Fear as it Relates to Pain

A very good friend of mine who is also a Physical Therapist asked that I do a post regarding fear and pain.  Sounded like a great idea as we all will experience or have experienced pain in our life.  

Pain can have a large impact on how we respond to it and cause altered behavior.  In particular, exposure to pain for a long time can cause us to become MORE sensitive to pain.  This heightened sensitivity leads to something called fear avoidance behaviors.  This is basically just a fancy way of saying that if you are afraid of something you will adopt behaviors to help you avoid it.  In the case of pain, this means we will do whatever we can to avoid pain.

As we develop a fear of reproducing the pain, we develop avoidance of the behavior or ANY behavior that may recreate the pain.  The longer the pain persists, the more "avoidant" we become.

An interesting aside -- if pain causes us to move in ways that are out of the ordinary in order to avoid the pain- that in itself can cause pain or muscle damage in the areas that are trying to compensate.

So can we do anything about it?

Fortunately, yes, but it is not easy.  The first step is finding ways to reduce the pain in the first place.  This may involve medication, physical therapy, massage, exercise, etc.  

The second step is very similar to the way we treat fear of anything -- spiders, snakes, etc.  It is a gradual and progressive introduction to the thing we are afraid of until we can be in its presence and even hold it without evoking the emotional response we had learned.  We are retraining the brain.  Teaching the brain that it doesn't have to be afraid of that activity and provoke a response.

It's the same thing with pain.  We gradually start working toward the activity that was causing us pain in the first place until we can perform that activity without pain any longer.  An example of this could be pain with walking.  Let's say your right foot hurts severely every time you take a step.  In this example, as the pain improves you want to gradually reintroduce walking.  This may mean using crutches or a walker to allow the right foot to be non-weight bearing and progressively adding more weight to the right foot as the reduction in pain allows - "finding the threshold" - the threshold of pain, that is. The critical piece to this is not crossing that threshold or else we evoke our friend Freddy Fear again and the avoidance behavior.  Crossing the threshold can also cause us to start to doubt whether or not we are improving and lead to greater fear avoidance.  Once full weight bearing with the walker or crutches you progress to a cane.  When you can walk without a "limp" with the cane you discard the cane.  When you can walk normally without a device, perhaps you start to jog, etc.

Obviously, this can be a very complex process in other scenarios.  The bottom line, however, is the same.  If we do not retrain the brain, we will not conquer the pain as simply reducing the pain may not be enough.  Why?  Because the longer the pain goes, the more hypersensitive we are.  This means that pain has to be practically 0 if we have had it long enough to even realize it has reduced!  This is one reason I think early mobilization after surgery is so critical.  In addition to reducing the deleterious effects of bedrest it helps us get moving before we become too afraid to move.  We confront the fear of what moving will feel like right away.  Once we confirm that we can move despite it or that it isn't as bad as we suspected we can move forward more rapidly as we have taken "Freddy Fear" out of the equation.

The post before this one was on Diaphragmatic Breathing.  This may be a good way to start moving again, especially in cases where ANY attempt at ANY movement is painful.  Deep, diaphragmatic breathing can be therapeutic.  If you don't believe me, give it a try :)