Whether we accidentally stub our toe or touch a hot pan, everyone experiences pain. Most pain resolves quickly as the injury heals, but, in some cases, the pain can last beyond the time of normal healing. Chronic pain, often defined as pain exceeding three months, affects one in five Americans, approximately 50 million people. In response to the disease’s widespread impact in the St. Louis region, the St. Louis Regional Health Commission (RHC) launched its Chronic Pain Initiative in 2018.
As part of this initiative, the RHC released the Chronic Pain Prevention and Treatment Policy Paper in January 2019, with statewide and regional policy recommendations for managing chronic pain. Over 35 stakeholder interviews with providers, patients, and diverse experts in pain management went into this policy paper. Angela Brown, acting chief executive officer of the RHC, commented on an overarching message of the interviews: “Emotional pain and chronic physical pain cannot be separated.”
Chronic pain is a physical and psychological disease; a simultaneous disease of body and mind.
“Pain is depressing,” said Heidi B. Miller, MD, medical director at the RHC. “And depression exacerbates pain. The physical and psychological aspects of chronic pain can be wickedly intertwined. My patients speak to the profound emotional toll chronic pain takes on their lives.”
Furthermore, patients often have to redefine their sense of self when pain restricts their daily functioning.
“While there is hope for strategies that increase function and decrease the impact of pain, progress takes both physical and psychological work,” said Dr. Miller. “There is, unfortunately, no easy fix, and certainly not in the singular form of a pill.”
One of her patients, Father Gerry Kleba, poignantly spoke to the psychological pain associated with chronic physical pain: “My pain is not nearly as severe as my disappointment.”
While patients in pain most expertly understand the convergence of physical and emotional suffering, a growing body of research reaffirms this dual processing of chronic pain. Neurologic mapping shows that the same region in the brain associated with processing emotion is activated by chronic pain. Jennifer Brinkmann, president of Alive and Well Communities, which activates communities to heal by addressing social, emotional trauma, discussed how this multidimensional understanding of chronic pain can help our region improve chronic pain treatment.
“In addition to providing clinical mental health services, we need to encourage providers to be trauma-informed,” Brinkman said. “Providers should recognize and respond to how emotional stress and traumatic events impact patients’ experiences with pain, and similarly, how pain can be a source of further stress and trauma without clinical and community supports. If policy makers, managed care organizations, and providers all understood the critical importance of addressing emotional pain in chronic pain management and developed new treatment responses, chronic pain’s societal burden would be greatly reduced.”
Effective pain management addresses both the physical and emotional components of chronic pain. Patient-centered, multidisciplinary, and trauma-informed care will not always provide complete pain relief, but this approach can help patients shift their perception of pain and reach milestones that are most meaningful to them.
After participating in a mind-body patient group at a local Federally Qualified Health Center, one patient eloquently demonstrated her mental and emotional determination to live a full life despite the pain: “I won’t let it [the pain] drop me. I won’t let it steal my spirit.” We need more chronic pain treatment methods that help patients hold onto their sense of hope in spite of the pain.
If you experience chronic pain, there is a lot you can do yourself to decrease the impact of pain and lead a meaningful life. Ask your doctor if your pain is chronic pain and if these strategies could help.
Be mindful. Mental health and physical health are deeply connected. Your thinking affects how you feel pain. Seeking help for your mental health could not only reduce your pain, but could also assist you reach your goals despite the pain. If you are looking for a local mental health provider, Mental Health America has a directory at www.mhanational.org/.
Build community. Traumatic events (emotional, physical, and social) can increase your risk of developing chronic pain. However, forming social connections and a supportive community can help improve your overall health and reduce the impact of trauma.
Be supportive. Listen to people living with pain and believe them. Supportive social connections from neighbors, friends, and family can help reduce the impact of chronic pain.
Advocate. Access to pain services is not equitable in our region. Advocate for programs and policies that expand access to health care for all.
Focus on function. If you are a health care leader, help your patients set realistic expectations and goals. Some patients will never be pain free, but multidisciplinary treatment plans can help them work towards what matters most to them. In addition to reducing pain, you can help reduce the suffering associated with their pain.
Become trauma-informed. Pain is complex, obscure, and often invisible. Show your patients that you understand that their pain is real. Help empower your patients to reach their functional goals.
Amanda Harris is the Strategic Planning manager at the St. Louis Regional Health Commission.