Dear Dr. Karpel:
I’ve had pain in my knees for 5 months. The doctor can’t find the reason. I’m taking pain medication, but he won’t raise the dose any higher. I don’t want a higher dose, anyway, because I don’t like the medication. It makes me dopey, and I try not to take it, if I can. But because of this never-ending pain, I don’t feel like doing anything anymore. I used to love to get together with all my friends. We had so much fun. Now I stay home all the time. My doctor has me taking anti-depressants, but I still feel like this pain has taken the joy out of my life. I just don’t know what to do anymore.
Mae
Dear Mae:
When pain is continuous and has no clear source, it can cause a lot of physical and emotional distress, which can cause an increase of the pain. This is called the pain cycle and it usually snowballs, the pain causing depression and the depression causing further pain. It sounds like that’s what’s happening with you. This something to be concerned about because you’re now no longer moving about and doing all the things that previously kept you physically and psychologically healthy.
This is how the pain cycle works: the pain leads to lowered activity and increased use of medications that cause lethargy and fatigue. This leads to further decreased activity, which leads to social isolation, boredom, less flexibility, less strength and stamina, and less ability to cope with the daily stressors of life. Then this leads to depression and anxiety, which further causes a lower tolerance to pain, greater sleep disturbance, and increased fatigue and muscle tension. And, as you can imagine, this leads to increased pain and the whole pain cycle repeats with even greater intensity. Does this sound familiar?
To break the pain cycle, you need to approach it from several different angles. First of all, relaxation techniques can reduce the stress that’s caused by the continuous pain. They can also help you cope with the daily stressors of life that have become more difficult to deal with because of your pain. Also, relaxation techniques may reduce pain by releasing endorphins in the brain. These are natural pain-relievers, as well as mood elevators. Additionally, relaxation exercises decrease the symptoms that are caused by stress, such as sleep disturbance, fatigue, and muscle tension, which all tend to aggravate pain. Here’s a simple relaxation exercise you can try anytime, anywhere, and you can use it as many times as you like during the day or night: Close your eyes. Breathe in and out slowly 3 times. Imagine you can see your breath entering your body as a pink mist. See and feel that pink mist circulating healing oxygen throughout your body. See and feel it surrounding your pain, soothing it. See it leave your body as a blue mist, as you exhale, taking your pain with it.
Increasing your pleasurable activities, in spite of the pain, is also important for breaking the cycle of pain and depression. Enjoyable activity can serve as a distraction from your pain and it can decrease your social isolation. Therefore, it helps improve your mood.
However, Mae, remember to pace yourself. This will help you to increase your activity level while limiting how much you’ll end up paying for it with a further increase of pain. Pacing yourself involves being careful to alternate between activities that are more physically demanding and easier activities. Also, don’t be afraid to ask for help when you need it. And schedule enough time to recuperate after being active.
Finally, changing your beliefs about you and your pain is also important for breaking this cycle. Replace negative self-statements of being “broken” or no good because of the pain, with such statements as, “I may have pain, which limits what I can do, but this doesn’t mean I’m any less of a person.”
None of these suggestions are magical cures to eliminate your pain. But if you can get on with your life in spite of the pain, you may notice that you feel more in control of your life, rather than feeling ruled by your pain. And this will ultimately break this cycle and help you, once again, to have the joy back in your life.
