Seven Ways You Are (Unknowingly) Making Your Pain Worse


Sometimes it’s the little things we do or don’t do that sabotage our best efforts to avoid pain.

When you have pain, the hurt can seem to have a mind of its own. It may come and go at will. It takes a toll on your mood and energy level. It can affect how you go about your usual activities. All along, you may think you’re doing all you can to keep pain under control. But sometimes even the most conscientious among us can unintentionally undermine her efforts to feel better, says May L. Chin, M.D., director of the division of pain medicine at George Washington University Medical Center, in Washington, D.C. It’s not enough to take medications you have to put some effort into it with changes to your lifestyle and your attitude. Otherwise, you could end up aggravating your pain and sabotaging your best-laid plans to feel better. Here are seven ways you might be unwittingly making your pain worse, with sound advice from leading pain experts and those living with pain on how to correct these common errors.

When you feel bad, working out may well be the last thing you feel like doing. Often, when people are in chronic pain, they’re unwilling to exercise because they’re afraid it’s going to make the pain worse, says Doris K. Cope, M.D., director of the inter-professional program for pain, research, education, and clinical care at the Schools of Health Sciences at the University of Pittsburgh. But the opposite is true: Being sedentary leads to stiff muscles and joints and causes shortening of the muscles and tendons, all of which can lead to secondary sources of pain. Plus, being inactive makes it more likely you’ll put on weight, which can worsen pain in weight-bearing joints (hips, knees, ankles, feet) as well as the neck and back. But using your muscles improves your ability to function physically, which can reduce pain.

THE SOLUTION? Do something physical whether it’s walking your dog, dancing, riding a bike, or anything else–as often as you can. For most people, the exercise you enjoy and will do is the best form, Cope says. If you have arthritis in your joints, swimming or aqua aerobics may be appealing because the water’s natural buoyancy reduces impact and helps cushion the joints. Whatever you choose, start at a comfortable pace, take rest breaks as needed, and gradually increase the duration and intensity of your workouts, Chin advises. But not doing anything is more harmful than doing too much.

It’s kind of a Freudian thing, but I see it again and again in my practice, more commonly with women: Chronic musculoskeletal pain”especially lower back and neck pain” is often related to repressed anger, says Jeffrey Gross, M.D., a clinical associate professor of rehabilitation medicine at New York University School of Medicine. What’s more, a recent study at the Rosalind Franklin University of Medicine and Science in North Chicago found that when people with chronic pain were told to actively suppress their anger during a frustrating task, this aggravated their feelings”and their pain severity. If anyone can attest to these effects, it’s Martha Beck, 46, a life coach and best-selling author of Steering By Starlight: Find Your Right Life, No Matter What! (Rodale Books, 2008). Beck, who lives in Phoenix, has fibromyalgia. Anger is the emotion that sets boundaries, she explains. And if I do not set boundaries with my behavior, my body may do it for me. The single worst thing I can do to bring on my pain is to say yes to something when I want to say no, when someone puts pressure on me.

THE SOLUTION? Put pen to paper and write down brief statements about what makes you angry in your life, Gross suggests. The idea is to bring anger to your consciousness, not necessarily to act on it. I’ve seen patients get better from doing this it’s unbelievable. Indeed, in a recent study at Pennsylvania State University, researchers had people who suffer from chronic pain either express their anger constructively in writing or write about their goals in an unemotional way; over a nine-week period, those who wrote about their anger experienced greater improvement in pain control, depressed mood, and pain severity than those in the other group. In this case, feeling really is believing.

This is a bit of a chicken-and-egg situation, since poor or inadequate sleep can fuel pain, and unrelieved pain can lead to poor sleep. But doctors agree: Getting too little or poor-quality sleep can intensify the hurt by lowering your pain threshold and making you irritable the next day. It can even increase the risk of depression. This may be in part because the same area of the brain that mediates sleep also mediates pain, anxiety, and depression, says Ronald Kulich, Ph.D., attending psychologist in the department of anesthesia and psychiatry at Massachusetts General Center for Pain Medicine, in Boston. As many as 80 percent of patients with persistent pain experience sleep disturbances, yet they are infrequently asked [by their health-care providers] about the quality of their sleep.”

THE SOLUTION? Simply put, don’t let good-quality sleep fall to the bottom of your to-do list. If you suspect you have a sleep disorder like sleep apnea (a condition characterized by heavy snoring and brief episodes where breathing stops during sleep) or restless legs syndrome, see a sleep specialist. While Shannah Godfrey’s migraines have multiple triggers, she knows that if she gets less than six hours of sleep for two or more nights in a row, “I will definitely get a migraine, says Godrey, 46, a scientist in Independence, Missouri. Since she began going to bed earlier and using a CPAP machine to treat her sleep apnea, her migraines have become much less frequent.

Good sleep habits are essential too: Set a consistent bedtime and wake time so you get the seven to nine hours of shut-eye per night that most adults need. Avoid caffeine and nicotine, which are stimulants, and alcohol, which can impair sleep. Exercise at least four hours before bedtime and create a soothing sleep environment that’s dark, quiet, and comfortable.

If these aren’t enough to get you snoozing, ask your doctor about a sleep aid. Some cause daytime drowsiness and can impair thinking, which can have an additive effect with opioid drugs, setting you up for mental fogginess the next morning. So be sure to tell any doctor prescribing a sleep aid if you’re taking an opioid or an analgesic. In that case, you may need to start with a lower-than-usual dose of a sleep drug.

When you sit hunched over a computer at work or over a steering wheel while driving it puts stress on your thoracic spine and the muscles between the shoulder blades, Doris Cope explains. This can cause back or neck pain even in those who don’t have chronic pain, and it can exacerbate it in those who do. In fact, recent studies have linked poor body posture with neck pain, headaches, temporomandibular (jaw) joint disorder, low back pain, and other forms of chronic or recurring pain.

THE SOLUTION? If you have any kind of back or neck pain, it’s crucial to pay attention to ergonomic issues how you sit, stand, walk, and bend, Gross says. If you work at a computer, sit on your chair properly with your back and forearms supported and your feet flat on the floor, and make sure your computer is at a height that allows your head to stay in a neutra not a tilted, turned, or flexed position. And don’t forget to get up and move around every 30 minutes or sooner if you feel uncomfortable, Gross suggests. Our bodies are not meant to be in any one position for too long.

It might be called chronic pain, but often the aches, tingling, weakness, or hypersensitivity wax and wane. Flare-ups are especially common if you have arthritis, back pain, fibromyalgia, or neuropathic pain. One thing that can make chronic pain worse during these intense periods is to put too much stock in them to believe, in other words, that the flare-ups mean your doctor missed something serious; that increasing pain levels are causing greater damage to your joints, back, or wherever the pain is occurring; or that this new intensity of pain will be with you from now on. As in forever. When you have chronic pain, you can feel like it’s the end of the world and fear how you’re going to function and fulfill all your responsibilities, explains Irene Tamaras, 44, who has chronic low back pain and fibromyalgia, and is CEO of Dynamic Pain Relief, in North Bethesda, Maryland. But if I fall into the “Why me?” state, it intensifies my pain and affects how strong I feel.

Tamaras isn’t alone. Besides causing distress, anxiety, and feelings of hopelessness, the tendency to catastrophize about pain actually boosts muscle tension and may increase pain by increasing inflammatory substances in the body, explains Ronald Kulich. Pain is processed at the brain level, and there’s a wealth of research that suggests it can be influenced by your thoughts.

THE SOLUTION? First, try to accept that chronic pain often varies in intensity over time and the ups and downs you’re feeling don’t necessarily mean anything. By accepting where I am and recognizing that a pain flare-up will pass without my having to fight it, I’ve been able to shift to a positive, strong mental state, says Tamaras. Also, try to focus on what you can actively do to relieve pain flare-ups¸ by adjusting your medication (with your doctor’s help)¸ performing relaxation exercises like biofeedback, applying heat or cold, and so on People who engage in active ways of coping where you have the control show four times the improvement in pain and functionality as those who rely on passive therapies like massage where someone else has the control, Kulich says. If you have trouble taking these steps on your own, consider seeing a psychologist who specializes in cognitive-behavioral therapy (CBT), which focuses on changing your thoughts and behaviors (in this case, changing how you experience pain).

When a physician prescribes a pain medication, you should think of it as simply a starting point: The dosage will likely have to be adjusted, and you may have to try different drugs to find the one(s) that will relieve your pain sufficiently without causing problematic side effects. Dosage and the response to treatment have to be monitored after the prescription is written, stresses Russell Portenoy, M.D., chairman of the department of pain medicine and palliative care at Beth Israel Medical Center, in New York City. Even if the treatment seems to be helping, reassessment over time is needed to make sure that it continues to help. Sometimes patients take a medication month after month, without being certain that it continues to be useful.” If this sounds like you, tell your physician. Most pain medications including analgesics, antidepressants, and anticonvulsants have significant €œfailure rates, meaning they don’t sufficiently help the hurt.

In addition, people with chronic pain can develop treatment-resistant pain (what’s called hyperalgesia) as a result of continuously using opioid medications, such as morphine and hydrocodone. It’s not an addiction problem, Kulich says. Rather, with long term opioid treatment you can develop tolerance to the drug and/or an increased sensitivity to pain, which means you need more of the drug to get the same relief you used to.

THE SOLUTION? Pay attention to whether a pain-relieving medication is actually helping you, and stay in close contact with your doctor after starting a new drug or adjusting your dosage, recommends Portenoy. (Don’t just stop taking it without telling your doc.) When you communicate well with your physician about medication matters, your doctor can likely help you find a protocol that works for you. If she doesn’t ask about side effects and how well your pain is being controlled, by all means, speak up.

To be fair, this one isn’t always a mistake. But unless you’re looking for triggers for your migraines or you’re trying to fine-tune your medication dosages, keeping a pain journal can backfire, says Jeffrey Gross. Why? Because it makes pain a central focus in your life, which can lead to more pain-related distress and a sense of helplessness: It becomes a psychological issue as much as a physical issue, Gross explains. The worst thing you can do is dwell on the pain.

THE SOLUTION? Ditch the pain diary, unless you’re keeping one on your doctor’s advice, and focus on what’s good in your life instead. One of the things that has benefited me is to keep a gratitude journal to focus on the fact that I have a husband who helps take care of me, that I have good health care, and so on, says CJ Scarlet, 48, an author, life coach, and mother of three, in Clayton, North Carolina, who gets severe joint pain from lupus and scleroderma. It helps me put things in perspective-and I think pain is all about perspective.

Written by: Stacey Colino, a freelance writer in Maryland
Originally published in Pain Solutions Magazine, Fall 2009

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