Other How to manage physical pain

barefoot

Sponsor
Has anyone had psychotherapy focused on managing physical pain?

I’m experiencing severe pain, which has been going on for several weeks. I can’t get any relief - no position is comfortable, pain killers don’t touch it, physio is on pause as not possible while the level of pain is so high.

The pain is just becoming all-encompassing. I can’t find an escape from it and it’s all I can think of and talk about (obviously very boring and annoying for other people, and I don’t want to be constantly moaning either!)
My therapist is away for a couple of weeks. Even so, talking to her about pain is…fine…? She is validating of the pain I’m experiencing and sympathetic. She also has a tendency to go into fixing/rescuing mode, being quite directive and trying to offer practical suggestions. But, while it’s good to have a bit of a vent and not feel I’m being boring bleating about how much it hurts, and it’s also nice to feel some care and compassion from her, it doesn’t help in any other way. Eg it doesn’t help me with managing the pain better or not experiencing it as all-encompassing…I just feel very sucked in, engulfed by the pain. And talking to my therapist about it doesn’t change that.

I know some therapists specialise in helping patients with pain and/or illness. Wondering if this is something worth me looking in to, if only for just a few sessions?

Does anyone know what this might involve? Is it likely to be more of a CBT approach?

Or, if anyone has any tips to share about managing pain, that would also be great.

I feel miserable about it, drained and exhausted and have no idea how long the pain will last or what might help. I don’t think that uncertainty is helping. Also think this feels harder because I’ve spent the best part of the last two years feeling unwell with chronic post-Covid symptoms - I was finally feeling that I was coming out the other side of that and starting to get myself, my health and my work back on track. And now this has happened and stopped me in my tracks. So, I think that is also compounding my low mood about current situation.

Anyway - any experiences or tips to share, I’d be grateful 🙏
 

Freddyt

MyPTSD Pro
We addressed mine through EMDR. It was deeply tied to my first trauma. In the end it wasn't real pain, just recalled pain. When my anxiety reached a high level it came on like gangbusters. It literally felt like my head was going to explode.

Now it only shows up when I am topping the charts anxiety wise. I know where it comes from so it rarely shows up now days. When it does I tell myself it's all in my head and to go away and mostly it does.

When it doesn't I use Ibuprofen 400 mg. to take the edge off and find engaging things to do to take my focus away. Once the edge is off the pan it's easier to tell myself its going away and usually it does.
 

Friday

Moderator
Does anyone know what this might involve? Is it likely to be more of a CBT approach?
IME Pain psych is about

- 80% disassociation >>> learning how to control & direct it; divorcing yourself from the pain, numbing the pain without numbing “you”, being aware of -so you don’t reinjure yourself- but not a slave to the pain, anxiety, and other physiological & psychological aspects of pain.

- 10% “Perseverance” skills >>> like stress management, & grounding, etc. for PTSD, it’s a foundational (new) way to live.

…or after one has mastered pain psych, &/or disassociation; reverse that, with 10% fine tuning directed disassociation & 80% perseverance skills…

- 5% Cognitive Distortions that accompany pain, and beliefs around pain (usually perfectly reasonable in the short term, become totally unreasonable & misery making in the long term) >>> particularly focusing on catastrophizing, mental filter, jumping to conclusions, & emotional reasoning.

- 5% ignoring others “validation” / self-fulfilling misery >>> Oh that must be so exhausting! It must be really frustrating for you! You must feel so helpless! Etc. >>> NOPE! Stop wishing exhaustion, frustration, and helplessness on me! 😁

^^^ rather than internalising it as the “correct” way to be thinking/feeling/acting and therefore a standard to live up to (because humans are social animals, and absorb the messages of others & internalise them, even when we’re trying not to, but a whole helluva lot less when we’re actively trying not to!). People telling you how terrible your life must be, with pain; is like some unholy amalgamation of inner critic + people wanting to know all the gory details (how exciting! -or- You’ll feel better if you just talk about it! -or- whatever well intentioned reasoning, or excuse for being nosy is) with PTSD.

ETA … There ARE short term / acute pain pain-psych schtuff out there, too. I’ve just never done it.
 
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Renly

MyPTSD Pro
I have struggled for years with pain in my neck - it wasn’t debilitating, but pretty constant & uncomfortable and cost me lots of $$ with frequent chiropractic visits. I never associated the pain with any of my traumas - just thought I had a bad neck. After EMDR-ing 2 memories where I had been strangled, I realized all the pain went away. Not sure if this is relevant to the type of pain you are experiencing, but maybe EMDR is an option?
 

Muttly

MyPTSD Pro
Have had chronic back and pain issues off and on for a couple decades (or longer?). And in October injured my back. Was in significant pain. It was finally starting to get better and I was back to work full time (although not full duty) and now i'm going backwards. Like you, it's almost impossible to find a comfortable position and regular meds don't help. As it's flared back up so soon, I assume I will need surgery. I feel for you, that you are also struggling.

From my experience, there's sort of three parts to pain. There's the physical sensation of pain, how the body reacts to it and the emotion/thoughts around it.

As far as the emotion/thoughts go - when I let myself worry about surgery, life long disability, the possibility there is no relief, etc, things quickly become all consuming and unmanageable. What I try to practice is accepting and then detaching the pain from the emotion and thoughts that can swirl. Yes, the pain feels awful, but it's the body's way of providing information. So I can thank the body (hard to do) for letting me know it's injured/sick instead of trying to deny. That was a hard lesson for me to learn. Trying to deny means I can damage the body more. It also means I end up focusing on the pain. Of course, that still leaves the uncertainty of what is going to happen to me. That's like managing any other big stresser. For me, I have to break it into small pieces. What can I do to help myself and what step can I take *now*.

As far as how my body reacts to pain, I know that when I'm in pain I clench up. This makes things worse. I also don't eat well and can have troubles sleeping. This is where basic self-care comes in. I may not be able to solve all the ways pain impacts me but I can do things that help myself.

And the last piece, the pain itself. That's where I totally agree with Friday. Dissociation can be a healthy coping mechanism. Or divorcing yourself from the pain. I play a lot of video games when the pain is really bad because it takes me outside my body. I also have DID so dissociation is a natural thing for me.

I think I adapted a lot of that from what I have read a therapist who deals with chronic pain does. Not sure if any of that will help or even makes sense
 

Freida

MyPTSD Pro
yep -- in fact I first started therapy to find ways to deal with fibro because I'm always in pain. It just varies in intensity.
Then I got diagnosed with ptsd
Then found out the two are connected.

I've done emdr on it and regular talk therapy and it helps me not make it worse by catastrophizing it.
But the biggest help I got was understanding the mind/body link. The book The Body Keeps the Score is my bible because it's all about what you don't feel emotionally you do feel physically. That whole avoidance thing becoming a pain in the ass - literally.

Then came the stress managment, the better diet, the yoga, blah blah blah. All things that help once I figured out that taking the triggers down can take the pain down. Don't get me wrong - I'm still in pain all the time. But I don't feel quite as helpless as I did in the past
 

Vickster

Learning
I'm struggling with finding help with my pain and this whole experience, but I found a piece that helps me.

It might be worth looking closely at what pain means to you.

I realized that early traumas made me associate physical pain with a threat against my life. So feeling physical pain makes part of me think I'm about to suffer greater pain and death. So pain has to be avoided at all costs.

I have learned that saying to myself "It's just pain" over and over when I'm climbing the stairs, for instance, makes it easier. I do it not to minimize the pain, but to not "maximize" it to meaning worse things. It normalizes it to what it is: a way my body tells me something is wrong with it. That helps me recognize that I have some control over it, unlike my earlier days.
 

whiteraven

MyPTSD Pro
I also have chronic pain, which is severe at times. I'm not very good at managing it, but my former therapist recommended mindfulness for pain. I do find it helpful; it has helped me become aware of the sources of the pain. I can't always do anything about it, but becoming more aware and relaxing the muscles at the pain's location does sometimes help.
 

Defaultxlove

MyPTSD Pro
my CBT is going really well. it doesnt take the pain away but she really helps me stay focused and motivated on health goals. such as managing pain.

hope you the best
 

barefoot

Sponsor
Sorry it’s taken me a little while to come back to this thread. I appreciate all your responses.

I should probably have been clearer in my OP - this isn’t pain linked to trauma, it isn’t psychosomatic pain or a chronic pain condition. Something happened three months ago, which caused a shoulder injury (I’m not sure exactly what’s happened - physio originally thought possibly some kind of damage to rotator cuff, now thinks frozen shoulder may be more likely) And I’m now experiencing intense, acute pain as a result, which I can’t seem to find relief from as yet.

So, I don’t think EMDR would be appropriate or helpful in my current situation. Sorry for not being clearer about the nature of the pain in my first post!

I’m taking max dose of paracetamol every day. I’m also already taking NSAIDS for something else anyway, so taking two prescription strength antibiotics-inflammatories per day. I’m sometimes topping up with codeine or tramadol (they’re not doing much for the pain, but are helping me relax and rest, which is something!)

I just had a steroid injection into the joint a week or so ago. Have had three physio sessions but she recommended pausing them to try to get pain under control first as the pain was too severe and the mobility in that arm is too restricted to do any movement exercises at the moment.

I’ve just had my fifth GP appointment about it this morning and she has now referred me to orthopaedics so a shoulder specialist can have a look and see what’s going on. Was amazed that she made the referral this morning and I am already booked in for an initial consultation next week! (NHS!) So, I’m pleased that that’s not much longer to wait and hopefully I will get some clarity around 1) what’s actually wrong with my shoulder 2) what can be done 3) what timescales I could be looking at for improvement.

So, I’m doing what I can going down the physical/medical route. But was wondering what could be helpful psychologically.

@Friday and @Muttly - interesting that you mention dissociation. I dissociated for years without realising - often when emotional feelings were ‘too much’ but also, I think, to get out my body when being in it didn’t feel physically good (including times of pain or illness) For quite a long time in therapy, it was a goal of mine to stop dissociating as I had been. And somehow, I have got to a point where I don’t really do it any more. Perhaps I just mildly space out a little if I’m talking about something that is emotionally very difficult, but that’s about it. So, I’m curious about this idea of dissociating…and of how I can now do it intentionally and deliberately. I quite like the idea of floating around outside my painful body at the moment! Are you meaning you get yourself into a dissociated headspace so that you are ‘gone’? Or are you more meaning you find real time, in the moment distractions to get absorbed in?

@whiteraven - did you find the mindfulness for pain helpful. Are there any particular bits you remember being helpful that you might be able to share?

@Defaultxlovee - great to hear that your CBT is helping you to manage your pain. Is there anything specific you’re able to share with me that has been particularly useful (especially anything I could do myself?)

Thanks again for all the responses and I’m sorry to see that so many here experience a lot of pain. Sending some soothing vibes out to you all!
 

whiteraven

MyPTSD Pro
Something happened three months ago, which caused a shoulder injury (I’m not sure exactly what’s happened - physio originally thought possibly some kind of damage to rotator cuff, now thinks frozen shoulder may be more likely) And I’m now experiencing intense, acute pain as a result, which I can’t seem to find relief from as yet.
Oh, this is horrible pain - I'm so sorry you are dealing with it. I broke my shoulder a number of years ago then it took almost a year for it to stop hurting. I mostly used ice, if I recall, and I had to sleep in a recliner because lying in bed was too painful.
I’ve just had my fifth GP appointment about it this morning and she has now referred me to orthopaedics so a shoulder specialist can have a look and see what’s going on. Was amazed that she made the referral this morning and I am already booked in for an initial consultation next week! (NHS!) So, I’m pleased that that’s not much longer to wait and hopefully I will get some clarity around 1) what’s actually wrong with my shoulder 2) what can be done 3) what timescales I could be looking at for improvement.
This is good news! I was referred to an orthopaedic guy and he immediately recommended surgery. I opted not to have it; it took awhile to get better, but I haven't had any issues with it since. Keep us posted!
did you find the mindfulness for pain helpful. Are there any particular bits you remember being helpful that you might be able to share?
Absolutely. I don't know if you've had any formal training in mindfulness - I had had, which I think really helps, and I did the mindfulness for pain on my own. I used a CD - Mindfulness for Pain Relief Management, by Jon Kabat-Zinn - and the most useful thing for me was learning to "breathe into the pain." You sort of fill up the space where there is pain with your breath - honestly, it is the best thing for me. Mindfulness is about being aware and present, and we typically try to ignore or avoid pain, so it takes some practice, but it really works for me.

I am studying color therapy, and I also visualize colors (usually green, as a healing energy) filling those painful spaces.
 

Muttly

MyPTSD Pro
. I quite like the idea of floating around outside my painful body at the moment! Are you meaning you get yourself into a dissociated headspace so that you are ‘gone’? Or are you more meaning you find real time, in the moment distractions to get absorbed in?

For me the answer is both. Right now, my pain is way up there. I'm not about to get in a dissociated head space in the moment. Well, not able to stay there, so I'm finding distractions to get absorbed in. (Video games that don't require a ton of thought, because I can't think, but keep my focus). The fact that I can't get in a dissociated head space is probably in part because I didn't start trying to cope with it soon enough. I let it get overwhelming. I may also be worried/frustrated about what's going on.

When I do what you refer to as dissociated headspace, it sometimes happens without my conscious thought. If I feel there's things I have to do, I just disconnect from the body. Can't explain that one. When I am some place at home, where I can "Zone" out, I create stories inside my head and disappear inside my head. I suppose maybe that sounds weird? I just create very vivid, elaborate stories that take all my concentration and live in that life, instead of the life my body is having.

I am not sure if that is helpful or even makes sense. As I mentioned, not thinking the best.
 
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