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Ingrid Wallace, LPC  

Clinician's Corner

by Ingrid Wallace, LPC

The surgery was supposed to help---but it didn’t.  The aches and pains---just getting old, I guess.  The medication---doesn’t seem to be working anymore.  I’m tired.  I’m irritable.  I’m worried.  The pain was supposed to go away---but it's worse.  Is it all in my head? 

Pain that lingers beyond the expected healing period and does not respond to conventional medical treatment affects 50 million Americans. The impact is staggering in terms of lost productivity and medical treatment costs alone---upwards of $120 BILLION per year according to the American Academy of Pain Medicine. Chronic non-malignant pain takes many forms---low back pain, work-related injuries, fibromyalgia, migraine headaches, arthritis, neuropathies, and degenerative conditions are some examples. Not just a symptom of other medical problems, chronic pain is a disease of its own. Researchers continue their quest; however, the precise mechanism of chronic pain is not well understood at this time, nor is there a specific cure for chronic pain.

(example, toothache)   (example, fibromyalgia)

Specific, often sudden onset of injury or illness

Pain serves as a warning signal of damage

Responds to treatment; as tissues heal the pain goes away

Suffering is in proportion to the amount of damage

Emotional responses are appropriate as the condition is treated and improves

Doctors seem confident on a medical course of action

May arise from a minor injury or mysteriously without a cause

Pain signals persist but further damage to tissues, structures, nerves is uncertain

Resistant to treatment; tissues heal but the pain does not go away

Suffering is well beyond what can be accounted for by medical evaluation

When pain doesn’t go away it becomes a source of  fear, depression, anger

Doctors may become as perplexed and frustrated as patients when pain persists

Chronic pain syndrome is a biopsychosocial constellation of problems affecting the body, mind, and spirit. It may interfere with sleep, mood, thinking, couples and family relationships, sexuality, social activities, and work. Many people with chronic pain perceive themselves as completely disabled. Factors that influence chronic pain may include:

Stress: Over time, stress leads to physiological and neurochemical changes that can worsen pain, foster illness, and increase suffering. In addition to the stress of pain, what other stressors complicate your life and contribute to suffering?

Mood: People with chronic pain syndrome often experience anxiety, fear, sadness, depression, irritability, frustration, worry, guilt, hopelessness, and desperation.

Attitude: With chronic pain---positive becomes negative, thinking may become foggy and confused, sense of purpose and planning for the future become lost. Suffering and seeking a cure for suffering become all-consuming.

Support system: Obviously the person in chronic pain is tired of dealing with it, but chronic pain puts tremendous strain on relationships. Loved ones run out of patience and don’t know how to help anymore. Friends tend to fade away and social circles shrink. Co-workers may think you’re faking it and are milking the system. The medical system overshadows social connections as doctors and healthcare providers become the most frequent contacts.

Lifestyle: Over time, chronic pain sufferers may adopt illness or “sick” roles, frequently displaying pain behavior and maladaptive coping. Independence is replaced by dependency, enthusiasm morphs into passivity and isolation, interest in activities wanes, and social and vocational function may be seriously affected.

Nutrition: Who would think that diet could have an effect on chronic pain? Health experts target consumption of caffeine, alcohol, fats (especially animal fats), dairy products, salt, and sweets as contributing agents to a number of disorders including chronic pain. When in pain, appetite may be affected resulting in undernourishment, overeating, or craving comfort foods and carbohydrates. 

There is no cure for chronic pain. There is no quick fix. Pain may be persistent, but suffering is optional. It is possible to learn to manage pain, improve quality of life, and live more fully. Learning pain management skills is not “one size fits all.” Each of us is unique with individual needs, tolerances, and preferences. The path to effective pain management may vary but encompasses:

Medical Help: People with chronic pain often see dozens of physicians before finding a good match. It may take time and effort, trial and error, but seeking out a trusted physician, healthcare team, or interdisciplinary pain management program is a big step in the right direction. Putting faith in trusted professionals is essential in making the transition from being stuck in a “sick role” to becoming a “well person with pain.” Recommendations for appropriate medication and course of treatment can be made. Keep in mind that YOU are the most important member of your treatment team. Come prepared to appointments with questions and concerns, ask assertively for further explanation if need be, and learn as much as you can about your particular pain problem. 

Psychological Help: Chronic pain can filter insidiously into every aspect of life, altering how we think, feel, communicate, and behave. Not only is the body affected, but quality of life in general often takes a downward turn. Emotional distress is common as people start to doubt the reality of their pain. And as with other chronic medical conditions, recurring flare-ups and setbacks can be discouraging and frightening. Keeping track of, and diminishing, automatic negative thoughts and beliefs about pain is a worthwhile practice; some people keep a “pain diary.” It takes work, but cognitive restructuring, that is, reframing the hold pain has over us, is another vital element of successful pain management. When a client tells me “I can control the pain now---the pain doesn’t control me,” I sense we are on the right path. And learning to communicate assertively---to set limits, to ask questions, to stand up for yourself or say “no” to unreasonable requests—is a surprisingly valuable pain management tool. Understanding feelings, working on stress management and control issues, moving from disability toward acceptance, setting goals, creative problem solving, distraction, and developing positive coping strategies are worthwhile endeavors that often result in decreased suffering.

Self-Help: Pain management can be guided by healthcare experts but it also requires courage, conviction, and a commitment to wellness on the part of the person in pain. Making informed choices about your healthcare and taking responsibility are keys to managing pain effectively. With approval from your treatment team, this may mean engaging in regular exercise (within your limits), watching your diet, learning relaxation techniques, pursuing complimentary therapies, delegating tasks, resuming old (or picking up new) hobbies and interests, making plans for the future, getting out more often, traveling, volunteer work or return to work. IT SOUNDS IMPOSSIBLE, BUT YES, IT CAN BE DONE! Faith and spiritual connectedness may also be of great comfort and inspiration for some people in pain. Finally, find out about local support and self-help groups for chronic pain and/or underlying medical conditions, where peers in pain offer their wisdom to one another. Many people have found the American Chronic Pain Association website a helpful start.*

Ingrid Wallace, M.S., LPC, practices at the Milwaukee location of Cornerstone Counseling Services.  She can be reached at 262-542-3255, ext. 286.

*Log on at

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