• Dr. James H. Gruft

Pain Management: The Path to Healing.

Updated: Dec 15, 2020

The other approach is pain management. Entering the road of pain management does not mean that we must forever relinquish the possibility of finding a cure for our pain. However, it does not mean that we are not going to wait for a cure. To manage or cope is to deal with life as it comes, with all the resources we have at our command.

The ability to cope is a well-recognized asset. It has been singled out in recent times as one of the key factors of health. Without the ability to cope, we are easy prey to the stresses of modern civilization. Most people with chronic pain, given the opportunity, learn the basics of coping.

As unscientific as opinion might seem, what people think about their health is very potent. In a study involving 2,812 people evaluating their own health status, it was found that these self-assessments were sensitive predictors of mobility - even when health behaviors like something, alcohol consumption, body mass, and frequency of exercise were factored out. What was particularly striking about the study was that people’s opinions about their health predicted mortality in males more accurately than having diabetes or being a former smoker. This means that people can accurately estimate their health by making self-assessments, or it means that person’s perception of his or her health can have significant influence.

It is a fact that our ability to cope with stress can influence our health. One important study shows that unchecked mental stress in people with the coronary-artery disease can diminish oxygen delivery to the heart. (a condition called myocardial ischemia). What is remarkable about this study is that the magnitude of heart abnormalities induced by mental stress was as significant as those brought on by vigorous exercise. Furthermore, stress caused by asking patients to reveal something unpleasant about themselves induced more myocardial ischemia than tests designed to be stressful. This study demonstrates that we can take stress personally, it can physically harm us.

In a landmark study on pain by Flor and Turk, people with chronic back pain were compared to those with rheumatoid arthritis. The subjects completed two pain questionnaires designed to assess their degree of coping versus non-coping their degree if coping versus non-coping and their level of resourcefulness versus catastrophizing. These as well as the person’s diagnosis, medical history, physical exam, and diagnostic tests - were all analyzed for their ability to predict a person’s level of physical function.

The results of the study were startling. The patient’s history and physical exam is taken by the doctor, the diagnostic tests ordered, and even the diagnosis, couldn’t accurately predict how each person functioned. The only good predictor for each person’s physical function was how he or she perceived his or her ability or inability to cope and solve problems. In other words, how people felt they were handling their pain condition was a more accurate predictor of their own ability to function than their diagnosis or the doctor’s assessment.

To have and maintain a sense of well-being depends, to a great degree on how much control we feel we have over our lives. This feeling of control - that we can cope with life’s conditions has great implications regarding our health.

In an elegantly designed study, healthy people were exposed to different respiratory viruses, all implicate das being causes of the common cold. Prior to exposure, each person in the study completed questionnaires measuring the amount of stressful life events he or she had over the last year, and the degree to which the persons felt that current demands exceeded his or her ability to cope. The rate of clinical colds increased directly with a higher “stress-index score.” The more stress the person perceived he or she has, the more likely he or she was to catch a cold. The implication is that stress is associated with a suppression of the immune system, making a stressful person more susceptible to illness.

By the same token, increased ability to cope results in heightened health. In another remarkable study, nursing home residents were divided into two groups: the control group on one floor received the typical care of an excellent nursing home. The experimental group on another floor was given increased responsibility and choice in their living situation. An announcement was made telling the subject that they should be aware that they could rearrange their rooms however they wanted and could visit whomever they wished. They were encouraged to make their complaints known to staff, and each was offered a living plant of their choice to care for (they all took one). On the control floor, communication to the nursing-home residents stressed the staff’s responsibility for them. On the experimental floor, the emphasis was on the resident’s responsibility for themselves.

The results were dramatic. Those in the experimental group were found to be significantly happier, more active, and more alert. The experimental group spent more time than the control group visiting other patients, meeting with people outside the nursing home, and talking to the staff. All of these activities significantly increased after the study began and were much more frequent than those in the control group.

Our inner sense of ability to cope with life is related to the amount of control that we feel we have over lives. It confers a sense of well-being and this sense of well-being is, as we’ve seen in the above studies, predictive of our future health. Thus, coping is critical to our health.

Psychological stress had been defined as the relationship between person and the environment, which is perceived by the persons as taxing or exceeding his or her resources and threatening his or her wellbeing. That is, stress is perceived as a pressure on the individual. However, stress alone cannot account for the breakdown of health - whether physical, mental, or spiritual. The relationship between stress and illness in an ulcer, headache, or chronic lower back pain, how we cope with the stress completes the equation. In some situations, where many people are exposed to the same problems, stress may be constant, but different individuals respond to stress in dramatically different ways. The variable that can best predict how a person will fare is his or her self- perceived ability to cope with stress.

Coping has been defined as constantly changing efforts to manage external and internal demands and internal demands that are appraised as stressful. In other words, it is only when we are dealing with something that we perceive as taxing or exceeding our resources that we are truly coping. Coping, therefore, is not an automatic process, but one that is required in every situation requires effort. This definition also makes it clear that stress not only exists as a result of an outer occurrence but can be internal as well. Even our interpretations of external events can lead to stress that we need to cope with. How many times have been sleepless with anguish after hearing how a friend wronged us, only to find out later that the rumor of treachery was false? Was the anguish we felt any less real because it was baseless?

Internal stress appears to be most damaging when we are unable to give it expression - when our thoughts, words, or deeds are suppressed or inhibited. As in the case of someone who was traumatized as a child, healing may only begin when the initially absent, repressed reactions to his or her trauma (such as anxiety, rage, anger, despair, dismay, pain, and grief) are felt and articulated. Hence, coping applies to outer and inner stress and is related to the amount of control we perceive we have, whether it be related out attitude, our values, our environments, or ourselves.

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