Why is pain a psychological issue? Well, let me clarify that – why is pain a behavioral medicine issue? (And what the heck is behavioral medicine??)
Behavioral medicine is a subset of psychology and other medical disciplines that addresses the impact of behavior (and thoughts) on physical health. And, yes, pain is a behavioral issue.
Consider this – regardless of the type of pain a person suffers from, physical activity will (almost without exception) worsen that pain. Now, sometimes light exercise can be beneficial, as can physical therapy (the exceptions). However, all too often I see patients who have “good days and bad days” – and on the good days they overexert themselves, and that leads to the bad days, when they are sore, achy, fatigued, irritable, and so on.
The good news in this is that pain patients can influence their pain, and avoid flare ups, by increasing awareness of what activities or behaviors worsen their pain (in the moment or in the next day “hangover effect”).
So, how do you do this? For instance, keep a journal or diary – a brief record for a week or two of daily activities, medication use, and pain scores (e.g., Monday – took oxycodone in morning, walked through the grocery for one hour, argued with spouse). This will allow the person in pain (and his/her caregivers) to monitor the cause and effect process, and pinpoint patterns of behavior that consistently help/hurt when it comes to pain. This record keeping can be important because most people don’t remember what they had for breakfast yesterday, let alone what they did 48 hours ago to lead to pain today. This delay is what I call the “hangover effect” – that gap between the behavior that seemed like a good idea at the time, and the negative symptoms one experiences in the moment – and because of this gap, we don’t always put two and two together. However, the things you did (your behavior) in the past affects how you feel in the present – without recognizing this, you are left confused or fearful of where the pain is coming from, left wondering why it’s getting worse? (Consider the idea of a hangover from alcohol here – if you wake up feeling awful and don’t know why, the thought most of us have is some sort of illness; but, if you remember drinking a lot of booze the day before, now that changes the diagnosis, and that information changes the treatment.)
Now, behavior doesn’t just mean “the stuff I did yesterday,” like going to the doctor or doing the laundry. Other behavioral factors to be aware of include: medication use (to be discussed in future posts), sleep habits, diet, substance use (including tobacco and alcohol), social/occupational stressors, and so on. All of these are factors that patients often have some say in, but that are not always associated with pain management issues. Such behaviors should be included in your record keeping to aid in finding the pattern of behaviors that help/hurt, specific to you.
If I have one goal with this Blog (and in my work with patients), it is empowerment – pain and the psychological symptoms that come along with pain do enough to take away a person’s sense of independence. I aim to give some of that feeling of control of your life back – to give patients more of a say in their lives. The flip side of this, of course, is that recognizing you have control means you have the responsibility to do something about it. I don’t think this is a bad thing, but it is a choice – being a victim or being a survivor. Sometimes, being a survivor takes more energy, and can be more frustrating, because you learn to blame yourself for behavioral decisions that negatively affect your well-being.
For me, though, I’d rather blame myself than feel helpless. So consider this idea of behavioral medicine as a means of learning from professionals how you can re-gain control over your life, and prevent pain flare-ups.
As always, feel free to contact me to set up an appointment to receive further information and treatment similar to what I Blog about here. Though I have a limited number of appointment slots available, I will do my best to accommodate.
