Chronic pain is different from acute pain. Acute, sudden pain is a signal to fight or flee, to struggle or run. Chronic pain by contrast is not an adaptive survival response but a nuisance, a defense gone wrong. It's like those car alarms in your neighborhood going off late in the night signifying not theft but inept parking -- solitary, unheeded, insistent, and typically useless.
But you can fight chronic pain. For chronic pain, here are seven experiments.
1) Make it worse first. Start with becoming aware of what makes your chronic pain worse. Three things that typically worsen pain are anxiety, depression, and attention to the pain. If you focus on chronic pain, it gets worse. Take two minutes right here and now to focus on your pain. Concentrate. You feel it more. So to some extent pain is under your control. And if you can make it worse, you can make it better.
Keep a daily journal for one week. You can use a calendar to record your pain on a scale of 0 (no pain) to 10 (worst pain) three times a day. When is it worse? Is the pain "just pain" or does it depress you, make you less a person?
Keep track of levels of fear, sadness, fatigue and what triggers them. This helps you map how the pain pulls on your attention and, conversely, what pulls attention away from the pain.
Chronic pain often coexists with post-traumatic stress disorder, so they need to be addressed together. We have suggested meditation or "nidra sleep" for post-traumatic stress disorder and those strategies can be added if you need them.
2) Cultivate intensity. Not only should you take your attention away from the pain and where it's living in your body, but you should actively direct your attention toward non-pain areas.
You might think that being relaxed will ease chronic pain. But, especially in the early stages of your campaign against chronic pain, move away from being passive, which lets chronic pain prey on you, and try being active, which breaks its hold on you.
Part of this "intensity" strategy is anger management. I don't mean just controlling or reducing anger, but directing anger so that you can use it for pain relief.
Try this exercise: Think of an issue, personal or political, that excites your moral outrage. As you focus on it and add energy to it, notice how your pain goes down and your energy goes up.
3) Become somebody else. When you have chronic pain, you are constantly -- even if at a low level -- signaling to the world how much pain you are feeling.
What does it mean, "become somebody else"? Through a process like method acting, you need to become somebody who doesn't have chronic pain. You start by hiding it from others, pretending it doesn't exist. Start with casual acquaintances or even strangers you encounter. Try to get them to say how well you look, how bright, strong, stable -- and pain free -- you look and act. Over time, add more people to this "play" you are performing, and then after you begin to master this, start with people closer to you. Try to get them to forget you have chronic pain.
We have relationships not just with others, but with ourselves. In the process of developing a pain-free self in relation to others we pay less and less attention to our chronic pain identity, a social role we have learned to play over the course of our pain history. As we learned from the experience of making it worse, pulling social attention away from chronic pain makes it better.
4) Be somewhere else. Your chronic pain lives in your body in one site or several, waxing and waning, migrating according what is going on in the rest of your mind, body, and social situation. To be somewhere else in your body, you are shifting away from the pain. Close your eyes and focus on a healthy, pain-free area of your body. If you become distracted, come back to your breath and then use your breath to refocus your attention on those areas.
Yoga consists of poses, breathing, and meditation -- all of which can be helpful. In a previous post, we talked about how yoga can help addiction recovery. If you've struggled with an addiction, you already know what it's like to hate what controls you but that which you can't live without. Chronic pain is like that -- you hate it, it controls you -- yet you have trouble unhooking from it.
6) Aspirin, or "blessed willow bark" as one of my patients calls it, can be thought of as a variant Ayurevdic remedy. Even if you hate medications or have found "stronger" drugs than aspirin ineffective, don't underestimate it either alone or as augmentation with other remedies.
Consider enteric-coated aspirin with your individual physician. The body does not become tolerant to this chemical. Unless you are on blood thinners or are allergic to aspirin, it's worth a try. Many of my patients and friends resist but after trying it come back surprised at its usefulness.
Aspirin taken without food or enough water can be harmful to the stomach lining, so always use enteric-coated pills and take it with meals. And if you are wary of pharmaceuticals, bear in mind synthesized aspirin is over a century old and was prized by the Native Americans of the great plains for years as an infusion of willow tea.
7) Utilize external stimulation. Massage, acupuncture, acupressure, hot packs, cold packs, transcutaneous electrical nerve stimulation (TENS), vibration, sonar, transcranial magnetic stimulation (TMS), aerobic exercise are all external therapies that can help direct your attention away from the site of pain.
This group of strategies is put here as mainly a placeholder. The subject is huge and fills whole books, but you might want to keep it in your quiver along with the other arrows.
I would love to hear from some of you out there who do try these measures. They work reasonably well for me most of the time. I hope that other chronic pain sufferers can find a little help from these simple yoga-based experiments.
Dr. James E. Groves is the author of The Harvard Medical School Guide to Yoga.
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