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The Realities of Psychological Pain Management
Michael A. Borders, Psy.D., ABPP The following narrative is
shared at the request of my clients because pain is a universal human
experience that many clinicians find difficult to working with. It is a part of
the human condition that cannot be ignored. It does not discriminate and is sometimes
readily visible and many times not so much. Managing chronic, unrelenting pain
can be a frustrating and daunting task for everyone. Compassion can make the
difference between managing pain and suffering with it. Most people would and
do respond with empathy and compassion once they understand just a little about
the experience of another. Hence, the narrative that follows.
Imagine for a moment waking
up from a difficult nights sleep in searing pain. You notice that your eyes and
cheeks are wet, not from sweat, but from tears. You have had a nightmare while
sleep, and for a moment the sleeping experience and waking experience mesh
tightly together. You have been unconsciously and uncontrollably weeping
through the night. It is now 3 am. Even though you have been asleep, you know
that when you wake up you will feel just as tired as you did when you went to
sleep the previous evening. Even so, the
sleep you were able to set in place by coaxing your body into relaxation with
the behavioral techniques you were taught in the early days of the diagnosis
and the help of prescription medications was a small respite.
Your family avoids the
issue, patronizes you, or tells you that “you don’t need to take all that
powerful medication”. They are led to believe that science has the answer for
what ails and that diet, exercise, vitamins, and supplements will work toward a
“cure”. To be fair, it is hard to
understand another’s experience of pain. The unconditional support,
understanding, and empathy required of personal and professional relationships
are often too difficult. The transition from companion to care giver requires a
delicate touch, lest the relationship be broken in the process.
Everyone seems to have “the”
answer for you. You want a cure but have experienced what the nightmare and
tears in the dark truly reveal. You find it hard not to loose hope in the
things you try; things that don’t work, and that increase your feelings of
guilt and failure. Your health insurance provider will pay for only what
“traditional science” suggests is the cure. You know that there are those that
have had the disease for 10, 15, or more years that have faced the nightmare of
being discontinued by their health insurance, either by issuing unreasonably
increased premiums or when COBRA ends after the loss of a job. The “lucky” ones
just get limits placed on treatments or medicine selections that they in turn have
to fight with each request for treatment.
All of this stress increases
the amount of pain and the amount of time spent in pain. Your tears in the dark
speak to the reality that a sense of helplessness is creeping in again, and no
one else seems to hear its soft footsteps. It is getting more and more
difficult to fight the thinking that the accident 5 years ago ruined your
chances of a comfortable lifestyle forever. As you lay there in the dark, with
silent tears on your cheeks, pain racing through your body, you realize that
the future will likely be filled with the struggle against daily pain equal to
or, heaven forbid, greater than the past. You try to think of more pleasant
things to prepare for another day as sunlight breaks into the room. The previous
evening was difficult. But it was not unlike most evenings you've experienced
over the last few years of this relationship with pain. With feelings of guilt, depression, anxiety and helplessness
you take the prescribed narcotic pain medication, so that you could spend a few
hours with the pain in the background and your family and significant
relationships in the foreground of your experience. As usual, the cautiously
and judiciously prescribed medicine, manages to dull the pain enough to give a
temporary release from the agony and allow you to spend some “quality” time
with your spouse and children. As you know now, getting out of bed to shower is
a small victory. You have discovered that for you, pain cessation is the myth
and that the reality is daily pain management.
It is also important to talk
about the feelings of anxiety and depression that of a common feature of
chronic conditions such as Fibromyalgia. Some of this seems to come from the
disabling aspects of the illness. Less talked about are the anxiety, guilt and
depression many feel when they have to depend on powerful narcotic medication
to get through the day and virtually beg for understanding and empathy from
others in their social network and those upon whom they have to depend for
healthcare. The psychotherapist’s cognitive and behavioral techniques help
somewhat but pain management does not often fit into a nice neat box like the
25 (if you are fortunate) or so 50 minute sessions. This often leaves the
person with feelings of failure for not doing the cognitive and behavioral
techniques right.
The extreme exhaustion that
Fibromyalgia patients and those with other pain conditions experience is a
product of muscle spasm, over-extended psychological coping resources, and
“pain dreams”. During the pain dream experiences, the person is in excruciating
pain while in the dream. Many report that the sound of their own moaning from
the pain wakes them up several times during the night. It’s then that they often realize that the
actual pain was so bad that it became the main part of the dream state as their
mind and body attempted to unconsciously cope. They report that the wide awake
pain is always in the exact spot that they were dreaming about.
The label itself can be a
hurdle to overcome. Helping professionals react differently to potential or
perceived “failure”. The reality is that some professionals read the diagnostic
label and cannot get past the packaging. There are those who use the labels as
the signal to avoid working with the person. It is not an issue of “scope of
practice” as much as an issue of “scope of assumption”. People will often
assume the worst based on nothing more than a label. The label of Fibromyalgia,
for instance, seems to cause even the presumably open and empathic “helping
professionals” to be reluctant to move beyond “traditional approaches” to
treatment. Implicit to some diagnoses is the assumption that our art and
science is inadequate to help the person feel better and be productive with
their lives. There are some conditions that are quietly considered
“untreatable” and providers make assumptions that support their reason to avoid
working with those who have been diagnosed with them.
A common experience is that
of one of my well educated, very credible, hard working and well respected
professional clients. He was once told by a physician that ONLY overweight,
lazy, stressed out women, who don’t want to work get Fibromyalgia. Another was
dismissed outright by a respected “pain specialist” at the Washington Hospital
Center in Washington, D.C. who revealed at the end of the billable consultation
that he “did not believe in Fibromyalgia” so there was nothing he would
do for the woman’s needs. Again, imagine that you are 42 years old,
accomplished in your field; at least formerly, and was hoping that the hard
work, formal and informal study disciplines and significant financial
investments you have made would “pay off “ for you and your family with a
comfortable lifestyle in your middle and later years, your slice of the
American pie. Imagine that the places where you expect to find understanding,
empathy, and positive regard cease to exist.
The experience of pain poses
an existential challenge to everyone who encounters it. I have worked to repair
the damage caused by physicians, psychologists, and other mental health
professionals who either cannot or will not address the challenges faced by
patients with Fibromyalgia, Sickle Cell Anemia, peripheral neuropathy, phantom
limb or other forms of chronic, severe, debilitating and, as yet, incurable
pain or illness. These patients cry for understanding, acceptance, warmth, and
empathy. Their sense of personal dignity is often betrayed when they have to
beg their closest friends, family, and so called helping or healing
professionals for these essential and easily provided healing relational
components.
A corrective to this problem
lays in the team approach. With the patient in the driver’s seat, the
multidisciplinary treatment team is quite powerful. The more complex diagnostic
conditions like Fibromyalgia beg for a team approach. Two things are
accomplished here. First, a support system is constructed. Second, there are
more tools available with which to create uniquely tailored solutions.
Complimentary and alternative approaches are more accepted into the team
approach. There is also the perception of both shared risk and a greater
potential for success.
The experience of physical
and psychological pain as described above is very real for many more people
than what psychologists and physicians might believe. Pain, as the narrative
describes, introduces to us biological, psychological, social, and spiritual
challenges that often transcend the clinician’s theoretical frame of reference.
It challenges the helper and healer in ways we are often reluctant to admit. A
synergistic set of healing relationships can be created for the person,
however, if we are willing to hear their story. Part II to follow at a later date...
Dr. Borders regularly consults with people of courage who participate in High Risk Occupations (HRO). These include military, law enforcement, fire, aviation, and security services. Many of these people and their families have special needs and financial difficulties that deeply impact their overall quality of life, health and well being. Young military members and their families in particular will have life long special needs as a result of their courageous service on our behalf. Please consider giving $5, $10, $25 or more to help GPI continue in it's efforts to meet these special needs. *GPI is not a nonprofit organization and donations are not tax deductible. Donations can be made by clicking on the blue payment button above. |