• hard to diagnose
• mistaken for other disorders
• mistaken as a psychological problem
• hard to treat

The wonderful American Pain Foundation has come out with a Fibromyalgia Toolkit that has information about:

• the disorder
• treatment
• how to cope
• recent advances
• current research

This is a great project and will be helpful to patients and families to learn more.  Thanks APF!

In chronic pain, pain signals, in a sense, get “stuck” in pain-mode, no longer providing helpful information to you.  Chronic pain creates actual changes in your brain.  As well, with pain, you often use the body part less, so there are less signals of normal movement going to your brain.  This can create a downward cycle:

Pain →
less use of your body →
fewer “normal movement” signals competing with pain signals →
more pain →
less use of your body, etc.

How can you break this cycle?

These newer treatments are based on the concept that re-training your brain can decrease pain.

Mirror therapy uses your visual system to “see” normal movement and reassure your brain that it no longer needs to produce pain signals.  Graded motor imagery is a step-wise program aimed at breaking up movement into components, allowing your brain to slowly resume normal movement without producing pain.

Mirror therapy has been shown to be helpful in:

• early CRPS
• phantom pain
• stroke
• low back pain

Graded motor imagery has been shown to be helpful in:

• chronic CRPS
• phantom limb pain

Ongoing research is helping us learn more about these exciting treatments and fine-tune our use of them.

Click here to read other articles about these newer brain-based treatments.

Other articles in this series:

1. Why comprehensive treatment works better
2. Benefits of a psychiatric evaluation
3. Treatment of psychiatric symptoms
4. Using psychiatric medications for pain
5. Learning psychological skills
6. Making positive behavioral changes
7. Making positive psychological changes
8. Benefits of supportive therapy
9. Benefits of a pain support group
10. New brain-based treatments

Today’s video is from Take Money 9.

I often use suggestions such as these of more comfort when I teach patients relaxation and guided imagery exercises.  But would these suggestions achieve a better effect during hypnosis instead?

A recent study says yes.

Researchers worked with patients with fibromyalgia and looked at the effect of suggestions when used both with or without hypnosis.  These suggestions were to both increase and decrease the feelings of pain.  The study found that both with and without hypnosis, subjects could change their experience of pain with suggestions.  However, the effect of suggestions was more when subjects were hypnotized. 

The study also used f-MRI, an imaging test that looks at brain function.  Activity in certain brain areas changed along with increases and decreases in pain - both with and without hypnosis.  But, again, the changes were greater when suggestions were made under hypnosis.

While hypnosis isn’t right for everyone, you might consider adding this skill to your options for helping with pain.  Readers, have you used hypnosis?  Was it more beneficial than other relaxation skills to decrease your pain?

The original article is “Fibromyalgia pain and its modulation by hypnotic and non-hypnotic suggestion: An fMRI analysis,” in the European Journal of Pain, 5/09.

For many years, I’ve run 8-week Coping with Pain support groups a few times per year.  These sessions are divided into 4 weeks of skill-building, where the focus is learning exercises such as relaxation and visualization.  The other 4 weeks are discussions focusing on issues related to living with chronic pain, such as positive coping techniques and dealing with a decrease in independence.

As long as a patient can benefit from the group and participate appropriately, I encourage them to attend a series.  Some patients find them so helpful, they attend more than 1 series.

What are the benefits of these types of groups?

1. Decrease isolation
Many people with pain lose the social contacts of work, and are able to do less with friends and family.  Pain can be very isolating.  Groups can increase general socialization.

As well, specifically related to pain, groups can help people realize they aren’t the only ones with significant pain.  This is very important for lesser-known diseases such as CRPS.  Groups can decrease isolation.

2. Problem-solve with others
Each person in a group knows ways to cope with pain.  Sharing these can help others, and group members benefit from things others have learned.  There’s less “re-inventing the wheel” when you can use the experiences of others.

3. Help others
Patients with pain often do less - at work, at home, hobbies, etc.  They become the “help-ee” rather than the “help-er.”  While it’s good to learn to be in both these roles, patients are mostly on the receiving end of assistance.  Helping others in support groups lets patients have more balance between helping and being helped.  Helping others often increases self-esteem.

4. Expand support networks
As we said above, pain can be isolating.  Adding new people to your support network can be good for you, to have other people to rely on.  As well, this can lessen the load of those already in your support network, who may be overburdened from the impact of your chronic illness.

5. Share resources
Living with chronic pain often means living with limitations and challenges - living a new type of life.  Sharing resources, information, and tricks and tips is an advantage of a group.

One important challenge of any group is to keep it focused on coping with pain.  Groups should not settle into complaining, focusing on pain, or focusing on whose pain is worse.

Readers, have you attended a group?  In what ways did you benefit?  Please share your thoughts in the comments!

Other articles in this series:

1. Why comprehensive treatment works better
2. Benefits of a psychiatric evaluation
3. Treatment of psychiatric symptoms
4. Using psychiatric medications for pain
5. Learning psychological skills
6. Making positive behavioral changes
7. Making positive psychological changes
8. Benefits of supportive therapy
9. Benefits of a pain support group
10. New brain-based treatments

As you may know, 1 of my all-time favorite websites isI Can Haz Cheezburger, where it’s imagined what cats are really saying.  The picture above got me thinking about the 2 extremes of handling pain.  There are those who do too little for themselves, and who let their pain control their activities.  And there are those who do too much, who won’t “give in,” who have problems accepting help.

The picture above certainly illustrates the “do too little” tendency.  Readers, which side of the see-saw do you tend to come down on?

Supportive therapy consists of helping people cope with a difficult situation through listening and support, problem-solving, and instilling hope.  Supportive therapy can be helpful in many ways to patients with pain.

1. Telling your story
Chronic pain is, for many, a life-changing situation.  Research by Viederman and others has shown that telling your story to someone who listens, cares and responds is important.  In addition to concrete help, exploring how a life-changing situation fits in with the rest of your life is beneficial.  “Life Narrative” work has been done with patients with cancer and is very positive.

As well, sometimes your friends and family give the message that they don’t want to continue hearing about pain and its consequences.  Having a place to talk about and make sense of your experiences is necessary, and can happen in supportive therapy.

2. Ongoing adjustment
With chronic pain, you don’t adjust to 1 situation and then go about your life.  Chronic pain usually requires on-going adjustment, as your condition changes.  As well, your life changes, and your pain will impact your life differently at different points.

For example, when you have little kids, not being able to do some activities with them can be discouraging and require creativity to work around.  In contrast, when your kids are older, they may require less physical interaction.  But then, perhaps, the financial stress of your not working may affect your family more.  Having a place to work through some of these issues is important.

3. Family support
As you know, your pain affects not just you but your family and friends.  Having your family get support during difficult times is useful, too.  In my practice, I often see not just the person with pain, but a spouse or family, too.  A good resource for families is: Surviving a Loved One’s Chronic Pain.

Readers, in what ways have you found supportive therapy helpful?

Other articles in this series:

1. Why comprehensive treatment works better
2. Benefits of a psychiatric evaluation
3. Treatment of psychiatric symptoms
4. Using psychiatric medications for pain
5. Learning psychological skills
6. Making positive behavioral changes
7. Making positive psychological changes
8. Benefits of supportive therapy
9. Benefits of a pain support group
10. New brain-based treatments

Cartoon from European Federation for Psychoanalytic Psychotherapy in the Public Sector.

Andrea’s Buzzing About writes about taking jobs just for the health insurance they provide.

Living with Fibromyalgia investigates the genetics of fibro.

The Migraine Girl writes about therapeutic yoga.

Pain Relief Blog explores accepting your life as it is.  Wise words.

Four Angels Momma shares thoughts and photos about perfection.

Going Down Swinging: A RSD Blog looks at victimhood and empowerment.

Free My Brain From Migraine Pain offers a monthly teleconference.  A great resource!

Rhymes with Migraine offers support and encouragement to a friend.

The Back Pain Blog reviews which MD to see for back pain.

Pain for Philosophers shares a website of artwork made by pain sufferers.

That’s all for this month.  Hope you have a moment to sit back and enjoy some of the writings.  The next edition of the Pain-Blog Carnival will be July 29.

For even more reading, stop by Florence Dot Com for this week’s Grand Rounds, a medical blog carnival.

When you experience ongoing pain, both the pain itself, as well as the changes it causes in your life, are challenging to cope with.  People often experience loss - loss of:

• good health
• being pain-free
• doing enjoyable activities with family and friends
• going to work
• hope or spirituality

Many go through the “Stages of Grief,” which are:

• Denial - you can’t believe this is happening to you
• Anger - that so many negative changes are occuring
• Bargaining - you’d do anything to get back your previous life
• Depression - difficulty coping, and mourning for the loss of your pain-free life
• Acceptance - coming to terms with pain and the changes it brings

These stages are a process, a working through, and for many, are slow.  And I believe that to move forward, you often must first recognize and mourn for what you’ve lost.

Let’s look more at acceptance, acceptance of both pain and the changes in your life.

Acceptance is:
1. No longer struggling with pain.
You might say, “I don’t like this, but I accept it.”

2. A realistic approach to pain.
You might say, “I’ll put realistic energy towards getting better.”

3. An engagement in positive everyday activities.
You might say, “I’ll put my energy towards my life.”

Is this worthwhile to work towards?  Yes!  A pain researcher, McCracken, has shown that - no matter what level of pain intensity - greater acceptance of pain all by itself predicts:

• lower reports of pain
• less pain-related anxiety and avoidance
• less depression and disability
• better work status

How can you move towards acceptance?  Again, the process is often slow.  What I’ve found to be helpful is:

1.  Grieve for what you’ve lost
2.  Mindfulness training = acceptance of what is
3.  Have a goal of living a full life despite pain

To read more about acceptance, here are several other How to Cope with Pain articles:

• 2 types of mindfulness to cope with pain
• A journey from being lost to acceptance
• Take this test to see how you’re doing with acceptance

Other articles in this series:

1. Why comprehensive treatment works better
2. Benefits of a psychiatric evaluation
3. Treatment of psychiatric symptoms
4. Using psychiatric medications for pain
5. Learning psychological skills
6. Making positive behavioral changes
7. Making positive psychological changes
8. Benefits of supportive therapy
9. Benefits of a pain support group
10. New brain-based treatments

Thanks to Salviaforme for the photo.