubt, and more our pain pathways become physically changed thereby impairing their function. This includes impaired sleep, immune function and overall healing. Just like our Wifi…our nervous system can become ‘glitchy’ (I hear this word A LOT when my son is complaining about our Wifi).

So what is the good news? Just because those pain pathways in your nervous system have been altered does not mean that they cannot heal. They may never be ‘fixed’ but they can be improved which inevitably will change your experience with pain. Neuroplasticity, as defined by Oxford Languages is the ‘the ability of the brain to form and reorganize synaptic connections, especially in response to learning or experience or following injury.’ Yes, you read that correctly, your brain can regenerate and change, it just takes some know-how and lots of practice.

Stay tuned for our next instalment where we will discuss the Biopsychosocial model (it is such an important part of your pain experience that it deserves it’s own blog post!)

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When Emotional Intelligence Meets Pain Management

​Emotional intelligence (otherwise known as emotional quotient or EQ) is the ability to understand, use, and manage your own emotions in positive ways to relieve stress, manage pain, communicate effectively, empathize with others, overcome challenges and defuse conflict. EI can be thought of simply as the power house three's...our attention to emotions, clarity in understanding emotions, and emotion regulation.

When dealing with pain and all of it's 'ripple effects' our mindset and our emotions affect our perception of pain, how we ​deal with anxiety related to pain (or life stressors) and how we communicate with others about our pain. And the truth of the matter is, most of us aren’t taught how to identify or deal with our own emotions, or the emotions of others let alone how to deal with those emotions while living with chronic pain.

​So why is understanding your EQ an important part of your pain management strategy?

According the article, 'Emotional Intelligence Moderates Anxiety Reactions in Chronic Health Conditions' as cited in the American Journal of Applied Psychology,  Emotional Intelligence plays a major role in determining not only the experience of anxiety but it also helps to moderate the amount of anxiety experienced.​ In other words it represents an individuals ability and tendency to ‘work well with emotions’ and to regulate emotional responses in a way that allows for more effective coping

There is a lot to unpack here so let's start by understanding a little bit more about Emotional Intelligence and it's protective effect through mechanisms related to stress processing and regulation.

In one well known model of EI, as written by psychologist Daniel Goleman, 'The Mixed Model' has 5 key areas:

  • Self Awareness: Self-awareness involves knowing your own feelings. This includes having an accurate assessment of what you’re capable of, when you need help, and what your emotional triggers are.
  • Self Management: This involves being able to keep your emotions in check when they become disruptive. Self-management involves being able to control outbursts, calmly discussing disagreements, and avoiding activities that undermine you like extended self-pity or panic.
  • Motivation: Everyone is motivated to action by rewards like money or status. Goleman’s model, however, refers to motivation for the sake of personal joy, curiosity, or the satisfaction of being productive.
  • Empathy: While the three previous categories refer to a person’s internal emotions, this one deals with the emotions of others. Empathy is the skill and practice of reading the emotions of others and responding appropriately.
  • Social Skills: This category involves the application of empathy as well as negotiating the needs of others with your own.

I have always said that those who live with chronic pain are acutely aware of their bodies. More aware of where they carry their tension, how they carry themselves, where they feel the pain. It's a matter of necessity when trying to describe their experience to their health care team and loved ones (if they are listening). ​

This is where we get to take the self awareness piece one step further. Improving your self-awareness is the first step to identifying any problem area you’re facing. Here are some ways to improve your self-awareness:

  • Keep a journal of your emotions: at the end of each day, write down what you experienced, how you felt and how you dealt with it (you can address both the physical and emotional here). This not only helps you to articulate what you are feeling for yourself (a healthy outlet) but also it can offer real clarity to your physician and your loved ones when the time comes to communicate with them.
  • Ask for input from others: when dealing with your self-perception, input from others can be invaluable. Try to ask multiple people who are in the same situation as yourself and who know you well, where your strengths and weaknesses lie, especially in how you deal with your persistent pain. Write down what they say, compare what they say to each other and, again, look for patterns. Most importantly, don’t argue with them. They don’t have to be correct. You’re just trying to gauge your perception from another's point of view. It is important to ask these questions to those who know what life is like with chronic pain as they will fully understand what you are going through.
  • Slow down or meditate: Emotions have a habit of getting the most out of control when we don’t have time to slow down or process them or when you live in a state of perpetual 'fight or flight' mode due to your pain. The next time you have an emotional reaction to something, try to pause before you react​. You can also try meditating to slow your brain down and give your emotional state room to breathe. Meditating also allows you to a) switch the fight or flight response into more of the rest and digest mode so you can cut through the 'noise' and reconnect with your thoughts and sensations and, b) become aware and more accepting of the emotions and sensations you feel by looking more inwards​, rather than focusing solely on external factors.

Emotional Intelligence is a highly effective tool when it comes to mitigating the pain through tough conversations. As you probably know all too well, communicating with loved ones and professionals can often be stressful and when tough conversations arise, the pain can become more intense. The more aware we are of our emotional state during these times the more able we are to respond accordingly so not to increase the physical pain.

Self Management: Once you know how your emotions work, you can start figuring out how to handle them. Proper self-management means controlling your outbursts to reduce stress, distinguishing between external triggers and internal over-reactions, acknowledging negative self talk and rewarding more self serving internal dialogue, and doing what’s best for your needs.

One key way to manage your emotions is to change your sensory input. If simply breathing through it is just not cutting it then try giving your physical body a shift to break the cycle. If you’re feeling lethargic, do some movement, get up out of the couch. If you’re stuck in an emotional loop, give yourself a metaphorical “snap out of it” slap. Anything that can give a slight 'shock' to your system or break the existing routine can help. Funneling emotional energy into something productive can also be very helpful. It’s alright to let overwhelming emotions stew inside you for a moment, if it’s not an appropriate time to let them out. However, when you do, rather than vent it on something futile, turn it into motivation instead by getting back to the things you enjoy such as crafting, hiking, reading, creating, or writing.

Motivation: When addressing motivation as it relates to emotional intelligence and ​chronic pain we’re talking about your inner drive to accomplish something. As Psychology today explains, there’s a section of your prefrontal cortex that lights up at the mere thought of achieving a meaningful goal. And yes, chronic pain warriors can have goals and aspirations as it is such a healthy and meaningful way to look ahead.

Empathy: Empathy is your most important skill for navigating your relationships​. Empathy is important because it helps us understand how others are feeling so we can respond appropriately to the situation. It is typically associated with social behaviour and there is lots of research showing that greater empathy leads to more helping behaviour. And helping behaviour leads to a broader sense of well-being and vitality.

If you are living in chronic pain you know all too well that empathy can be a bit of a tough subject. There is often a lack of empathy from professionals and loved ones when it comes to addressing or communicating your pain experience. This often comes from a place of not knowing what you live day in and day out. Where empathy becomes an important part of your pain management is in the a) understanding of where you partner is emotionally so it can be addressed together and b) in communicating with them how having empathy could help mitigate your pain. Emotional intelligence helps to bring the awareness, the acknowledgement and the resolution all ​ together.

So how can you practice empathy? In a word....listen!

You can’t experience everyone else’s lives to fully understand them, but you can listen. Listening involves letting someone else talk and then not countering what they say. It means putting aside your preconceptions or skepticism for a bit and allowing the person you’re talking to a chance to explain how they feel. Empathy is hard, but virtually every relationship you have can be improved at least marginally by waiting at least an extra ten seconds before you retake the conversation.

Seek to understand. Understanding is key to having empathy. When someone tells you about an experience that’s not your own, take some time to mull over how your life might be different if you experienced that on a daily basis. This especially rings true for loved ones who don't experience pain day in and day out.

By definition empathy means getting in the emotional dirt with someone else. Allowing their experiences to resonate with your own and responding appropriately. It’s okay to offer advice or optimism, but empathy also requires that you wait for the right space to do so. Be mindful of how they must feel and allow them space to feel it.

It is very important to understand that emotional intelligence is not the opposite of intelligence, it is not the triumph of heart over head - it is the unique intersection of both"    David Caruso

How Joy, Pleasure and Awe lessens the pain

​Pain is both a physical AND an emotional experience. Ask anyone living in pain and they will tell you 'hell yes that's true'! 

As a society we have become really good at attempting to block the pain, and in many cases to address the physical pain. We do, however, have some work to do around addressing the emotional side of chronic or persistent pain. And this is where pleasure, joy and awe come in to the rescue!

​Pleasure is the opposite of pain in the spectrum of our human emotions. Pleasure helps to draw our brains away from pain to help us cope by calming our nervous system and bringing us out of the fight or flight mode. We can think of the opposition this way (thanks to Dr. Beth Darnell)...

pain is physical and emotional in a negative way and pleasure is physical and emotional in a positive way"

Experiencing pleasure and joy releases the feel good chemicals in your brain that lowers your pain experience and boosts your mood. And the good news is, you already have this pain management tool built right into your system...you were endowed with it at birth...now we just have to put it into practice!

​So here's the big takeaway...getting out and experiencing life and it's multitude of emotions, most especially joy, pleasure and awe can seriously alter your experience with pain.

​Science shows that the pleasure of remembering things you love stimulates the same changes in your brain as experiencing the same thing.

​Awe is one of the most powerful human emotions we can experience. It is right up there with grief, just on the opposite end of the spectrum of course.

​There was recently a study done by Beau Lotto, a professor of Neuroscience at University College in London where he and his team studied 270 people and their response to awe while watching a Cirque Du Soleil show in Las Vegas. The study divided the group into two. Half of the group wore an EEG cap to measure their brain activity while watching the show where the other group was given a questionnaire before and after the show.

The outcome for both groups were similar with some definite overlap.

 Those who wore the EEG cap while watching the show and experiencing awe became lost in their experience. It was determined that the part of the brain responsible for controlling our attention was less active. They also found that the part of the brain that controls our sense of self had an increase in activity along with an increase in activity in part of the prefrontal cortex which increases our desire to approach a stimuli or to go forward.

In other words they were more willing to take risks, they were more comfortable with uncertainty and they redefined their perceptions of themselves.

Let's let that one sink in a little bit! You can see how powerful of a tool awe can be for​ someone who is being dragged down by the negative emotions associated with pain.

So how do you add awe or pleasure to your pain management tool kit?

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  • Create your list of things that bring you pleasure or creates that sense of awe...brainstorm and then write them down
  • ​Daily dose: Carve out a few minutes per day to practice joy everyday, mix in a little pleasure and if we are lucky...awe. Schedule it into your daily routine and then as Nike says, 'Just Do It'
  • ​When you do experience joy, pleasure or awe be sure to fully appreciate that moment and the feelings associated with it...pay attention to the small details
  • Shared pleasures: Doing something that brings you joy or pleasure with someone you love is double the dose of benefits
  • Keep it simple: It does not need to be some grand adventure...experiences of joy and pleasure and come from many places, especially when we are paying close attention!
  • Rinse and repeat!

The Flatulent Car And Innocence Lost

‘Growing old is mandatory, growing up is optional’
This, by far is one of my favourite quotes from the wildly creative Walt Disney and it resonates with me now more than ever. So what exactly does a car with gas (which is quite ironic as you will see in a moment) and Walt Disney have to do with each other? Allow me to explain…
I was at my very part time corporate job (I run a small employee wellness program at a local engineering company) last week where one of the heads of a department pulled me into her car to show me something. It is a Tesla that has a woopy cushion feature that you can control where the sounds are coming from. Those of you who know me would understand that I instinctively found this to be very amusing! You can also see the irony in the whole thing as it is a Tesla and they do not run on gas…but I digress.
My point is simply this…getting back to your ‘child like’ self can be an extremely healthy adventure! I will take it one step further and say that in losing or misplacing our youthful creativity, we lose out on opportunities for personal growth.
Creativity starts with the willingness to to look at the world through innocent eyes. It involves shaking ourselves from our prejudices and and established thinking or doing habits.
Sadly, the world grinds away at our trust and our innocence. Experience often teaches us to doubt, to scoff or roll our eyes. Think back to when you were young, where the world was a place of limitless possibilities. Everywhere you looked, you found something new and different. This type of boundless clarity is often lacking in our behaviours as adults, especially when it comes to finding solutions to our ‘stuck state’ of wellbeing.
As Aldous Huxley once wrote, “The secret of genius is to carry the spirit of the child into old age, which means never losing your enthusiasm.” Next time you are feeling stuck, ask your inner child…what would they do?
So, I challenge you. What can you do today that will help you get back to your childlike creativity?
What actions might you take to get you back to a giggly state where you really feel the ‘freeness’ of a deep belly laugh? For me it was simply saying yes (because it would have been very easy for me to say, ‘sorry I don’t have time’) to being in my co-workers car and having a fantastic giggle about something so deliciously juvenile.

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