Pain After Spinal Cord Injury
This section deals with a difficult issue: pain. If you’ve had significant pain in the past, you understand the impact it can have on your life. Chronic pain is common among people with SCI—as many as 40 percent report ongoing issues. But pain does not have to interfere with happiness. With the right diagnosis, treatment, and attitude, people with chronic pain can maintain a very high quality of life over the long run.
Additional Points About Pain (supplement material)
Research has demonstrated over and over again that the mind and body work together to produce the experience of
pain. This means that your nervous system, your thoughts, your feelings and your behaviour all have the power to either ease or intensify the pain you feel.
Pain and the nervous system
The pain process is complex. Pain signals start in nerve endings in the skin and muscles and then travel along pain pathways to the spinal cord and eventually to the areas of the brain that control physical sensation and emotion. The spinal cord behaves like a processing plant for pain: it can direct, redirect and change pain signals. At the same time, the brain sends signals down to the spinal cord. These downward signals, created by events that are happening in your life, have the potential to tone down or amplify the pain signals.
Once the signals reach the brain, they go in many different directions depending on past experiences and on what is happening now. For example, if you've had prior experience with pain related to an illness, the signals may go to a brain area that causes you to feel stressed and worried about your illness. However, if at the time that the pain signals reach the brain you are at an exciting hockey game, the pleasure areas of your brain may be aroused and cause a detour of the signals so that they do not cause the same worry.
Similarly, physiological factors like fatigue, exercise, temperature and positioning will also have an impact on your pain experience. Patterns of brain activity vary widely from person to person and from one situation to the next. Therefore, the experience of pain varies widely as well.
Chronic pain
One of the most important factors affecting the pain processing plant is repeated pain signals that do not stop. When pain signals are continuous over a period of time, they get amplified in the processing. If acute pain can be thought of as one person in the processing plant hollering up at the brain “there's pain happening here,” chronic pain would be the equivalent of having 20 people hollering the same message at the brain.
The signal going to the brain becomes 20 times louder and 20 times stronger than the original signal. The neurological changes that cause this amplification may persist even after the original injury is healed.
If your pain hasn’t gone away after about 3 months, you may be dealing with chronic pain. Your health care provider may recommend an interdisciplinary approach to managing this problem, including working with a physician, a nurse, a psychologist, a social worker, an occupational therapist and/or a physiotherapist.
Cognitive and behavioural strategies for managing pain
The word "cognitive" refers to thinking and perceiving. Cognitive strategies can enhance the signals that the brain is sending downward to the spinal cord, so that they override the pain signals that are heading up to the brain.
You can make your pain experience more manageable through education, relaxation, self-talk, distraction, humour, music, meditation and prayer. When you take charge of your thoughts, you not only change your feelings, you also influence your body's physiological responses. And that influences your perception of pain because when your mind is calm, when your mood is good and when your body is relaxed, you will react less to painful stimuli.
Your negative self-talk has the power to make you feel worse. For example, if you feel pain when you get up in the morning and automatically think "this pain means that my injury/illness is getting worse,” the worry and physical tension will increase your suffering. Your thoughts are shaped by your past experiences, your beliefs, your knowledge, your culture, your gender, your religion, and, of course, the media.
Your trouble-making thoughts may be so automatic that you’re not aware of them. So how can you root them out? By becoming a scientific observer of yourself. For a few days, keep a diary – recording those times when you feel particularly intense pain or strong emotions. Record the situation, the emotions and the thoughts. Once you’ve done this for a few days, you may be able to identify a pattern. You may notice that you keep having the same automatic thoughts that go along with the painful feelings.
Let’s say that you’ve noticed the recurring thought such as “this pain means that my illness is getting worse." Now that you’ve identified it, you can stop yourself whenever you notice that thought.
If you happen to be alone, shout “stop” or if you're not alone, just pinch yourself. (This might sound silly, but it helps to break a bad habit.) Then substitute a more accurate and positive thought like “Sometimes I worry too much. Expecting the worst isn't going to help. I'll ask my doctor/ therapist for their opinion. In the meantime, I'll be proactive and use my pain management techniques to take charge of the pain so that I can get on with my day." When thoughts change, brain activity changes and the experience of pain changes too.
Some thoughts take the form of mental imagery. Many athletes use imagery when training and to enhance their performance. Mental pictures change the activity of the nervous system that controls nerves and muscles. For this reason, you can use imagery to change your pain experience. Develop images that have meaning for you and that fit with your experiences and preferences. For instance, picture yourself in a pleasant spot in the country or by a river. Let all your senses soak in the details of the place. Imagine the pain evaporating in the warmth of the sun or being washed away by the coolness of the water.
The decrease in pain is not simply a matter of being distracted or of fooling yourself. Your thoughts actually influence how your brain works. Recent high tech scanning technology has confirmed that when people use their imagination to picture themselves in pleasant situations, the parts of the brain that manage pain and mood become very active. We now understand that firewalkers can walk over hot coals without experiencing pain because their meditative state of mind overrides the pain signals being sent by the nerves in their skin.
Although they are often overlooked, relaxation techniques are powerful tools that reduce the physical tension and the mental anxiety associated with suffering. Whether you use self-hypnosis, biofeedback, guided imagery, breathing exercises, progressive muscle relaxation, yoga, or some other meditation technique, whether you’re in a group or on your own, practicing daily relaxation will yield noticeable results.
You'll notice that you sleep better, think better, are less irritable with others, feel less depressed and anxious, feel more in control, have less pain and discomfort. Your body will use oxygen more efficiently, your muscles will be more relaxed, your heart rate will slow down, your blood pressure will be lower, you'll breathe more slowly, and your brain will produce more alpha (relaxing) brain waves.
The major obstacle to accessing this power is convincing yourself that something as low tech as relaxation can be a powerful and effective way of achieving these changes. Research has proven it time and time again. But the only way you'll be convinced is to try it out for yourself and identify the technique that's best for you.
Like so many skills, progress may initially be slow and the visible changes may be small at first, so you need to take a leap of faith and invest some time in order to reap the benefits. In Western culture, we tend to have a “quick fix” attitude toward pain management. Advertisements lead us to believe that medication has ALL the answers.
When we buy into this notion, we often end up frustrated. When we focus only on quick fixes, we are not taking the time to learn the strategies we need to make our life healthier, happier and more comfortable.
Many health care providers can teach you the cognitive and behavioural pain management techniques that will work best for you, including your physician, nurse, social worker and psychologist. You may also enjoy learning through self- help books, tapes and community-based courses.
Energy-based techniques
Another type of strategy to consider may be energy work. In this type of work, there is a basic belief that the energy field of the body extends through and beyond the physical body. This energy is the chi or life force. In a healthy person, the energy flow is balanced throughout the body. When there is illness or pain, there is a block in the energy flow. Acupuncture needles can be used to unblock the flow of energy. A therapeutic touch or healing touch practitioner may use their hands, a meditative state and positive intent, e.g., a real desire to help, to balance the energy flow.
When trying energy techniques, it is important to seek out practitioners who are licensed. Mind-body techniques require practice. You will need to give the technique you choose a fair trial. Although these patterns and behaviours took many years to develop and will take some effort to change, you can “teach an old dog new tricks.”
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Source: Spinal Cord Injury, Alberta Education Initiative: Glenrose Rehabilitation Hospital & Foothills Medical Centre
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