Showing posts with label dbt therapy for pain management. Show all posts
Showing posts with label dbt therapy for pain management. Show all posts

1/17/22

Types of Pain and how Physical and Emotional Pain Correlate As the disaster duo

What are the Types of Pain One Can Have and How Do We Accurately Assess the Level  of Pain?


Pain is a concept that is different to all people. Many medical facilities use a rating scale of 1-10 to rate your pain. Does this seem like an accurate assessment to you? When asked this question, how do you answer? Most of us think for a minute and pause. Next, we look at the attending physician with a little bit of confusion as to how they will rate your rating. If you say a 5 does that mean you feel "manageable pain"? If you say 10, are you feeling like you are being dramatic when you are truly feeling completely drained  physically, emotionally and all of your thoughts and focuses are on this pain.  Can you truly rate it a 10? 



The Famous 1-10 Scale of Pain Assessment 




Number scales are extremely difficult to use to assess pain. Many chronic pain patients feel some kind of confusion when it comes to the rating scale. We are so afraid of being” rated back” or not taken seriously because each day we feel chronic pain.


Emotional Pain Scale 


When we have chronic pain, it often comes with emotional pain which has yet another chart. This is also incredibly  complex and can be a result of chronic physical pain or vice versa. Chronic emotional pain can also turn to chronic physical pain and the two occur together in most occurrences. This is why handling a chronic pain patient's emotional state is just as important as monitoring and treating the physical pain of a patient.


The correlating Duo 


Serious anxiety and emotional distress can cause some serious pain. The lingering effects of a depressed state will inevitably lead to physical health problems. Chronic physical health problems lead to an unsteady mind state. We cannot generally have one type of pain without the other. If somebody is bedridden and unable to do the things that they find pleasurable in life than they are more likely than not, suffer much in the same way that a person who is grieving suffers. They will grieve the way they used to live their life and how they have to adjust to their new normals. We will discuss how to effectively handle emotions later on in this course as well as Many effective mental health coping mechanisms actually work to treat physical pain because you are treating the emotional pain that is correlating with it. That is why there are mental health professionals that work at pain management clinics. They play a vital role in treating both kinds of pain. Having a healthy emotional state can greatly decrease your physical pain.


When You Deal With Both Types of Pain, Rating it on a Scale Makes it Even Harder


Because emotional and physical pain go hand in hand when dealing with a chronic pain condition, rating our pain on a scale can be a cumbersome task at best . This can make it even more difficult to describe exactly how we are feeling when no one else can even have a clue as to how we are actually feeling both physically and emotionally. Some types of pain can not yet be accurately assessed by a physician. Even with all the medical advancements we have today, some conditions can only be assessed by how we tell the doctor we feel. 


Reasons we Need Pain Scales for Certain Types of Pain 


 We can understand why a pain chart is there. In an acute pain situation, it's more useful. An example would be, you were climbing a ladder and fell off. This causes an ankle injury. The doctor takes an x-ray and sees that bones are broken. So, when in an acute situation saying that you feel a level of pain of an 8 or 9 because you have a newly fractured bone, the pain scale makes sense. It can be measured by a scan of the bones so the number you say correlates with the scientific evidence in front of the person treating you. A broken ankle can not be ignored. It interferes with tasks. It interferes with your concentration level as well as your basic needs. It also requires bedrest and elevation of the limb to heal so based on this pain scale you would be in a level of pain of a 10.


Acute and chronic Pain Correlate Together as Well


In an emergency setting we may not know the doctor treating us. If something isn't broken but you have acute pain like a migraine, that can be a more complicated assessment. It is not pain that lasts forever, Pain may be both chronic and acute at the same time. Some days you feel less bad and can deal and others you have migraines that come on abruptly. Sometimes they can be managed by over the counter medications, or prescriptions from a general practitioner.  Other days, the migraines are so bad that they are considered a "10" and require emergency treatment. Migraines are both acute and chronic at the same time  


Chronic pain is a condition that lasts for more than three months and various treatments can manage it but there is no exact cure.It causes underlying anxiety, depression, fatigue and a loss of interest in activities that you once enjoyed. You may feel stress that a certain situation or food may possibly trigger an acute migraine bad enough that emergency medical assistance is necessary. This causes you to avoid certain activities and things you enjoy and now you are dealing with emotional symptoms triggered by your chronic pain condition. 


We all feel pain differently


 Not one person feels pain the same way that another person feels it. Human beings are completely unique in this way. When it comes to chronic pain,because we are so used to feeling like we are in a level of pain like a 10, we may assess our pain differently to a doctor and say it is a six. A migraine is not something that can be seen on an X-ray or a chart. The same thing applies with conditions like fibromyalgia and neurological conditions that affect our lives on a deep level but no doctor can find any evidence of the condition. This is when we have to explore the various treatments that come with chronic long lasting pain that some days may be manageable at home while other times it is not. 


Developed Tolerance to Pain 


When we have chronic pain, we begin to develop a tolerance to it physically, but mentally and realistically,  we are on the level ten on both the 1-10 pain and emotional scales. When something can not be clearly identified by research and lab testing, we may feel like our care providers don't understand how truly bad we are feeling. This is when those  with chronic pain who have a high pain tolerance feel like the pain scale backfires. We can be at a normal person’s eight, where they might be crying and writhing, and yet we are still sitting up, or reclining on the hospital bed, and may be able to even crack a joke here or there as a method of dealing with it.  They ask your pain level and you freeze up because you feel like the above image, hopeless, miserable, feel like crying but there's no more tears to give and you don’t know what number is appropriate.


 To you, there  is pain you can deal with and pain you can’t, and your pain is getting to the point you can’t – that’s why you are there. So you throw out a number. You don’t want to sound dramatic so you low-ball it and the doctor isn’t seeing a patient in that much pain, so what happens? You feel like you wasted a trip and are more exhausted because you weren't having a screaming episode in front of the doctor. So what are we supposed to do, lie there moaning and putting on a huge display to get our needs met?


Communicating With Your Providers is a Key Factor in Treating Your Pain 


In order to effectively treat chronic pain, one has to be able to learn to effectively communicate with the ones treating them. Becoming educated on effective communication methods with the people in your life that help you deal with your emotional  and physical pain can provide you with many more options for treating how you feel. Good communication skills can make a world of difference for chronic pain sufferers. You will learn how to communicate with your doctors and other providers in a way that opens up decreased pain on all levels after this course. A good way to start this is to start giving constructive feedback on how your pain management plan is working.  A fantastic start to this is telling your doctor specific things such as what is shown below are helpful. 

  • How is my life going in general?

  • What does my pain limit me from doing that I would like to be doing if I wasn't hurting constantly. 

  •  What does a typical day look like? 

  • What parts of my day have changed because of the pain I am in ?

  • Am I a possible danger to myself because of the pain? 

  • How much time each day am I spending in bed?

  • Can I go to work full-time, part-time or not at all?

  • What do I reasonably hope to gain from the visit? 

  • Do I feel lonely, anxious, hopeless, irritable or a variety of other mental states that I should tell my provider?


Additional Types of Pain


We have discussed acute as well as chronic pain and touched a bit on how they can intertwine and affect each other. There are various types of pain however that can greatly interfere in one's life. 




Neuropathic pain:

Nerve Pain can be one of the most sensitive types of pain there is. It occurs when there is damage to the nerves or other parts of the nervous system. Some common symptoms of this variety of pain are-

  • Often described as shooting, stabbing, pins and needles, or burning pain

  • Can affect sensitivity to touch

  • Common type of chronic pain

  • Can be intermittent as when one feels like they are doing okay one day and the next can also be so  severe that it makes performing everyday tasks difficult. 

  • Can lead to mobility issues


Understanding Nociceptive pain


This is often the type of pain that causes permanent damage to some area of the body or body tissue. 

  • Often described as being a sharp, achy or throbbing pain

  • Often caused by an external injury 

  • Often experienced in the joints, muscles, skin, tendons and bones

  • Can be both acute or chronic


Radicular pain:


Very specific type of pain that can occur when the spinal nerve gets compressed or inflamed

Radiates from the back and hip into the legs by way of the spine or spinal nerve root. This can feel both neurologically painful and chronically painful. 


  • Experience tingling, numbness and muscle weakness

  • Commonly known as sciatica because the sciatic nerve being affected

  • Pain is often steady and people can feel it deep in the leg

  • Walking, sitting and some other activities can make it worse 

Post Surgical Pain


When one has an upcoming surgery, generally there is a great amount of fear about the pain they will have. Surgical pain comes from an incision being made that causes damage to the surrounding tissue. Sometimes the procedure itself, such as a cystoscopy can cause pain. This is an exploratory surgery. There is no technical cutting or incisions but the exploratory nature of the procedure itself, causes post surgical pain. This type of pain is caused by the use of force of an instrument that stretches the area being explored further.  

One can also have pain from a breathing tube that has germ inserted. This can cause the throat to experience irritation. 

If it is a long surgery or the positioning necessary for your body to be in, is uncomfortable, this can cause pain as well. 



Superficial Somatic Pain


When you have Somatic pain, this comes from an injury of some kind. They can be as simple as falling off the bike and scraping your knee or having surgery or a biopsy and the cuts and wound area hurts for a while until it heals. It can also be from surgical pain from the incision and for the pressure from the force of a surgery.


Deep Somatic Pain


When you have pain that is deeper than superficial pain it is known as Deep somatic pain. 

This type of pain comes from a torn ligament, a muscle being torn or a tendon or a broken bone. Sprains can also cause this kind of pain. Surgical pain involves both types of deep somatic pain and somatic pain. The deep somatic pain is when incision cuts through tissue that is deep. Superficial somatic pain is from the scarring or injury and the outer layers of the skin. 


Central neuropathic pain 


When the brain or spinal cord is injured central neuropathic pain can occur. A Traumatic brain injury can cause central neuropathic pain and injury to the spinal cord. 



Visceral Pain


Visceral pain is from internal organs and it usually is from a digestive system situation or appendicitis. These are some examples there are other types of visceral pain as well. It is hard to always find the exact location of the pain because it may feel general in the area to the patient. It can sometimes take a while to diagnose this type of pain. It can also be caused by surgical pain and different types of damage to organs and infections as well as cancer. A type of visceral pain that happens during surgery is anytime a surgeon cuts through the G.I. tract, that would be an example of this kind of pain. 


 Referred Pain


When the brain receives a lot of information at once by an area of nerves that is unable to distinguish where it is coming from, it is known as referred pain. An example could be a human being grabbing his left arm because he is having a heart attack. He feels pain in that arm so he grabs it. The pain signals are confused and are sending pain to different areas. The bundle transmission of this pain is causing it to expand and go to different areas because the information is coming in so fast that it can’t distinguish where the body is supposed to hurt.



Peripheral neuropathic pain


 Peripheral neuropathic pain starts with nerves that are not part of the spinal cord or the brain. They are the nerves that are in the extremities of the body. These include your arms and legs. 



Phantom Limb Pain


When someone undergoes an amputation of a body part, they can experience a strange type of pain that is quite unique. This is known as phantom limb pain. The limb is missing but the patient feels pain where the body part used to be. It can also happen in areas that are not limbs like a possible situation where a woman has to have a mastectomy. She may feel pain where her breasts used to be and this is also known as a type of phantom limb pain. It used to be thought of as something psychological but research is finding that this type of pain is legitimate and causes patients a great deal of distress. They can actually become in severe pain that is acute and chronic in nature. Sometimes it will be really bad other times it will be tolerable. It is a serious type of pain that is still being studied to understand how to effectively treat patients with phantom limb pain. 





11/02/21

Learning the Various States of Mind and How Mindfulness Can Help Us Feel Less Intense Pain



Mindfulness Verses Mindlessness and the Various States of Mind that Follow 

We all have various moods. This is absolutely normal. We are humans beings who experience a range of emotions ranging from mild to intense.  Moods can also be known as various states of mind. One always wants to examine the distinct difference between these constantly shifting states. This helps to build awareness of how we are feeling when in these extremely different states of mind.

This is an Image of Being Mindful 



The above image shows a peaceful scene of the beach, sand, rocks, glaciers and ocean. These all remind of us serenity, peace and tranquility. It is not being shown to look at it in that way however. It is shown to notice the different things that we see when we look at that photograph and the words within it. The word Mindful is also an acronym. 
  • Moment to Moment Attention
  • In the Here and Now
  • Non Judgemental Attitude
  • Detatch from Unhelpful Thoughts
  • Forgive and be Greatful
  • Unconditional Acceptance
  • Learn with a Childlike Mindset 


Learning More on Moment to Moment Attention

 


This is being here in the present state of here and now. If this word is unfamiliar to you, and it may be at this point, you can start with a word that we all know as a regular word in the English language. Focus. That is when we are attentive to what is going on around us, paying attention to what is going on in the here and now and not drifting off into a sea of thoughts. It is a state of being aware of all of your surroundings, going on the small things even, appreciating the here and now, not focusing on the past for the future. It is just being present and hang attention in a non-judge mental state.Interesting study moment to moment attention. 

Whenever we give anything our attention, we are giving “it”, “that”, or “who”, the ability and power to change how our brain is working at the moment. If something has our undivided attention, we are ducked in like a Hoover and entranced. It almost has a giant illuminating bright light surrounding it as well. That is whatever “it” may be. Imagine the ability to truly control your focus of your attention? Getting better at it, reeling it in to where you want it. Like a Lasso, we want to rope our moment to moment attention and rope it in again and again to gain control over the thoughts that are constantly flowing in and out of our minds. Imagine being able to get rid of bothersome, anxious and worrisome thoughts as easily as they flowed into your brain? They flow back out the same way. That is one of the great benefits of mastering mindfulness is mastering your attention. 

In the Here and Now



When we speak of in the here and now, that’s exactly what it is. Here right now, being aware , alert and cognitively processing everything that is going on in the present moment. Not 20 minutes, not next week, right now. This again involves being mindful and not being distracted by anything else in the world that might be ruminating in your head. Being able to do this can also give you a great amount of power over your emotional well-being. The acronym Mindful all ties together perfectly like knots in a rope. Each word loops to the next, making more sense as you become more in tune with every present moment. When we are grounded in the present mind, we are able to be both more mentally and physically fit. It truly is the key to helping to manage your stress, worries and mindful people are proven to be happier people as a result. Being connected to the here and now and being able to bring back your moment to moment attention to the present moment is the first two steps to living a more mindful existence. It is proven to help chronic pain as well as acute pain sufferers feel less physical agony. 

Mindfulness is a Great tool in the Pain Management Toolbox. 



Being present helps your pain in that you are more aware of engaging in activities that do not trigger more pain. If you are mindful that you get migraine headaches, you will be less likely to engage in activities that can trigger them. If you have hand pain, being aware of this and mindful can help you to position your hands in a way that are more comfortable. If you have back pain, being in the present moment, will allow you to focus on sitting or standing in a proper position that reduces discomfort. When we are actively being in the present and using our skills to be acutely aware of being mindful, we are happier individuals as a result. Our stress levels decrease, and our ability to cope with the mood shifts that come along with chronic pain. 

 

The Reasons Living in the Present Moment Can be Challenging.

Do you feel like being in the present moment and grabbing your attention like a lasso is difficult? That’s because it is. We are trained to dwell, think and ruminate. Our minds process images, information and history thousands of times a day with something we all know called.... thoughts. The internet itself encourages us to live in our past. When we say “Hey Siri” or have our sound on, we are being listened to for keywords to market products to us. Other images, advertisements and alerts also do this. We constantly get reminders that it’s someone’s birthday whether we talk to them or not anymore. Are these things healthy groceries? No. We can’t constantly change everything in our calendar to are ever adapting light. That’s why we have to constantly shift and focus back to refocusing. Even the chime of our phones, sends signals to our brain of dozens of memories immediately, shifting our focus back to the past. Lasso back in when this occurs. 

How Can I Not Be so Judgy?



Now that we have your attention and your paying attention to how you feel in the present moment, how do you feel about that? Interesting question isn’t it? The first two parts of the mindfulness acronym are the easiest. You would think anyways. However, as human beings we have a tendency to go into black or white thinking modes a lot. We also tend to judge. 

What are Judgements?

Judgement doesn’t necessarily mean that one us sitting on a high horse watching others and thinking “wow” that’s really bad, that’s a terrible outside, I hate their hair. It’s more complex when it comes to mindfulness, yet not at the same time. It’s when we start thinking things are- 
  • Wonderful or horrible
  • Brilliant or Stupid
  • Gorgeous or Unattractive
  • The Best or the Worst
  • Describing how things should be or they shouldn’t be
  • Continuing to compare and contrast 


What’s the Issues with Judgements?

When we begin to get judge mental about anything at all, it brings us off course. It takes us out of the present moment and destroys our focus. That’s when the issues arise.,This is when we grab our imaginary lasso and rope our attention, the present moment and our judgements about all of it back in again with our imaginary lasso. Every time you get off track, picture yourself with that lasso, grabbing what’s keeping you grounded, and pulling it back in, until you have regained control yet again. We tend to stop observing how we feel and even end up back in chronic pain when we fall into the judgement zone. Managing information chronic pain with being mindful really does work as a part of a complete chronic pain treatment plan according to Patty Rounds Who teaches DBT for Chronic Pain both online and in person. 
She is one of the Most famous dialectical behavioral pain management licensed clinical social worker’s in New York State. I had a chance to personally get her input for this article and insight. 

We Stop Observing When We Judge



The thing about judgment is that it tends to feed emotions that are negative. Shame, anger and guilt or some common emotions one may feel when we go into a mindset that is judge mental. We also have a fragile view on positive judgment as anything that can be judged as good can also be judged as the opposite or bad. One has to take active steps to let go of any kind of judgement.

Guide to Let go of Judgements


  • A good way to start is by actively doing practice. Start counting how often you are doing it and noticing judgements.
  • Ask yourself the question if you want to be judging and if the judging is helping or harming you.
  •  Change judgment statements with  Statements of preference: such as “I love...” “I enjoy ...” or “I prefer.
  • State the possible consequences. Say things to yourself like this could be helpful or harmful because of this or that. This could be effective or ineffective because of this or that 
  • State only the facts. Recall a time when something happened a certain way.
  • We will go into this later but practice excepting radical acceptance or excepting what is. That means excepting all the preferences, consequences and facts that go along with said situation.
  • Let go of those judge mental thoughts.


  • Let the judgments drift away like leaves on a stream. 
  • It may sound silly but always be mindful and remember not to judge your judging.

Action Plan of a Non Judge-mental Stance

Using charts for all tasks, even thoughts, and making plans in writing can really be helpful for chronic pain sufferers. Sometimes one has to continuously remind themselves to lasso back in and follow the acronym. Start with a simple action plan for learning not to judge-


  • Find a judgment about yourself, someone else, or a specific situation.
  • Put in words why your letting go of this judgment
  • Use facts and descriptions of them instead of judgments and the possible consequences of such judge mental behavior.
  • Write down your preferences about how you feel about what happens when you follow through with these judgments.
  • Work on excepting the descriptions in a non-judge mental way and letting go of these feelings.
  • Work on identifying any actions that help you to feel better physically and mentally and also allow you to let go of the judgments. 
  • Use imagery and body posture as well as relaxation techniques to help you let those judgments flow down a mountain after a long summers night rain.
  • In your action plan, write down the changes that you notice in how your body and mind.
  •  Notice  the acceptance rather than denial of the emotions and pain-that you are having. Accept it’s happening and take the power away from it.
  • Again, this cannot be stressed enough. Don’t judge you’re judging.

. 


    Tips for Camping with Children

      Camping with Young Ones Becoming a new parent is both exhilarating and exhausting. I am personally not one. However, I have a lot of exper...