Pain Awareness Month: Destigmatizing Chronic Pain
September is National Pain Awareness Month. It is a month-long advocacy period that is meant to support pain providers and advocates as they work to increase awareness about issues and conditions that are related to or cause chronic pain. This month helps both those suffering from chronic pain, as well as their loved ones and caregivers, better understand the toll that pain takes on an individual. By raising awareness and shining a light on a problem that affects more than 20% of Americans, we can all become a little more compassionate as we work to ease both the physical and mental burden of chronic pain.
WHAT CAUSES CHRONIC PAIN?
Since 2001, National Pain Awareness Month has played an integral role in educating the public about chronic pain and its effects on mental health. For starters, it’s important that people who do not suffer from chronic pain have a better understanding of what causes chronic pain and how it can affect those who suffer from it. The Pain Center reports that pain affects more Americans than diabetes, heart disease, and cancer combined, and that the most common types of chronic pain are low back pain, knee pain, headaches, and neck pain. Chronic pain conditions include: Arthritis, Fibromyalgia, Multiple Sclerosis, PMDD, Endometriosis and uterine fibroids, and Migraines, as well as various other conditions. For example, other types of chronic pain are often defined as complex conditions that involve pain persisting for longer than three months without a specific cause. In other words, the initial reason for the pain stemmed from an acute problem, such as a surgery or an injury; then after a period of recovery, when most medical professionals assume the injury is healed and tests (e.g., MRI, CT scans) can even corroborate that assumption, the pain still persists. As such, without an identifiable source of the continuing pain, doctors may not be able to fully extinguish the pain.
Any of these aforementioned reasons for a prolonged experience of pain without viable options for help ends up influencing one’s behaviors, thoughts, and mood. In turn, individuals suffering from chronic pain may experience symptoms such as:
Decreased engagement with physical, social, and recreational activities
Feeling depressed, anxious, or irritable
Inability to concentrate at work, school, or in your home
Decreased sense of self-worth and self-confidence
Trouble with attention and memory
Increase desire to isolate and withdraw from others
As you may imagine, this cluster of symptoms, in addition to the experience of daily, physical pain, is a great burden for the sufferer to bear.
Furthermore, the U.S. Pain Foundation estimates that chronic pain affects roughly 50 million Americans. They also estimate that the U.S. spends around $635 billion dollars each year due to health care costs and loss of productivity. Pain is also the number one reason for doctors visits and is the leading cause of long-term disability in adults. The CDC also reports per the NHIS, a cross-sectional health survey, that “age-adjusted prevalences of both chronic pain and high-impact chronic pain were significantly higher among women, adults who had worked previously but were not currently employed, adults living in or near poverty, and rural residents. In addition, the age-adjusted prevalences of chronic pain and high-impact chronic pain were significantly lower among adults with at least a bachelor’s degree compared with all other education levels.” One can surmise from this data that chronic pain disproportionately affects those with less education, lower-income, and with less access to adequate healthcare; thus, it’s a societal problem as well as an individual problem.
Seeking both medical and mental health advice is the best way to decrease chronic pain.
WHY STIGMA WORSENS CHRONIC PAIN
In addition to sociocultural factors that play a role in people’s experience of pain and mental health concerns, stigma is also a large reason why people do not seek out help or they choose methods to mitigate pain that ultimately proves to be more harmful than helpful (i.e., prolonged/excessive opioid use). More specifically, the Institute for Chronic Pain (ICP) explains that stigma occurs when “someone is judged for having a condition that they didn't choose to have, like chronic pain...stigma thus arises when moral judgments occur not for wrong behavior, which might rightly get criticized, but for simply being who you are, for simply having the health condition that you have, or for how you are dealing with it.” In other words, stigma is often borne out of individuals’ lack of understanding and erroneous judgments, such as when people without pain make assumptions that the pain is not real if you cannot pinpoint a concrete medical issue. According to ICP, people who suffer from chronic pain often hear the following:
"What’s wrong with you that you never seem to get better?"
"I have back pain too, but I still go to work. Why can’t you?"
"Are you going to the doctor AGAIN?"
"Come on now, it can’t be that bad…"
"It must be all in your head."
When we slow down and imagine how hurtful and demeaning these comments must feel, we can start to understand why it is this intersection of physical and psychological concerns that creates the perfect storm for chronic pain to flourish. And since feeling misunderstood, ignored, judged, lonely, and dismissed all add to one’s experience of psychological suffering, stigma creates a vicious negative feedback loop that actually increases one’s experience of chronic pain.
As noted above, when pain increases, especially due to stigma and psychological concerns, people often turn to means of alleviating pain that are not ideal, such as opioids. Although these medications can be very helpful in certain circumstances related to pain, they are not meant for long-term management of all types of chronic pain. As the American Academy of Family Physicians explains, overuse and abuse of these drugs have led to major problems, including overdose and death. More to the point, at least half of all U.S. opioid overdose deaths involve a prescription opioid. This, in turns, begs the question: why is this the first line of defense when we know that psychological factors play such a large role in the experience of chronic pain? So as we continue to acknowledge stigma both within ourselves and in our own community, it is imperative that we continue to focus on attending to the mental health component of chronic pain to help mitigate people’s suffering without adding risk of addiction and death.
WAYS THERAPY AND HYPNOSIS CAN HELP ALLEVIATE PAIN
Although there are ways to try to treat the physical pain, sometimes it is hard to identify the cause of chronic pain, and medicine or medical procedures are no longer helpful or safe. It is often at this point that those suffering from chronic pain would benefit greatly from seeking out mental health professionals. More specifically, finding a therapy that incorporates the following techniques is usually the most helpful:
Psychoeducation to minimize stigma
Relaxation exercises (e.g., Progressive Muscle Relaxation) to promote mind/body awareness
Acceptance and Commitment Therapy to relearn how to enjoy life again
Hypnotherapy to help with pain management
Additionally, the theme of this year’s Pain Awareness Month is #MyPainPlan. This theme helps to highlight how everyone’s experience of chronic pain is unique, and how important it is to take time to figure out what might be the best individual fit for therapy.
