Although a large proportion of our society suffers from pain it remains an intensely personal experience. It is an invisible condition that cannot be adequately explained to those around us; it is the constant companion that accompanies us in a crowd or in the quietness of a bedroom. As pain becomes prolonged and persistent, our ability to cope with it seems to break down. Feelings of helplessness, loneliness, anxiety, depression and anger are common. We get frustrated when others cannot understand our pain and we become annoyed when they tell us that they empathize with us. Many sufferers wonder: How can I deal with this pain? How do I make it stop? We, at Brainworks, are keenly aware of the magnitude of the chronic pain problem in our society. We are very cognizant of the challenges, dynamics and struggles that clients experience secondary to pain. We believe that while experiencing pain may not be an option, suffering from it is.

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Below you will see we have collected some of the advances in chronic pain research over the past year, as well as touching on some articles in the news, some fantastic blogs on chronic pain and more.

The effects of slow breathing on affective responses to pain stimuli: An experimental study

Conclusions from study. These experimental findings provide support for prior reports on the benefits of yogic breathing and mindful Zen meditation for pain and depressed affect. However, chronic pain patients may require more guidance to obtain therapeutic benefit from reduced breathing rates.

The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain

Conclusions from study: CBT-I was successfully applied to patients experiencing chronic pain. Significant improvements were found in sleep as well as in the extent to which pain interfered with daily functioning. The observed effect sizes for the sleep outcomes appear comparable to or better than meta-analytic norms for subjects with Primary Insomnia.

Cortical thickness and pain sensitivity in zen meditators.

According to a new study published in the journal Emotion, people suffering from pain may be able to reduce their sensitivity to pain by thickening their brain. Researchers from the Université de Montréal found evidence that practicing Zen meditation can reinforce an area of the brain called the ‘anterior cingulate’ that regulates pain.

Hurts So Good: Chronic Pain Changes Brain Response to Acute Pain

Story via Science Daily:

New research reveals why a stimulus that healthy human subjects perceive as a reward might be processed quite differently in the brains of humans suffering from chronic pain. The study, published in the April15 issue of the journal Neuron, provides fascinating insight into an apparent switch in neural circuitry that may be an integral part of the pathophysiology of chronic pain.

Link to the research study: Predicting Value of Pain and Analgesia: Nucleus Accumbens Response to Noxious Stimuli Changes in the Presence of Chronic Pain

Meditation experience predicts less negative appraisal of pain: Electrophysiological evidence for the involvement of anticipatory neural responses

Abstract: The aim of mindfulness meditation is to develop present-focused, non-judgmental, attention. Therefore, experience in meditation should be associated with less anticipation and negative appraisal of pain. Our data is consistent with the hypothesis that meditation reduces the anticipation and negative appraisal of pain, but effects on pain-evoked activity are less clear and may originate from preceding anticipatory activity. Further work is required to directly test the causal relationship between meditation, pain anticipation, and pain experience.

Why Does Feeling Low Hurt? Depressed Mood Increases the Perception of Pain

Science Daily article:

When it comes to pain, the two competing schools of thought are that it’s either “all in your head” or “all in your body.” A new study led by University of Oxford researchers indicates that, instead, pain is an amalgam of the two. In a new study, inducing depressed mood disrupted a portion of the participants’ neurocircuitry that regulates emotion, causing an enhanced perception of pain.

Link to the research study: Induction of Depressed Mood Disrupts Emotion Regulation Neurocircuitry and Enhances Pain Unpleasantness

Adapt, discover and engage: a qualitative interview study with patients living with chronic pain

Relevance to clinical practice.  Findings from this study provide health care professionals with information about how patients with chronic pain experience needs. In turn, this can constitute a base that to enable evaluation of how closely the patients’ experiences of need correspond to the interventions that health care in general provides this group of patients. Patients should be supported to manage their possibly incompatible needs and to prioritise occupations that generate energy and satisfaction.

The Patient–Provider Relationship in Chronic Pain Care: Providers’ Perspectives

Results.  Three broad themes emerged from the analysis: 1) providers emphasized the importance of the patient–provider relationship, asserting that productive relationships with patients are essential for good pain care; 2) providers detailed difficulties they encounter when caring for patients with chronic pain, including feeling pressured to treat with opioids, believability of patients’ reports of pain, worries about secondary gain/diversion, and “abusive” or “difficult” patients; and 3) providers described the emotional toll they sometimes felt with chronic pain care, including feeling frustrated, ungratified, and guilty.

A few blogs out there on chronic pain and chronic pain management:

Health Skills

Healthskills is a blog for health providers who want to read about research related to self managing chronic pain. Bronwyn Thompson, MSc (Psych) 1st Class Hons, DipOT, Registered Occupational Therapist is a prolific writer and is passionate about the work she does. Where she values being both a scientist and a human, further sharing that it is possible to both be a scientist and be empathic, warm and value the ‘human touch’. If you spend just a little time reading her blog you will see Bronnie’s passion shine through. Bronnie demonstrates her compassion by integrating evidence & research with anecdotal commentary into practice. She writes, “most scientific yet human approaches I know of is Acceptance and Commitment Therapy – as a clinician, to practice ACT requires active use of mindfulness, being present, cognitive defusion, values, committed action – all the facets of living fully.”

Bronnie often deconstructs research, research papers and the complexities of pain so we can all achieve a better understanding of healthy living with pain. The breadth of Bronnie’s articles is as wide as her compassion. From trying to answer how to decide the difficulty level of a goal (something not easily answered) while at the same time the empathic approach of ensuring the experience of the person who has the pain is always kept at the forefront of intervention. Bronnie also stresses the importance of sharing information in away that is meaning to the patient. Bronnie’s quotes Bill Fordyce to title this particular post ‘Information is to behaviour change as spaghetti is to a brick’. Poignantly she explains further: “While sometimes simply helping people to understand more about their body and what pain is and is not, can be enough for people to take their own steps towards changing their behaviour, for many others – and particularly people who are anxious about their health – it takes more.”

Bronnie also touches on the importance of sleep in pain management, on helping people recognize unhelpful thoughts and behaviors and how subsequently habits take time to change. Many topics and concepts in pain management are explained that include graded exposure, happiness and positive psychology , resilience, catastrophising and positive emotions, the importance of psychological flexibility as a backdrop to coping with pain, on the value of humility and using three words we might not say much: I don’t know, on developing a set-back plan for those rainy days that will inevitably come, and lastly at the congruence between what a patient prefers, and the actual dynamics of the clinical encounter.

Have a look at some of Bronnie’s articles if you want to know more about chronic pain, you won’t be disappointed.

Body in Mind

The Body in Mind Research Group is based at Neuroscience Research Australia in Sydney. We have active collaborations with researchers scattered around the world. Together we are seeking a better understanding of the interaction between the body, brain and mind in chronic and complex pain disorders.

What does Body in Mind want to communicate, exactly? Advances and issues in the clinical sciences as they relate to the role of the brain and mind in chronic pain disorders. There are three subplots we would like to convey, summarised by the three ‘C’s: complexity, credibility and creativity.

Complexity: We reckon humans are terrifically complex and that embracing this complexity will improve clinical practice.

Credibility: We want to provide information that is evidence-based where evidence exists, that clearly labels speculation as speculation and that is openly and without prejudice, peer-reviewed.

Creativity: We reckon that the chasm that seems to exist between scientists and clinicians is a nuisance. We reckon that if we can bridge this chasm, we will establish a creative space in which scientists and clinicians trust each other and really start to solve some problems. I know, grand hopes. Still, hopes create opportunities, surely.

How To Cope With Pain

The author of the site is a Board Certified Psychiatrist in practice for 15 years in Pennsylvania. The author shares “My guiding principle in practicing as a physician is to help patients in all areas of their lives – medical, psychological and spiritual. Chronic pain is a challenge to your spirit, but a challenge that can always be faced and your situation improved.”

The site has a large number of blog entries, and topics include breathing & relaxation exercises, and techniques to cope with chronic pain that include guided imagery and stress management.

The goals of the site are to:
1. to decrease pain as much as possible
2. to decrease suffering
3. to improve functioning – to live fully despite pain

It is worth checking out.