Putting Pain in Its Place: Coping Tips for Fibromyalgia and More
November 16, 2005
Bound by chronic suffering, students learn mind-body coping techniques
By Mark Sauer
UNION-TRIBUNE STAFF WRITER
San Diego, CA
November 15, 2005
They lay on their backs, closed their eyes and concentrated on the simple act of breathing.
"Notice your breath as you inhale and exhale, how your belly moves, or how the air tickles your nose," Janet Wolf said, her voice taking on the soothing tone of a hypnotist.
The dozen people on floor mats, men and women from various walks of life, ranged in age from their 30s to retirement. They had one thing in common: chronic, debilitating and often unbearable pain caused by injury or disease.
They had been to specialists, had surgeries, and had tried all kinds of pain medications and relief techniques, such as acupuncture, biofeedback, electrical stimulation, yoga, tai chi, nutrition therapy, aqua therapy, massage and manipulation.
Some of it had worked, at least to a degree; some not at all.
Now they were trying to manage their pain with their minds.
Wolf, who has taught pain-management courses to more than 8,000 people in San Diego County over the past 12 years, was showing them how to shift focus to a safe and calming place far from their all-consuming pain.
"With pain, the volume goes up and down; a lot of neuroimaging studies have shown that," said Dr. Robert Bonakdar. "The question is, what can we do to continually turn the volume down? That's what this class is all about."
Bonakdar, director of pain management at Scripps Center for Integrative Medicine in La Jolla, said the idea of Pain Management Essentials, which meets weekly for eight, two-hour sessions, is not to suggest that "the pain is all in your head."
"We get patients to link the mind-body aspects of their pain," said Bonakdar. "Does the pain control their lives? Do they see themselves only in terms of their pain? Or can they see themselves beyond the pain?"
This approach, which is increasingly offered at pain centers in San Diego and across the nation, is counter to how medicine is conventionally practiced in this country, Bonakdar said.
Integrative medicine blends the conventional with Eastern ideas, like guided imagery and relaxation exercises.
"Western medicine is disease or injury-oriented – you see a broken back, you do surgery and fix it," he said. "When things fall out of that paradigm, the doctor and patient often get frustrated."
An estimated 50 million Americans live with chronic pain, and 80 percent of us can expect to experience "some type of back pain that will be somewhat disabling," Bonakdar said.
"Patients can't cope, they don't have the tools to deal with this pain. We're trying to expand the tool box and get doctors and patients to use all of them."
Sometimes psychological pain – impatience, frustration, anger, self-pity, being a burden to others – can be greater than physical pain, Wolf said. "And that won't show up on any X-ray."
Wolf offers touchstone phrases:
"Pain is inevitable; suffering is optional."
"Be willing to do things differently – major changes in lifestyle can bring relief."
"You don't have to believe this will work, you just can't not believe."
Her challenge with a class that is at once highly motivated and constantly distracted is to turn such bromides into beliefs, to teach them to calm the screaming pain demon within, freeing themselves to resume life at an acceptable level.
It is the relationship between the psychological and the physical – the critical vortex of pain – that Wolf goes after.
The pain gate
Andrea Seavey's reason for being there sounded like a song lyric: She hasn't got time for the pain.
"When I got up in the morning, my feet felt like I was walking on broken glass," said Seavey, a 65-year-old registered nurse, who retired in 2001 after being disabled by a broken foot. She then discovered she has an underlying, degenerative nerve condition in her legs and feet.
Seavey couldn't get going. She would take pills for the pain and go back to bed, not getting up until most of the morning was gone.
"I started the day late, couldn't get to sleep at night, and my mind was affected by all the drugs I was taking for the pain," she said. "I wanted the time back that I was wasting; I wanted my mind back, too. That's why I tried this class."
Wolf explained to her students about the "pain gate," a theory developed in 1965 that says pain signals pass through a portal in the central nervous system to the brain, and that we can exert control over whether the gate is closed or open.
Relaxation, positive thinking and exercise, Wolf said, are ways to close the pain gate. A key to control is understanding that negative emotional reactions (like anger and frustration) to stressful situations open the gate.
Seavey, who has cut back significantly on her pain medications, characterized Wolf's class as "life-changing."
"I've given up my reaction to the broken glass. I get up by 8 and just start walking on those feet and I don't think about them – I'm controlling my reaction to what I'm physically feeling," she said. "I don't take a pill now till maybe 2 p.m., when the real pain gets too bad.
"A big plus of this class was being in a room with other people experiencing the same thing I was, knowing they all could understand."
Patrick Attardo understands.
Disabled after suffering a back injury in 1997 while working as a nurse, Attardo continued to have severe lower-back pain and spasms after lumbar-disc surgery.
He tried all sorts of treatments and techniques – acupuncture, biofeedback, electrical stimulation, three years of deep-muscle massage. Some worked. So did a previous pain-management class and, for awhile, a pain-management support group.
"I went into (the Scripp's class) with a positive attitude, telling myself I had nothing to lose and everything to gain," said Attardo. "It was hard work – keeping journals, doing homework assignments. But it was worth it.
"We faced questions like: What is pain? How does it start? What does it do to you if you don't do anything to it? In addition to relaxation techniques, we learned there is no wand they pass over you and it's, 'OK, you're good to go.'
"I was a guy who went at 110 mph all the time," said Attardo, 51. "I've learned to re-gear myself, to go at a much slower pace but still keep moving. That's one of the hardest things to deal with, to re-gear and feel good about doing less than you used to do. That has taken me years to learn."
Carol Sveilich said alternative medicine and psychological approaches to controlling chronic pain have become far more accepted in recent years, especially among traditional physicians.
"When I first started running a pain support group in the early '90s, most of the physicians I spoke with would roll their eyes – they thought it was flukey, dangerous," said Sveilich. "That mindset is rapidly changing."
For more than 15 years, Sveilich has dealt with chronic muscle and joint pain from fibromyalgia. She also has Crohn's disease, inflammation of the small intestine.
Her experience with the support group the former UCSD academic counselor ran for nine years evolved into a book, "Just Fine: Unmasking Concealed Chronic Illness and Pain" (Avid Reader Press).
"One of the things I show in the book is there isn't a magic bullet for everyone, and people who have lived with chronic pain for a long time often turn to alternative, or complementary, approaches," she said.
"I remember one gentleman who was suffering in his back and neck from an accident. He had tried all kinds of procedures, medications, surgeries; nothing worked and he was suicidal. What turned it around for him was an eight-week course at UCSD that gave him the tools – coping mechanisms, mild exercise – that he otherwise would never have gotten."
Sveilich said pain sufferers who appear healthy "face a double-edged sword."
"Some are glad they appear normal and don't have people feeling sorry, or questioning them; others wished it showed more because they weren't being taken seriously and were being scrutinized by family, friends or co-workers."
A big part of coping with chronic pain and controlling it, Sveilich discovered, is realizing your reaction to it is critical and that it typically goes in stages.
"I spoke with people at every level – the newly diagnosed who were still angry and bitter, then depressed, to those who had gone through that and made peace with what they had," she said.
"We all go through these stages. The ultimate question is what are we going to do about it?"
© Copyright 2005 Union-Tribune Publishing Co.
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