Wellbeing

How to cope with pain

If you have a health condition, pain may be part of your life. But there are ways that you can help yourself cope, as Rachael Healy explains.

Coping with pain - illustration

“We tend to think of pain in physical terms, but it’s more complex than that,” says health psychologist Helen Poole, Reader in Applied Health Psychology at Liverpool John Moores University. “Our perception of pain involves how we think and feel about it.”

Pain can be a common part of living with heart and circulatory conditions – from the chest pain of angina and limb pain of peripheral arterial disease, to the recovery period after surgery. It becomes ‘chronic’ when it lasts for longer than three months.

Pain becomes ‘chronic’ when it lasts for longer than three months

“Those who have chronic pain can become anxious and distressed, not just because they are experiencing pain, but also because of worrying about the cause of pain, how long the pain will last and the negative impact it’s having on their everyday lives and social activities,” Dr Poole explains.

“Additionally, some people will have concerns about medication use in the longer term for their chronic pain.”

Psychological approaches are often used to help patients with long-term pain get on with their daily lives. “It’s important to emphasise that being referred to a psychologist doesn’t mean that the pain ‘is in your head’,” says Dr Poole.

“Psychologists can help with managing the stress and anxiety associated with pain, changing behaviours, and train you in coping skills.”

Exploring treatments for managing pain

There are several treatments and techniques, with growing evidence showing their benefits in helping you manage pain.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is now widely available on the NHS, for pain management, depression, obsessive compulsive disorder and other conditions.

“CBT is part education and part therapy – it can help people identify and understand the negative thoughts and behaviours that accompany pain and teach them coping strategies and relaxation techniques,” Dr Poole explains.

“The behavioural element also includes encouragement to re-engage with daily tasks and activities.”

Acceptance and commitment-based therapy

Acceptance and commitment-based therapy (ACT) is another common treatment. It can teach you how to accept and then move on from pain, making it more manageable and allowing you to get on with your life.

It also helps you find ways to work the techniques into your everyday life, so they can be useful in the long term.

Mindfulness

Mindfulness, too, is increasingly being made available to patients. It has some similarities to ACT. Dr Peter Malinowski, Reader in Cognitive Science and Director of the Meditation Research Lab at Liverpool John Moores University, has been exploring the ways mindfulness can help with pain.

“Mindfulness is a term with two meanings,” he says. “One, referring to a state of mind where we are able to observe arising experiences, including pain, without automatically judging them. The other meaning relates to exercises to practise this state of mind. Usually, this is mindfulness meditation.”

It means you’re able to accept whatever sensation, whatever emotion arises in your mind, and have some flexibility around it

Dr Peter Malinowski

Most patients offered this treatment complete an eight-session programme. “They learn this mindful quality, so that they’re able to relate to their pain in a different way,” says Dr Malinowski. “The idea is that afterwards, they then continue with it in their lives as they see fit.

“People are able to live much better with chronic pain. Not that the pain goes away, but how they relate to it changes as a result of the practice.

"It means you’re able to accept whatever sensation, whatever emotion arises in your mind, and have some flexibility around it so that actually you can deal with it. I think, not only for pain but also for other chronic conditions, this is the key to success.”

A 2016 analysis of existing studies into mindfulness- and acceptance-based treatments, by researchers at the University of Twente in the Netherlands, showed their effectiveness for patients experiencing pain.

The majority responded well to treatment and managed to incorporate techniques into their life, leading to benefits even after treatment had ended.

Breathing exercises

Breathing exercises, such as slow deep breathing and alternate nostril breathing (often associated with yoga), are sometimes used to manage stress and anxiety levels.

Study reviews have shown that paced slow breathing has been associated with pain reduction. It’s also easy to try at home, and can form part of a meditation session.

Coping with pain - illustration

Using meditation and acceptance to help manage pain

Sulakhan Singh Dard, 78, from Leicestershire, has had a heart attack, two heart operations and experiences ongoing pain from various health conditions. Regular meditation has helped him cope.

“I sit down, concentrate and relax,” he says. “You’ve got to have a quiet room, maybe the spare room or study, or the open air of the garden. Close your eyes and take your vision inside to the part of the body where it hurts.”

If your mind is strong, then your body will be stronger

Sulakhan Singh Dard

Sulakhan’s meditation practice is based in his Sikhism. “I chant ‘waheguru’,” he explains. “Keep doing it quietly. Sit for two minutes, five minutes, 10 minutes – whatever you can. Forget about the rest of the world.

"So many things will come to your mind, but you’ve got to somehow shove them off. And it takes time, it won’t happen straight away – it’s a practice.”

Ideas of acceptance and positivity (which are also part of CBT, ACT and mindfulness) are also helpful to Sulakhan in dealing with his health issues.

“Say to yourself: ‘The ailment is not stronger than me, I am stronger than the ailment. It’s only passing through and I will get over it’,” he explains. “You will lessen your pain and give yourself strength. If your mind is strong, then your body will be stronger.”

Coping with pain after surgery

Post-surgical pain can be easier to deal with than chronic pain. “Expectations about having pain, knowing this might happen and how long it might last can make it easier to cope with and manage,” says Dr Poole. “Many people can use simple distraction, relaxation and/or mindfulness techniques.”

But for some patients, an operation or procedure develops into long-term pain. Dr Poole and Dr Malinowski are currently working together on a study looking at the potential benefits of mindfulness for women having a hysterectomy, which leads to chronic pain for around one-third of patients. Participants begin mindfulness sessions two weeks before their operation and then continue afterwards.

Whether post-surgical or chronic, the key to managing pain is adjusting expectations and thinking patterns

“The study is still running so we don’t have complete data yet, but from the pilot study we did before, we have seen that people tend to return to work earlier and need fewer pain medications,” says Dr Malinowski. “So it looks like there could be potential benefits… My dream is that this is something that can be offered more widely.”

Whether post-surgical or chronic, the key to managing pain is adjusting expectations and thinking patterns. “It can have an immensely positive effect if people are supported to manage and cope with their pain themselves,” says Dr Poole.

“Accepting there is no cure for pain and moving forwards with valued goals, reengaging with daily life and activities, can have a tremendous impact on people’s mood, sleep, relationships and quality of life.”

Sulakhan says: “Pain and suffering is part of life. I still take medications and see my doctors, but I play my part too.”

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