Wednesday, October 3, 2007

Pain For Dummies - Part III

The Psychology of Pain.

This is a big one - probably the most important factor contributing to the development and treatment of chronic pain.

First let me get one thing out of the way: there is a link between chronic pain and psychological problems (depression, ...) - which means that yes - pain is (only) in your mind/brain.
But - and this is good news: we still can't tell for sure which comes first!

Imagine yourself having to live with chronic pain day in and day out. Going from doctor to doctor - spending a lot of time and money on treatments that don't work - loosing friends, social support, .... - who wouldn't get depressed? It's damn near impossible to stay happy when you hear the stories of people who went through hell for years on end. It's normal to become depressed when there simply is no end in sight to the suffering you have to endure.

What it comes down to is this: there are people who are just better at coping with difficult situations than others - copers vs. non-copers. Some people are just able to handle everything that life throws at them - no matter how horrible we think it is what they have to go through. Think imprisonment (concentration camps), torture, war, accidents where you have to cut of your own arm in order to survive.


Impossible? Definitely not - there are tens of thousands - hundreds of thousands (?) of people who are able to cope with such things. What happens is that just as we have a healing response when it comes to our tissue we also can heal psychologically. Our psyche receives "damage" and goes through the same stages that healing tissue does.

The basis for who is a coper or a non-coper are probably the same as for everything else: it's partly genetic - so choose your grandparents wisely ;-) - and the environment either activates those genes or it doesn't.
Nature and nurture instead of nature vs. nurture.

Let's say you are one of those who was unfortunate enough to have the wrong genetic code and is more likely to be a non-coper/pessimist.
What can you do to improve your situation?

- Distract yourself: attention is a limited resource; if you concentrate on the pain it gets worse - shutting out everything else. Focus your attention on something else and pain is reduced.

- Find an outlet: put a rat in a cage and give it random electric shocks; the rat has a chronic stress response leading to high blood pressure, osteoporosis and ulcers. Give the rat an outlet - something it can bite for example - and nothing happens. If you put a weaker rat in an adjacent cage the rat that gets the shocks runs over and bites the other rat that is just sitting there. Guess who gets the ulcers now?
I think everybody knows these two types of people: the ones who have to jog for miles every day and the others who take out their frustration on their subordinates. I recommend the first way of coping!
And while you are at it buy this book. Trust me. It doesn't get any better than this.

- Write about it. Pennebaker has done some amazing work on this. Expressing emotions helps enormously in dealing with them. I think that this has to do with the way our brains are built - we have two hemispheres that are organized differently. One hemisphere is the "human" part - emotional, creative, ... - the other is the more "robot" like part: pure rationality. There is a bridge between the hemispheres - the corpus callosum - but it can't transmit every bit of information - it's bandwith is limited.
If you use your eyes however - by reading something you just wrote down - the part of the brain that didn't have anything to do with the creation of those words and thoughts gains access to them through a different channel and is able to contribute too.
That's why it's also helpful to take out pen and paper and start drawing sketches when you are stuck working on a concept or a presentation.
Mind Maps also work by using this pathway; as soon as you are able to use all of your brain - and the differing points of view the hemispheres have to offer - the sky is the limit. ;-)

- Do something different. I can't stress this enough: keep learning - forever. Novelty is one of the best ways to distract yourself because learning a new skill - be it a new sport, a new language, a new way to move your body needs a lot of resources. It is estimated that we can only keep our focus for a maximum time of 15 minutes - after that our brains start to get tired.
Compare your sleep quality after a normal day with the quality you have when you solved a new type of puzzle before going to bed.
Our brains use the time we are asleep to consolidate memories and to add to the "experience database". If you give your brain something to do during the night it'll do so happily - leading to deeper and more refreshing sleep.
Yes - you can distract yourself even when you are unconscious!
Problems that seemed unsolvable the day before are often gone the next day; I had that experience a few years ago playing Panzer General: I just couldn't get past the Russian Defences at the battle of Kursk. After dreaming about it (!) I woke up and was easily able to smash a hole into their front line after which my tanks were able to pour through.
Imagine that: achieving victory through sleeping well - not by working harder. ;-)

If you want even more advice on how to become a better coper familiarize yourself with this very exiting branch of psychology: Positive Psychology - initiated mainly by Martin Seligman.

For those to take the test - don't despair - pessimists (like myself) are more prone to depression but at least we are able to see the world "as it really is" - and not through pink-colored glasses. That has it's advantages too.

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