Most of these problems are known as invisible disabilities. An invisible disability is not obvious to the naked eye. The person looks healthy and yet they call in sick to work or school a lot, can't work at all or only minimally, and have difficulties in their relationships but because they appear normal people around them might pass judgment unfairly about why the person isn't working, going to school, or passing up on social invites. Many of these disorders are poorly understood not just by the public at large but also by the medical community. With vulvodynia (chronic horrible unremitting vulvar pain), for example, the average woman sees eight doctors before she receives a diagnosis. Even after a diagnosis is made many doctors who are so called specialists understand very little about how to provide relief so it can take months or years of trying different treatment or switching doctors to get relief. Additionally pain management is very poorly understood by many physicians. Because of this doctors can be reluctant to provide pain medications or even a referral to a pain management specialist despite evidence that pain medicine can vastly improve a person's quality of life and a person who is actually in pain is at a low risk for abusing pain meds.
To make matters more difficult more women than men suffer from chronic pain. This is little comfort to the men out there who are trying to cope with a chronic pain disorder. However, for many years women in chronic pain were dismissed or stigmatized by the medical community as being "hysterical" or that the pain is "all in her head" or she was "frigid" and needed to "loosen up a little." These attitudes are unfortunately still found all too easily in doctor's offices across the country, and most women who find a good doctor who is both compassionate AND competent knows that doctor is like gold. So thank you to all of you doctors, NPs, PAs, and clinicians who are both compassionate and competent.
I am going to use this series to go over some cognitive distortions that can make the emotional and relationship of pain disorders worse. I am also going to discuss how therapy can be of help and also discuss alternative therapies that you might not know about that might also offer you some emotional or even physical relief. I will go over how to make your own "emergency list" of coping tools of what to do in a pain flare-up so you can feel as if you have some control over your life. And hopefully through this I can encourage you to keep trying treatments and coping skills until you feel as if you get your life back or your pain disorder goes into remission-it does happen!
One of the best known psychotherapeutic techniques to help people who are suffering from chronic pain is cognitive behavioral therapy also known as CBT. CBT is also used to help people deal with depression, anxiety, trauma, and relationship issues. For the purpose of this series I will give examples that relate to chronic pain. There are ten common cognitive distortions and I will discuss a few per blog over the next several weeks. I encourage you, the reader, to journal about the distortion and examine your life to see if or where you are using any of these distortions in a way that is harmful to your well-being and I challenge you to substitute the distortion with more rational, healthy thoughts.
The first distortion I would like to discuss is called "All or nothing thinking." This distortion can contribute to depression and anxiety, thus making your pain physically feel worse AND having a devastating effect on your emotional well-being. It is true that somebody who is depressed or anxious about chronic pain actually experiences that pain more acutely. A clue that you are getting tripped up with all or nothing thinking is words such as "always" "never" or "ever." There are very few situations in life that are all-or-nothing.
A few examples of all-or-nothing thoughts are:
1. I will never feel better again.
2. This pain flare up will never end. I just can't cope.
3. I will always feel horrible.
4. I will never be able to work full-time because of this.
5. Nobody will ever love me if I am always sick (wow-there's TWO distortions for the price of one there!).
Some healthier examples of thoughts that are also true and more advantagous to coping are:
1. I may feel better again. After all, I have some days where I don't feel so well and some days where I feel fine. I can learn to ride out the ups and downs and be easy on myself when I am not feeling well.
2. Most of my pain flare-ups last six or seven days (or a month, etc. It is important to track your pain so you know what the REAL answer is to this question). Even if I am in daily pain some days are better than others. I have a list of coping tools that I can use to help make flare-ups more bearable such as relaxation, massage, acupuncture, and pain medications.
3. Many people who have chronic pain find some type of relief-even if it takes years. I will be one of those people and I will continue to plug away at this because my well-being and comfort is worth it.
4. It is ok to find a flexible or part-time job that will accommodate my health because my health is a priority. I will explore options such as job-sharing, self-employment, work from home, and even disability so I can remain self-sufficient. Because I'm not a fortune teller I don't know for sure that I will NEVER be able to work the future may hold physical relief or a job that fits my situation.
5. The vows of "in sickness and in health" also apply to me. I deserve to find somebody who is compassionate and mature enough to understand and be supportive of my limitations. Everybody comes to a relationship with baggage-it may be a chronic pain issue, a mental illness, a crazy family, or an annoyingly quirky love of stamp collecting. Just as I will be loving an accepting of my partner's quirks I expect my partner to work with me with mine.
These healthy thoughts in no way are meant to minimize the difficulties of living with pain. It is depressing, anxiety producing, angering, and upsetting to be in pain. But cognitive distortions don't serve us and taking an honest look at which ones we may be self-harming with help us break out of patterns of depressive or anxious thoughts and move forward to feel better both physically and emotionally.
Next entry will cover a few more cognitive distortions. Here are a few books/CDs that I think are helpful for coping:
Pain Free 1-2-3: A Proven Program for Eliminating Chronic Pain Now
Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach Workbook (Treatments That Work)
The Mindbody Prescription: Healing the Body, Healing the Pain
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