On a recent Saturday morning, I met with 15 of my patients each of whom suffered from chronic pain. The group medical visit is a relatively new way for a physician to provide care to patients suffering from a common condition. They are more commonly used for conditions such as diabetes, congestive heart failure or chronic lung disease.
I chose to use this special type of visit for my patients to allow sufficient time to explain new concepts in the approach to chronic pain, discuss how pain affects our lives and introduce them to new evidence-based selfmanagement tools to improve their function and enjoyment of life.
Pain itself plays an important physiologic role. When it is acute and caused by harm or injury to the body, it provides useful information to us so that we can take immediate steps to attend to the affected area and remove it from danger. If you could feel no pain, you wouldn't know that you had stepped on a nail or that you were developing a serious foot infection. Therefore, it would not be desirable to be completely painfree.
Similarly, both fear and sadness are normal, functional human responses. If you had no fear, you would not take appropriate care when facing dangerous situations. We feel sadness when we experience loss or when we are not satisfied with our circumstances. It can be the first step in looking at our lives, setting new goals and improving those circumstances.
The central nervous system is very efficient. When certain patterns of thought and behaviour are repeated, particular patterns of neural connections become more entrenched.
If we take the same way home each day, it becomes so automatic that we don't have
to think about it. If we think the same good or bad thoughts day in and day out, they become patterns of thought and limit our ability to perceive anything else. This is how we tend to narrow our points of view, become prejudiced and pigeon-hole the people around us.
When pain becomes chronic, it can affect every aspect of our lives - the activities of daily living, our relationships, our enjoyment of life - how we see ourselves and our future. Because pain is at the root of these negative changes, it can become the focus of our attention and our daily lives. Pain can shade our emotions and shape our thoughts.
After ensuring that a patient's condition has been sufficiently investigated and appropriate medication and physical therapies applied, I now offer my patients three self-management tools. Mindfulness meditation helps us to centre our minds, cognitive therapy trains us to uncover our underlying beliefs and selfhypnosis engages our subconscious minds to reinforce positive thoughts.
With these three tools, we can regain our sense of control, transforming helplessness and hopelessness to engagement and empowerment.
Dr. Davidicus Wong is a family physician. See his blog at davidicuswong.wordpress.
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