Your thoughts can affect pain severity. In wartime, soldiers’ wounds often are less painful than the same wounds would be in a civilian. Why? Because the wounds signify that the wounded soldier will soon be going home, but the civilian’s injury is a source of fear and anxiety. This is known as the “Anzio effect” after the World War II battle that took place near Anzio, Italy, where it was first noted.
When pain is a source of fear, anger, or grief, it usually hurts more. Cancer patients may experience worse pain, because they fear it means their disease is worsening or that they may be dying. Because your thoughts about your pain have a major effect on how bad it feels, it can help to change your thoughts. For example, you might try changing a negative thought such as, “This pain keeps me from doing everything I like,” to a more realistic, positive one such as, “This pain makes it harder to do things, but I can sometimes find different ways to do them.” Doing this can actually turn down your pain level.
Distraction is one of the best short-term mental approaches. The Chronic Disease Self-Management Program developed by Stanford University recommends mental exercises like counting backward by sevens, imagery such as imagining a beach scene, or playing a game. Several studies have found playing video games to be a terrific pain reliever.
One participant in an online discussion on the Diabetes Self-Management Blog wrote, “I noticed that when I was doing something like reading an interesting book, or walking and talking with a friend, I was not consciously feeling pain.” Another wrote, “I keep my mind busy with genealogy [family history] during the day. I play sudoku and crosswords at night until I can fall asleep.”
Certain drugs that affect the brain can help to control chronic pain. Antidepressants in the class of drugs known as selective serotonin reuptake inhibitors (SSRIs), which including duloxetine (Cymbalta), are often prescribed for pain. So are tricyclic antidepressants (TCAs) such as amitriptyline (Elavil). SSRIs often boost energy, while TCAs can make you sleepy. According to the Harvard Medical School Web site, “Some physicians prescribe an SSRI during the day and amitriptyline at bedtime for pain patients.”
Narcotic medicines, which include opiates such as morphine and synthetics such as oxycodone, are sometimes given for pain. Narcotics dampen all senses, not just pain. Because of side effects including sleepiness, constipation, and addiction, they are less often used for chronic pain than they used to be. But they are still very helpful for some people, and most chronic pain specialists will prescribe them.
Pain specialist Karen Burt, M.D., director of Integrative Medicine at Contra Costa Regional Health Center in California, says that spiritual approaches help many people with chronic pain. “With chronic pain,” she says, “one needs to connect or return to all positive aspects of one’s being and one’s life. So if puppies and kids and nature and flowers and hot baths and your sister bring you pleasure and comfort, by all means, keep them in your life. By the same token, everyone has internal sources of positivity: one’s faith, one’s awe and appreciation of nature or life itself, and qualities like strength, courage, wisdom, hope, and inspiration.”
Dr. Burt talks of “developing a witness within,” a part of you that sees what your mind and body are going through, but does not identify as the one who is suffering. This practice helps to “open up a bigger sense of who you are” [so] you see that pain is only part of your experience.