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There’s more to pain than painkillers

Reaching for painkillers without getting curious first about the nature of your pain and the clues that it’s giving you, can leave you worse off in the long run.

According to the United States Department of Health and Human Services (HHS), America is in the midst of an ‘opioid crisis’, with:

  • $9 billion in grants from HHS to states, tribes, and local communities to fight the opioids crisis in FY 2016-2019
  • 14,000+ substance abuse facilities in the US
  • 1.27 million Americans now receiving medication-assisted treatment (which combines behavioural therapy and medications to treat substance use disorders)

Sadly, while not quite on the same scale (yet) as the US, the UK is also showing signs of dependence on prescription medicines. Indeed, in the year ending 2018, one in four UK adults had been prescribed at least one class of prescription medication for pain or mood.

This all begs the question: Is it time we rethink our attitude towards pain and how we deal with it?

Pain in 3D

Now we often talk a lot about the physical aspect of pain, but whatever your experience may be, pain is always in all three dimensions of the physical, mental and social.

In our last blog here, we talked about the physical aspect of pain, including what it is, why we get it, how it’s measured and what it means. Today, we’re going to look at the mental and social aspects of physical pain, completing the overall 3-dimensional analysis. 

Now this is not to be confused with the mental pain you experience, for example, following a bereavement or the social pain you might encounter following rejection or being excluded from a group of your peers, but rather the mental and social aspects that physical pain can have.

What’s your own relationship with pain?

You may not be aware of it but we all have a relationship with pain and that relationship will influence your experience of it. It’s important to realise that pain is designed to be uncomfortable; if it wasn’t we wouldn’t take the action needed to address the cause of pain when we experience it. In our last blog, we talked about why pain shows up and the vital clues it contains.  Depending on your relationship with it, you may be missing valuable clues about what the pain is drawing attention to. 

Now some people take paracetamol at the first sign of a headache. Others choose to rest and hope it will pass. Some folks battle through it, choosing neither to take medication nor divert from what they were doing, adamant that the body will heal itself. Then there are those who are so affected by pain that they actively avoid any situations where they might experience it.

Paul and the approach of ‘Paracetamol and carry on’. 

Consider Paul. He came to The Helpful Clinic a few years ago because his stomach and abdominal symptoms were getting progressively worse to the detriment of his ability to work. When asked how long he’d had these pains, he said about three to four years.  When asked how he’d handled them he replied: “Paracetamol and carry on”. 

Interestingly, when he applied the ‘is it helpful?’ question to taking paracetamol, he was shocked to realise that it didn’t actually make a blind bit of difference.  His belief in the “Paracetamol and carry on” approach was so strong that he hadn’t actually paused to check.  It dawned on him that he’d taken somewhere between 6,500 and 9000 paracetamol tablets during this time without the benefit of actually relieving his symptoms. And, during that time his symptoms had got increasingly worse because the underlying causes weren’t addressed. Not only that, this steady and significant long-term use of paracetamol had adverse effects (click here for research relating to adverse long term effects of the use of paracetamol).

What do you do when you experience pain? It probably varies somewhat and depends on what type of pain and where in the body it is, but you’ll likely have a default response that is linked to your most powerful response of all: your survival response, that is your Fight – Flight – Freeze response. 

Pain and the fight-flight-freeze response

Your stress or survival response is your most powerful and primal response and it kicks in whenever there is a perceived threat.  Guess what, pain is spotlighting a potential threat, drawing your attention to the fact that there’s something going on in your body that needs tending to. 

Although we all experience all of these three behaviours of the stress response, most of us tend to default to one:

  • Attempt to fight the pain and push through it regardless (the fight response)
  • Try to avoid any situations where you might experience pain (the flight response)
  • Numb any pain experienced (the freeze response)

Beliefs about pain

The second influential factor about your experience of pain is your beliefs about it. How do you view it? For example, people like weightlifters and bodybuilders often view pain as a positive experience, believing they are actually making gains when they experience it, hence the ‘no pain, no gain’ motto.

In a similar vein are those who tend to grit their teeth and tolerate pain because they believe doing so is a sign of strength and makes them appear macho. They may believe that pain is an inconvenience, slowing them down and getting in the way of their goals and aspirations.

Others believe pain is bad news and dash off and consult Dr Google at the first sign of it. While there is nothing inherently wrong with this, doing so often increases feelings of anxiety because people end up self-diagnosing something that is usually far worse than the actual reality. For example, a simple headache caused by a lack of water could result in someone believing they have a brain tumour.

You may have a mix of these or similar beliefs and whatever your beliefs are, they are shaping how you deal with pain and whether you’re actually mining the information the pain is giving you.

Robert Dilts and his colleagues, Tim Hallbom and Suzi Smith wrote a seminal book about beliefs not just in terms of pain but health in general.  It’s described as ‘… the most revolutionary book available to offer leading-edge technologies that rapidly and effectively identify and remodel limiting beliefs.’ 

The fear of pain

Regardless of how you react when you experience it and the beliefs you have, most of us have a natural fear of pain. From an evolutionary perspective, this makes sense. We’d never knowingly put ourselves into a situation where we are more than likely to experience pain, right? After all, such situations could lead to our demise, which definitely wouldn’t be helpful!

It’s also not necessarily the fear of pain itself, but the thought that it might get worse that is difficult. So physical pain is one thing, but doubled with the anxiety that it could escalate serves to exacerbate the situation further. It drives up the stress response which means our adrenaline, cortisol and other stress hormones become elevated.  Whilst these hormones can be helpful in the short term and indeed can provide ‘in the moment’ pain relief, over a longer period of time, it leads to worsening of symptoms and reduces the body’s ability to process what’s going on.  

This goes back to us all having thoughts and feelings about our thoughts and feelings (something we talk about a lot here at The Helpful Clinic). Feeling pain and then fearing it getting worse can actually make that happen.

Pain and medication

As mentioned, some people’s first response when they experience pain is to immediately reach for the painkillers. Is this your default response?

Now there’s nothing to say that reaching for painkillers is necessarily a bad thing. As always, the pertinent question to ask is: Is it helpful? And sometimes , the answer to that question when it comes to taking painkillers at the onset of pain is “yes”.

This is not about throwing the baby out with the bathwater but rather to get curious and check, is it actually helpful? And by addressing your pain in all three dimensions you’re much more likely to achieve long lasting and sustainable results.

Practice your ABC First Aid for Feelings

Everything starts with Awareness

If you’re not aware of what’s going on, you can’t affect it. If a situation arises where you experience pain, a helpful response would be to start by remembering your ABC for Feelings

A Start with Awareness. Become aware of what you are thinking, feeling and doing? Make a note of it, write it down, describe it to yourself. 

B Then come to your breath and body by pausing and bringing your attention to your breathing. Wriggle your shoulders and your toes. Pay attention to what the experience of your body feels like.  in this moment

C Finally, get curious about your choices.  What might this pain be about? If the pain had like a cartoon speech bubble coming out of it, what might it say? Do you need professional support to help you crack the clues? How are you responding to it? Is it helpful? What might be a more helpful response?

The power of self-compassion 

Have you ever considered how self-compassion can potentially help with pain? Research has shown that self‐compassion can improve functional and health outcomes among multiple chronic illnesses. As this research paper concludes: ‘self‐compassion may be a relevant adaptive process in those with chronic pain. Targeted interventions to improve self‐compassion in those with chronic pain may be useful.’

Now don’t think that practising self-compassion is a selfish act. It’s not. As highlighted in our self-care blog last year (here), looking after your own needs first actually puts you in a better position to help those around you. That’s why making time for yourself doing activities that you enjoy and having meaningful conversations with yourself, is actually really important.

Here are some ways you can practise self-compassion:

  • Allocate some ‘you time’ with no distractions or disturbances to, for example, read a book, watch your favourite movie or offload your thoughts by writing them down
  • Eat your favourite food every now and again, even if it’s not the ‘healthiest’ option available
  • Pay attention to how you talk to yourself and bring the kindness you’d give to other people, to yourself
  • Make sure you’re getting enough sleep, water and physical activity
  • Speak to people you trust and share how you are feeling

Inner Critic Alert! 

It’s worth noting that when we’re in pain, our Inner critic can go into overdrive. It’s a well-documented phenomena that mood can drop after illness, e.g. a viral illness. This research published online by Cambridge University Press contains some great information on the potential fallout we may expect following the Covid-19 pandemic in terms of impact on mental and social health.  

Our invitations to you…

You’ll know that in every blog we invite you to get curious and ask helpful questions. Here are our three invitations for you today:

  1. Get curious about your own relationship with pain. What do you tend to do when you experience it? Is it helpful? If not, what might be more helpful?
  2. What are your beliefs about pain? Write down your answers and what clues can you spot when you see the answers written down?
  3. See if the ABC First Aid for Feelings technique can help with any pain you might be experiencing. The 10-day First Aid for Feelings course on Insight Timer is a great place to start. It’s designed to help you recognise feelings and deal with them in a productive way.

So as well as questioning whether your response to pain is helpful, why not also practise self-compassion wherever possible. You might just be surprised at the helpful difference it can make.  

In our next blog we’ll be looking at techniques and interventions that can be helpful when dealing with pain. Keep an eye on our social channels. Connect with us on Facebook and InstagramSign up for our fortnightly newsletter to get helpful tips and tools straight to your inbox.

Go gently, hold steady, stay the course.
All the best, Thor