Effective Chronic Pain Management is a Right and a Responsibility

Posted on Thursday, June the 2nd at 8:23am

By: Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II

Can you imagine what it’s like to live with chronic pain day in and day out?  If you have chronic pain, you know all too well what I mean.  Or perhaps you know someone suffering with chronic pain.  For those who don’t have a personal experience of living with chronic pain, going through the following steps may help you to develop understanding, compassion and empathy for those who do.

1. Think back to a time when you hurt yourself in a fall or accident, or you had a painful condition such as surgery, a bad toothache or headache. 
2. Remember what it felt like to be in that much pain and what you wanted to do in order to stop it.
3. Now imagine you are experiencing that level of pain right now, and that you have had it for the past six months without any relief.  Every day when you woke up, assuming you were able to fall asleep, it was there.  Every night you wonder if you’ll be able to sleep because the pain is so disturbing.
4. Now imagine trying to explain this to your family and friends, or your healthcare provider.  What would you say to them?  What would you want from them?

For those of us who are living this way or have lived with an ongoing chronic pain condition, we know what it’s like.  Some of us give up trying to explain our pain to others—they just don’t get it!  Others continue to try to seek help, but sometimes in ways that are not in their best interest for effective chronic pain management.  Some people are on a quest to find a magic solution or just the right pill, procedure, healthcare provider or technique that will allow them the relief they want, or a plan that will help them effectively manage their chronic pain.

First of all, there is nothing wrong with wanting pain relief.  However, it may be unrealistic for some people with certain types of pain conditions to ever be pain free.  In this instance I ask my patients: even if you had a certain level of pain, would it be all right if you never had to suffer with it again?  Of course they answer yes. 

But here is the challenge—effective pain management is not only a right, it is also a responsibility. So my next question is: are you willing to do the work required for effective chronic pain management and freedom from suffering?

So what does take to be free from suffering?  The answer will be different for each person, but there are some general areas that are important to focus on and develop.  To begin, it is essential to identify and deal with all aspects of a person’s pain condition and its impact on the whole person. 

To do this an effective chronic pain management treatment plan must contain three major components: (1) Effective and safe medication management; (2) A plan to manage the psychological/emotional components of the pain; and (3) A proactive practice of non-medication based activities.

It is also important to investigate all aspects of the self: (1) physical; (2) psychological (thinking and feeling); (3) social/cultural; and (4) spiritual.  Interesting, these are the four areas that are impacted when living with chronic pain on a daily basis.  It is not just the physical body.  This means that if a treatment plan does not adequately address all four areas, a chronic pain management plan will not be as effective and may even lead to ongoing suffering.

In Western medicine the Spiritual area is often not addressed at all.  I consider the Spiritual aspect of self as the glue that contains and nourishes all three of the other areas.  I always ask my patients to explore this important part of their self.

I believe it is crucial to address the whole person in order to develop an effective chronic pain management plan and obtain the best treatment outcomes—but especially freedom from suffering.  Part of my initial evaluation session includes scoring each of the four areas of self—Bio-Psycho-Social-Spiritual.  Each area is scored on a 1 to 25 point scale.  This score is the starting point—if it’s low, it can be brought up and if it seems high, it is important not to become complacent as it can always come down.

It is important to look at the components needed for each of the four areas before looking at the total score.  In the Biological area there are interventions such as diet/nutrition, sleep hygiene, activity pacing, and stress management, eliminating or reducing nicotine, caffeine and sugar, etc., as well as having an effective medication management plan in place.  If the score is 1 to 3, that person should be in the hospital, and if the score is 25, they’re ready to run a triathlon. 

In the Psychological area I list examples like managing self-defeating defense mechanisms (or denial), positive thinking and feeling management plans, therapy or counseling, daily balanced structure, etc.  If the score in this area is 1 to 3, they need to be in the psych ward, and if it’s at 25, they’ve reached enlightenment.

Next is the Social area where I list ideas such as letting go of enabling friends/family members, setting assertive limits and boundaries, developing a chronic pain support system, connecting and communicating with family and friends in a healthy manner, etc.  This time if the score is 1 to 3 they are hermits ready for a cave, and if it’s 25 they are a well connected social butterfly.

Finally in the Spiritual area I list ideas such as prayer, meditation, finding peace in nature, working the steps if in a 12-Step Program, spiritual practice, religious practice, etc.  If the score is 1 to 3, they are totally cut off from their spiritual connection, and if it’s 25, they are in total harmony.

I’ll have clients pick a goal in their lowest scored area and commit to a proactive plan of action to raise that score.  When they accomplish that goal, I have them go to the next lowest box and do the same thing, as well as repeating the process for the final two areas.  The object is to keep moving forward.  The healing process is like walking up a down escalator; if you stop moving you go down.

People who are willing to develop a treatment plan that includes medication management, psychological/emotional healing, social/cultural and spiritual growth have a much better chance of developing and maintaining an effective chronic pain management plan, as well as finding freedom from suffering.  Remember, this is a right, and also a responsibility.