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Thursday, September 20, 2012

Psychological Approaches to Pain Management


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I don't know why, but I seem to be immune to painkillers.  For someone who periodically gets debilitating headaches (mostly allergy-related), this really sucks.

Regular or even extra strength over-the-counter drugs like acetomenophen (Tylenol), ibuprofin (Advil), or asceticylic acid (Aspirin) do about as much for me as Tic Tacs.  I watch Adam pop a single Advil and get pain relief and I'm envious.  Even prescription drugs don't seem to work for me.  Toradol, Tylenol 3s, and Naproxen?  All useless.  The low-dose oxycontins given to me after my c-section when I had Little A?  About as effective as Skittles.  I've had short-term success for headache relief by combining some of the prescription drugs, but this never lasts long.  Even the morphine they gave me when I was in labour with Big A (I wasn't dilating so they didn't give me the epidural until 9 hours into serious contractions), did absolutely nothing.  The nurses were shocked.

Of course, being a health-conscious individual, it concerns me to be taking large quantities of these drugs.  Chronic usage of even over-the-counter drugs can lead to serious health consequences like rebound headaches, bleeding ulcers, and liver damage.  Tylenol 3s, in large enough quantity, and in combination with other drugs (like 2 prescription strength naproxins) usually has the best chance of giving me some pain relief, but they also cause intestinal spasms which have me doubling over in pain.  Not good.

Yet whenever one of my brutal headaches hit, no matter how many times I remind myself how futile it is to pop pills, I end up so desperate for relief, that I cave and take some.  What's worse is, if I'm in a huge amount of pain, I will take more.  Two extra strength Advils, plus 3 Tylenol 1s (with codeine), was my latest experiment...which worked about as well as everything else (i.e. not at all).   In addition, I think I've finally realized that I end up feeling worse when I take pills.  This is consistent with recent reports that overuse of pain medications can make headaches worse.

So a few weeks ago I made a decision that from now on, when I get a headache, I will NOT take any pills.  No pills.  Period.  After all, my doctor has said that sinus headaches typically do not respond to most of these pain relievers anyways, and thus prescribed me steroid nasal spray.  But the problem is, even when I am diligent about using it - as well as my antihystamines, I still sometimes get these killer headaches.  So there have already been a few days since I made my pledge when I have come very close to caving - like last week when my allergies were really bad and I felt like my head was going to explode!  But I've stayed strong.  And you know what?  My headaches often pass much faster than they usually do when I actually take pills for them.  And no stomach cramping!  I also feel better knowing I am not putting my health at risk by over-using these potentially dangerous drugs.

I feel so relieved because I had begun to feel so desperate and hopeless because of the severity of my heachaches and inability to get any relief.  I now feel much more confident that I can manage the pain without meds and that the pain will be temporary  I've found that an ice pack on my forehead can help, as can deep breathing and staying calm when I feel a headache coming on.  For sinus headaches, continually flushing my sinuses with saline also helps alleviate the pain.

Although I am a therapist and strongly believe in the unity between mind and body, I've always been skeptical of cognitive approaches to pain management.  Until now, that is.  And there is certainly a lot of research that backs up the efficacy of psychological approaches to pain management.  The experience of pain is not only influenced by pathophysiology, but also by an individuals thoughts, feelings and behaviour.  Just learning more adaptive coping skills can provide lasting relief for individuals suffering from chronic pain.  Cognitive-behavioural and mindfulness-based programs are particularly effective.  Generally, therapists, hospitals and clinics offer individual and/or group pain management behaviour programs that run 8-12 weeks long.  The ultimate goal of these programs is to allow individuals to effectively self-manage pain on a long-term basis.

Honestly, if, in the past, you had suggested to me that I could control the degree of my pain with my reaction to the pain, I would have hit you over the head with something I deemed heavy enough to expeience the pain I feel when I get one of these headaches.  But now, I agree.  It just goes to show the power of our thoughts and feelings and the intensity of the mind-body connection.

Whether it's migraines, cancer, fibromyalgia, back pain or another condition, if you are suffering from poorly controlled chronic pain, explore the mental health resources available in your community that focus on pain management.  It might just allow you to ditch pills altogether.  I'm not saying everyone should stop taking pills.  If they work for you that's one thing...but if they really aren't helping, perhaps there are other things you can try.