Pain is not easy to define and in 1979, the International Association for the Study of Pain (IASP) published its first working definition of pain: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

This definition was reaffirmed in 1994 along with an extensive footnote discussion regarding its implications.  The IASP definition acknowledges that, for most people, tissue damage is the gold standard by which pain is understood.  However, the definition also recognizes that pain may occur in the absence of tissue damage and is impacted by emotional/psychological factors.

Psychological treatment for chronic pain needs to supplement medication treatment, not replace it. Emotional stress and negative thinking can actually increase the intensity of the pain, but the presence of psychological factors does not mean that the pain is imaginary. Psychological treatment goals are designed to help people learn how to understand, predict, and manage the pain cycle, how to use coping skills to minimize pain, and how to maximize active involvement in positive life experiences despite the presence of chronic pain.

Additionally, psychological treatment for chronic pain focuses on the emotional toll people experience living with pain on a daily basis. Important factors such as disability, financial stress, or loss of work are also a part of the pain picture, and psychological treatment is designed to address all relevant issues. The treatment for chronic pain does not include magical interventions; rather, it is a combination of proven psychological treatment approaches in addition to medication management and other non-chemical interventions that addresses all the issues people in chronic pain experience.

Once people understand the nature of their psychological pain, the treatment needs to focus on the emotional toll people living with chronic pain experience on a daily basis and must address all relevant concerns.  What is also very important, is to first help people tell the difference between their physical and psychological/emotional symptoms.  That is why I developed a two-part instrument to help healthcare providers to assist their patients to sort these symptoms out.  These worksheets are in both my Addiction-Free Pain Management® Workbook and APM™ Module One.  To learn more please check out our website www.addiction-free.com and go to our Publications page to review those books.

It is so good to be back in Sacramento.  A couple of weeks ago I spoke about how getting my favorite Acupuncturist back (Miles Roberts) was so great.  Well today I had my first session with my old massage therapist and that was also very special.  His name is Anthony Spearman and he is in the top five of all massage therapists I’ve been to over the past 26 years.

I want to take this opportunity to talk just a little about the importance of massage as one nonpharmacological component of an effective pain management plan. When using massage therapy you need to understand that there will be some immediate pain relief and reduced muscle tension, but it will be short-lived if not followed with other measures. This is understandable since there are many precursors or triggers for muscle tension that often resurface soon after a massage session. Therefore, other interventions must be implemented that are specific to each individual person, and must be used in the proper sequence.  Below I list some of the benefits for using massage to help treat chronic pain.

   Massage for chronic pain can:

1. Reduce Muscle Tension.  Muscles contract around any painful site to protect the area. If pain is resolved quickly, muscles relax. If pain persists, muscles can become habitually tight.
2. Improve Circulation. Tight muscles reduce circulation, letting waste products accumulate, which can leave you feeling fatigued and sore. Plus waste products can irritate nerves, causing pain to spread. Massage therapy releases contracted muscles and increases circulation. As massage relaxes the nervous system, blood vessels dilate to increase blood flow. Waste products are flushed away and replaced with oxygen and nutrients.
3. Stretch Muscles and Improves Movement. Eventually, the body lays down connective tissue in any contracted area with poor circulation. While helpful for healing injuries, this natural reaction can “glue” muscles and their connective tissue coverings into a shortened state. The stretching and kneading of massage therapy softens and lengthens connective tissue.

It is important to ask your primary healthcare provider whether massage therapy is right for you.  If so ask for referrals or ask other people living with chronic pain and use massage therapy who they would recommend.  Again it is crucial to use a multidimensional approach to mange your chronic pain.  To learn more please check out our website www.addiction-free.com and especially the Articles and Publications pages.

As anyone living with chronic knows sometimes it is very difficult to get a restful night’s sleep.  The National Sleep Foundation reports that 66 percent of chronic pain sufferers experience sleep problems. Only 15 percent of all people have sleep problems. Compounding the problem of disturbed sleep in people who live with pain is the fact that some chronic pain medications tend to disrupt sleeping patterns.

So what do you do when you live with chronic pain and need to sleep?  Do you give in and use potentially dangerous sleep medications or just suffer?  Most authorities recommend practicing good sleep hygiene, along with becoming very familiar with their sleep deprivation problem (i.e. understanding the cause). If sleep problems persist after implementing sleep hygiene practices, it may then be the time to seek medical help.  But what is sleep hygiene?  Below I’m putting the titles of the checklist I found on www.about.com a website devoted to educating people about back and neck pain.  If you want to see the entire checklist please go to that website and type in “Sleep Hygiene.”

1. Relax Before Bedtime
2. Watch Your Sleep Timing
3. Avoid Caffeine and other Stimulants
4. Don’t Smoke - in bed or at all
5. Exercise!
6. Don’t Exercise!
7. Use Your Bed Wisely
8. Don’t Toss and Turn
9. Don’t Nap
10. Check Out About’s Sleep Disorders Site

I’ve been helping people with this problem for a long time and have actually used most of interventions listed above.  One of the tools I also recommend for many of my patients is to use headphones with relaxation techniques, soothing sounds or music to help them to sleep. 

I also teach people relaxation response techniques that take about 7-10 minutes and one of the side effects is to reduce their sensations of pain.  Then we discuss the importance of their identifying and learning to better manage what I call their anticipatory pain. On our website www.addiction-free.com I have an article Coping With Anticipatory Pain that you may find interesting.