Empowering Life Beyond Pain: A Q&A with Beth Darnall, PhD
09.01.2016
Well, I wrote a whole book on this topic, but three things immediately come to mind:
- Understand the risks and consequences of opioids so you can make an informed choice about whether to start them or not. I can’t tell you the number of times I had patients sitting in my office, upset, saying “If only I’d known I never would have started taking them.” That was a major reason I wrote Less Pain, Fewer Pills: Avoid the Dangers of Prescription Opioids and Gain Control Over Chronic Pain, to give patients the information they weren’t getting. The whole first half of the book is opioid education so readers can make informed choices about their pain care.
- There is so much you can do to reduce your need for pain medication. Regardless of whether you take opioids or not, be sure to focus on learning everything you can about pain management and self-management, because it will help you need fewer doctors and fewer pills.
- Opioids come with a lot of side effects that can actually worsen pain. Opioids disrupt sleep and this can cause daytime fatigue and worse pain. Opioids also disrupt hormones like testosterone, estrogen and progesterone, and these can have effects on mood and fertility. And opioids can cause greater sensitivity to pain, and greater need for medication. Avoid the trap of opioid dose escalation; taking more of what isn’t working is not a good solution and it greatly increases your risk for accidental overdose. Use a comprehensive treatment approach instead and optimize all low-risk strategies.
Catastrophizing is a term used to describe when you are thinking and feeling fearfully about pain, expecting things to get worse, worrying and feeling helpless about it, and not able to focus on many things other than the pain and how awful it is. I give a pro-bono single-session class to patients at the Stanford Pain Management Center on how to gain control over catastrophizing. In truth, you could catastrophize anything in life—your job, your relationship, finances. But in the context of pain, catastrophizing exerts a toxic influence, so learning to stop it is key. The first step is learning to identify when you are catastrophizing. Once you are able to identify when it’s happening in the moment, there are several skills and techniques you can apply to control it. These are evidence-based skills rooted in cognitive behavioral therapy, and also some skills that calm the nervous system. I talk about catastrophizing self-treatment in both of my books. I also encourage patients to consider working with a psychologist skilled in pain management.
Women are more likely than men to have chronic pain. Women are 2-15 times more likely to acquire several painful conditions, like migraine, fibromyalgia, or lupus. Further, once chronic pain develops, women report greater pain intensity, and greater duration and frequency of pain episodes than men.
In short, pain is simply a bigger problem for women. For both sexes there is a great need for best pain care with the lowest risk, but I underscore the need to better address pain in women. In addition to having more pain than men, women are also more likely to have anxiety and depression, which increases the likelihood they are prescribed opioids. By focusing on treating pain with non-opioid options – especially with behavioral strategies that are effective for pain and psychological issues – we can alleviate pain and suffering while also lowering risks.
Opioids have specific risks for birth defects in developing fetuses, so women of childbearing age taking opioids should be aware of this and speak with their doctor. Breastfeeding women should also speak with their doctor about their specific risks. Opioid use has also been shown to reduce estrogen and progesterone levels, which may have specific impacts for older women.
Many people will say that what’s worse than the pain is how pain has robbed them of their ability to engage in meaningful activities, like going to family picnics, school events, reunions, social dinners, or working outside the home—all of the things that once brought them pleasure in life. Over time, people may lose their connections, meaning, and aspects of their identity. And, without those important doses of pleasure, pain grows exponentially. As people withdraw from life because of the pain it becomes harder to focus on anything else. Empowering life beyond pain is all about reconnecting with the aspects of your life that are meaningful to you. It’s also about having compassion for where you are right now.
Maybe you were a competitive athlete and because of your chronic pain you are no longer able to compete or exercise strenuously. There may be a tremendous amount of suffering in the loss of your former life and abilities. Empowerment is about focusing on what you can do, right now, and working to expand that. Maybe you can sit outside and enjoy the peacefulness of nature. Maybe you can walk in the grass barefoot and experience movement and sensation in your body in a new way and build an appreciation for that. You can learn to work with your body and respect its limits, such that you are able to be more active on a consistent basis and avoid the “crashes” that come from trying to push beyond your physical limits.
Empowering life beyond pain is an active process. Rather than waiting for pain to get better or relying on doctors to fix pain, it’s about moving forward with what you can do, right now. Setting meaningful and achievable goals, learning and delivering good self-care practices, using skills to self-manage pain and stress, and learning to be kind to your body and yourself as life moves at a slower pace than you expected are key to effectively managing pain. The very act of engaging in active pain management shifts your energy, intention, and mental focus towards the positive.