Non-Pharmaceutical Approaches to Pain Management
by Hope Rehab Team
The Need for Non-Pharmaceutical Pain Management Options
Drugs such as opiates play an important role in the management of chronic pain, but there is always the potential for addiction and other undesirable consequences. This is particularly likely to happen when we try to self-medicate pain or use these drugs in a way other than how they have been prescribed (e.g. taking medication at a higher dose or more frequently). Even if we use pain medication under the careful scrutiny of a medical team, there may still be the risk of developing a dependence on these substances. It is for these reasons that non-pharmaceutical approaches to pain management are always worth considering.
It is important to follow medical advice from a licensed professional, but those of us who have already been through the hell of addiction may be reluctant to risk it again. Unfortunately, there are some types of chronic pain where heavy duty pain medication can be the only option. Here we need to weigh the risk of addiction against the necessity of having our pain properly managed. In such cases, it is important to let the medical team know about our past history with addiction, so this can be taken into consideration when creating a treatment plan. For most of us though, non-pharmaceutical approaches to pain management will often be the better option.
Pain is Subjective
Pain is a subjective experience. It is not something that we can capture on an x-ray, MRI, or any other type of medical imaging technology. We can’t point to something in the body and say that is pain. We can only observe symptoms such as inflammation that we know are associated with pain – interestingly though, people can have the exact same observable symptoms, yet report different levels of pain.
This is why despite our great advances in medicine, the best way to determine it is to ask a person to rate their pain on a scale (e.g. from 0 to 10). It is up to the individual to decide on how much pain is being experienced, and there is nothing anyone else in the world can do to prove this assessment right or wrong. The definition that is most often used in nurses is by McCaffery (1968) states that pain is ‘whatever the experiencing person says it is, existing whenever the experiencing person says it does’. It is not like a broken bone or blocked blood vessel which can be verified. This is what it means when we say that pain is subjective.
It is important to note here that when we say that pain is subjective, it is not the same as saying it is unreal. People who think it is unreal just need to remember the last time they stubbed their toe or experienced a cramp. Pain certainly exists, but the fact that it is subjective means that how we experience it differs from person the person. It is these differences in how we subjectively experience pain that make a positive approach to it possible.
Our Awareness of Pain Differs Depending on the Situation and Our Expectations
Think back to a period in your life when you were experiencing some type of physical discomfort. Did you notice that there were times when you were more aware of the pain? Perhaps, when there was nothing to distract you or your mood was low? You may have also noticed that the more you focused your attention on the pain, the worse you felt.
Our environment can also reduce our awareness of pain. There are countless stories of badly wounded soldiers in the middle of a battle who performed heroic acts and later claim to have been completely unaware of their injury at the time. Ambulance drivers recount tales of accident victims with broken legs who manage to walk away from their crashed vehicles while only dimly aware any discomfort. There are also those who suffer from chronic pain, yet notice that sometimes they become so engrossed in something interesting that they temporarily forget about their pain.
There is also no doubt that our expectations play a huge part in how we relate to pain. If we are expecting something to be painful, it usually will be. This is a type of confirmation bias where our brain prioritizes data that confirms our prior expectation. In other words, if we are expecting something to be painful, our perception will be more aware of any physical sensations that can be interpreted as painful.
The Gate Control Theory of Pain
The gate control theory of pain is widely accepted in the medical world and has led to technological developments such as the Transcutaneous Electrical Nerve Stimulation (TENS) Machine (this is used to help with chronic pain and pain related to childbirth). A basic understanding of this theory can provide insights into how we can become better at dealing with our own pain.
Our experience of physical pain are usually triggered by a signal from somewhere in the body running along a nerve until it arrives at the spinal cord. In the gate control theory of pain, the spinal cord is depicted as being made up of gates, and the pain signal must pass through one of these gates for us to become aware of it. The interesting thing is that these gates are always somewhere on a spectrum between being opened or closed – the less opened they are, the less we experience pain.
Of course, if you were to examine your spinal cord, you are not going to find any actual gates. What is really happening is that when a pain signal arrives at the spinal cord, the body makes a decision about which kind of nerve fiber it passes through as it continues its journey to the brain. One kind of fiber is like an expressway to the brain and the other is more like the scenic route (if you want to experience less pain, you want the signal to be sent on the scenic route).
Some of the factors that determine how openness/closedness of a spinal cord gate include:
- The intensity of competing signals arriving at other gates in the spinal cord.
Our stress levels (e.g. if we are feeling stressed, it can mean the gate is more open).
Our emotional state.
What is happening with our attention (e.g. if we are focused intently on something, the pain gates are usually more closed).
How Does the Gate Control Theory Improve Our Ability to Deal with Pain?
Now that we know a little of how our brain manages pain, we can use this information to help us better deal with it in the future. Some positive steps we might take can include:
Make relaxation a part of your daily life (e.g. these days there are plenty of guided relaxations videos online for free if you need some help).
If you become more aware of other signals in the body (even pleasant sensations), it will lessen the intensity of pain signals.
Become better at managing your stress levels.
Be aware of pain signals in your body but avoid catastrophizing (i.e. don’t assume that every niggle in your body is cancer as this will make you more aware of these signals and thus increase their intensity).
A TENS machine can be helpful for some types of pain, and they are relatively cheap to buy. These work by producing a small electrical current that compete with pain signals at the pain gates thus reducing the experience of pain.
Distraction can be an important ally when dealing with pain so keep yourself busy.
The Buddhist Theory of the Two Arrows
Another approach that may help us better deal with pain is the theory of the two arrows. Imagine that one day you are minding your own business, and out of nowhere, you are hit by an arrow. This is kind of how life works, we are always being hit by arrows that we didn’t expect and didn’t ask for. The best we can do when this happens is lick our wounds and then get back on our feet as soon as possible – hopefully, with a better understanding of how to deal with his particular arrow in the future.
As well as these arrows that life fires at us from time to time, the Buddha identified a second kind of arrow. This is an additional layer of pain that we experience when we react to the first arrow in a negative way. For example, if we spend time focusing on how unfair life is or how this kind of think shouldn’t have happened, we can end up more than doubling our pain. As far as this theory goes, the first arrow is just life, but the second arrow is always optional, and it is this second arrow that is the real source of our suffering.
We can apply this theory of the two arrows to our own pain by:
Developing a sense of acceptance towards pain rather than trying desperately to get rid of it. This acceptance triggers relaxation in the body which reduces our perception of pain signals (see gate control theory above).
- Notice how our attempts to escape pain often make the situation worse.
Meditation techniques such as loving-kindness (metta) can be useful in teaching us how to support ourselves when we are facing any discomfort.
Understand that ‘should not be happening’ is a meaningless assertion; there is only what is happening.
Learn to ground yourself (put your attention on one of the five senses) when you notice your thinking is obsessing and catastrophizing around the pain.
Dealing with pain can be a huge challenge, so we do hope that the information here can be of some value to you. If you found this post useful, please support us by sharing it on social media.