Greater incidence of prior trauma in people with migraine

Adults who suffer migraine headaches are more apt to have post-traumatic stress disorder (PTSD) than the general population, a new study suggests. And having PTSD and migraine may lead to greater headache-related disability.

Excerpts follow:

<snip>

Among a group of 593 adults with migraine, PTSD was present in roughly 30 percent of those who suffered chronic daily headaches and about 22 percent of those with “episodic” migraine headaches. By comparison, approximately 8 percent of the population is estimated to have PTSD.

<snip>

“The implications are such that abuse causes not just psychological distress from PTSD but also physical pain such as migraine,” Peterlin said, and there is an increased disability seen in those migraine sufferers with PTSD than those without PTSD.

<snip>

SOURCE: Headache April 2009.
The full article can be found at

http://www.canada.com/news/Post+traumatic+stress+common+migraine+sufferers/1461579/story.html

 

Cognitive behaviour therapy helps with chronic pain – research

Wiley-Blackwell issued the following news release:

CBT and BT: Some effect against chronic pain

Cognitive Behaviour Therapy (CBT) and Behaviour Therapy (BT) show some
effect in helping the disability associated with chronic pain, according
to a Cochrane Systematic Review. The researchers assessed the use of CBT
and BT on chronic pain, mood, and disability.

“For people with chronic pain, psychological therapies can reduce
depression and anxiety, disability, and in some cases pain, but guidance
is still required on the best type and duration of treatment,” says lead
researcher Christopher Eccleston, at the Centre for Pain Research at the
University of Bath.

Both CBT and BT try to manage pain by addressing the associated
psychological and practical processes. CBT involves the avoidance of
negative thoughts. BT helps patients to understand how they can change
their behaviour in order to reduce pain. Both approaches have been in
development for around 40 years and are sometimes recommended for
patients with long lasting, distressing pain that cannot be relieved by
conventional medicines.

In a systematic review, researchers considered the results of 40 trials
of CBT and BT, which included 4,781 patients in total. Patients
suffering from pain due to any cause, except headache, migraine, or
cancer, were included. Most studies were of CBT, which showed small
positive effects on pain, disability, and mood. There was less evidence
for BT, which the researchers say had no effect on disability or mood.

“Although there is overall promise for CBT in chronic pain, the term
covers a diverse range of treatment and assessment procedures. Right
now, we are not able to say which specific features of therapy may be
critical for improvement of a patient’s condition,” says Eccleston.

According to the researchers, simpler studies of CBT and BT that focus
on a purer form of treatment, rather than a variety of mixed methods,
would benefit the field.

 

Zen meditation alleviates pain

The University of Montreal issued the following news release about a
study published in *Psychosomatic Medicine* and funded by the Canadian
Institutes of Health Research, the Mind and Life Institute Varela Grant
(J.A.G.), & the Fonds de la recherche en sante du Quebec:

Study finds Zen meditation alleviates pain
University of Montreal pain management study in Psychosomatic Medicine

This release is available in French.

Montreal, February 3, 2009 – Zen meditation – a centuries-old practice
that can provide mental, physical and emotional balance – may reduce
pain according to Universite de Montreal researchers. A new study in the
January edition of Psychosomatic Medicine reports that Zen meditators
have lower pain sensitivity both in and out of a meditative state
compared to non-meditators.

Joshua A. Grant, a doctoral student in the Department of Physiology, co-
authored the paper with Pierre Rainville, a professor and researcher at
the Universite de Montreal and it’s affiliated Institut universitaire de
geriatrie de Montreal. The main goal of their study was to examine
whether trained meditators perceived pain differently than non-meditators.

“While previous studies have shown that teaching chronic pain patients
to meditate is beneficial, very few studies have looked at pain
processing in healthy, highly trained meditators. This study was a first
step in determining how or why meditation might influence pain
perception.” says Grant.

Meditate away the pain

For this study, the scientists recruited 13 Zen meditators with a
minimum of 1,000 hours of practice to undergo a pain test and contrasted
their reaction with 13 non-meditators. Subjects included 10 women and 16
men between the ages of 22 to 56.

The administered pain test was simple: A thermal heat source, a computer
controlled heating plate, was pressed against the calves of subjects
intermittently at varying temperatures. Heat levels began at 43 degrees
Celsius and went to a maximum of 53 degrees Celsius depending on each
participant’s sensitivity. While quite a few of the meditators tolerated
the maximum temperature, all control subjects were well below 53 degrees
Celsius.

Grant and Rainville noticed a marked difference in how their two test
groups reacted to pain testing – Zen meditators had much lower pain
sensitivity (even without meditating) compared to non-meditators. During
the meditation-like conditions it appeared meditators further reduced
their pain partly through slower breathing: 12 breaths per minute versus
an average of 15 breaths for non-meditators.

“Slower breathing certainly coincided with reduced pain and may
influence pain by keeping the body in a relaxed state.” says Grant.
“While previous studies have found that the emotional aspects of pain
are influenced by meditation, we found that the sensation itself, as
well as the emotional response, is different in meditators.”

The ultimate result? Zen meditators experienced an 18 percent reduction
in pain intensity. “If meditation can change the way someone feels pain,
thereby reducing the amount of pain medication required for an ailment,
that would be clearly beneficial,” says Grant.

 

Books on pain & pain management

The War on Pain – by Scott Fishman Very helpful in understanding the many biological/medical sides of pain better. Fishman is Chief of Medicine somewhere and has done/seen it all. Embedded throughout are helpful suggestions for coping. Gives a picture of what is “normal” regarding chronic pain.

Based on interviews with pain patients and pain healthcare professionals:

Pain. The Science and Culture of Why We Hurt by Marni Jackson

The Truth about Chronic Pain by Arthur Rosenfeld. In both, there are plenty of sketches of what the typical chronic pain experience is like.

Managing Pain Before It Manages You by Margaret Caudill. Provides practical suggestions for managing many of the common issues confronting people living with pain.

 

Depression alters how we handle pain

Reuters released an article: “Depression alters how we handle pain” by
Will Dunham.

Here are some excerpts:

[begin excerpts]

Scientists have found clues in the brains of people with major
depression that might help explain why so many depressed people also
battle chronic pain, U.S. study published on Monday says.

Brain imaging showed that people with depression had more activity in
brain regions involved in emotions when they anticipated or experienced
pain, the researchers found.

Irina Strigo of the University of California San Diego and colleagues
told volunteers eight seconds beforehand that a painful experience was
coming – being touched on the arm with a device hot enough to cause
brief pain but not injury.

“Not only do you really show this high activation of emotional areas
when the pain was not there, but when the pain is there you see this
helplessness, not even trying to modulate your experience,” Dr. Strigo
said in a telephone interview.

<snip>

More than three-quarters of depressed people have recurring or chronic
pain, while 30 per cent to 60 per cent of people with chronic pain
report symptoms of depression, the researchers wrote in the Archives of
General Psychiatry.

“If a person has chronic pain together with depression, this is a very
debilitating condition. This condition is very difficult to treat and
the disability is much higher and the cost of treatment is very high,”
Dr. Strigo said.

She said the study’s findings may point toward new ways to help
patients, either through behavioural therapies or perhaps drugs.

[end excerpts]

The article is online at:
<http://tinyurl.com/6e4mps>

 

Psychological Therapies Ease Arthritis Pain

The British Psychological Society issued the following announcement:

Psychological Therapies Ease Arthritis Pain

Article Date: 13 Sep 2008 – 4:00 PDT

Arthritis sufferers can alleviate their pain by using mental imagery and
hypnotherapy.

This is the finding of Bryan Bennett and colleagues from Bangor
University who presented their findings on the11 September 2008, at The
British Psychological Society’s Division of Health Psychology Annual
Conference held at the University of Bath.

 

PTSD Influences Levels Of Depression And Pain

The American Pain Society issued the following news release:

PTSD Influences Levels Of Depression And Pain
22 Jul 2008

Patients with accident or trauma related chronic pain often have post-
traumatic stress disorder (PTSD) and depression. What isn’t clearly
known, however, is how PTSD relates to mood disorders and pain severity
in chronic pain patients.

University of Michigan researchers examined the contribution of PTSD to
the pain experience, functional disability and frequency of depressive
symptoms. They studied 241 patients referred to the university
hospital’s pain rehabilitation program who reported their pain began
after a traumatic injury. The subjects completed the McGill Pain
Questionnaire and were administered the Pain Disability Index and the
Post-traumatic Chronic Pain Test.

Results showed PTSD and depression are significantly correlated and both
disorders are associated with perceived disability attributed to chronic
pain. Therefore, in cases of disabling accident-related chronic pain
with comorbid depression, symptoms of PTSD may be critical to
understanding both disorders.

The authors concluded that increased attention to treating PTSD as a
primary focus in the rehabilitation of patients with chronic pain and
comorbid depression is important when prior treatment efforts for pain
and depression have not been successful.

 

10 Resolutions for managing chronic pain or illness

LIVING WITH CHRONIC CONDITIONS: Beyond Survival.
by Brian Grady, Ph.D.

“There is nothing more we can do; you will just have to learn to live with it”. This is the message heard by many people suffering a chronic condition – chronic illness or pain. Medical treatment has not fully resolved the problem. The patient’s question remains: “But HOW do I live with this?”

The answers are not easy, but they exist. As people learn to adjust to a new life, priorities often change, and some old attitudes and habits will shift. Meanwhile, learning a set of well-understood coping strategies makes a chronic condition manageable. Life can be rewarding again.

Recognizing the various problems that come with a chronic diagnosis is a start for the patient and their caregivers. While some of this depends on the condition, there are common emotional, behavioural, social, physical issues facing people with chronic pain or illness. These are all interconnected.

Mood changes, such as depression, anxiety, or anger result from disappointed hopes for a cure, difficulties with medical systems or insurance, loss of ability to do valued activities in work, sports, hobbies, or family life. Some people go through a stage of grieving the person they were and the life they had. Behaviour and social changes that go with this might be withdrawing socially and becoming less active.

Some people become more dependent; others insist on trying to do things the way they used to, regardless. It can be tough on everyone, and families usually feel some stress. A spouse may have to take on much more of the family’s responsibilites and chores, while also providing practical and emotional support for an ill partner. Marital strain may result.

Physical changes result from the condition, and also from the changes in behaviour and mood. These often involve sleep problems, weight change (more or less), fatigue, loss of strength, flexibility and endurance. Medication side-effects also play a role in physical changes.

Clearly, learning to “live with it” involves much more than just managing symptoms. The condition is a rock dropped in a pool of water. Ripples wash across the pond, and nothing remains the same.
The person who is ready to learn to “live with it” will be helped by making positive decisions about themselves, their life, and their relationship with the condition. Here are some suggestions – ten resolutions – that can help people learning to cope with their changed lives. Those who make these resolutions their own stand a good chance of thriving, not just surviving.

10 Resolutions for people managing chronic pain or illness:

1. RECOGNITION: I realize that my condition has not been completely cured or resolved by medical treatment, or the force of my will, by waiting, other sources of help, or by deciding it’s not important. I am prepared to recognize this and move in a new direction.

2. POSITIVE APPROACH: I recognize that I need a positive relationship with my body and symptoms. I am learning positive ways to live with this condition.

3. LETTING GO: I let go of parts of my past life that are over. I may grieve what is lost, but I am committed to living well with what is.

4. SELF-ACCEPTANCE: I accept myself and forgive myself for having had difficulties. I recognize that I am human, and have human limitations like everyone.

5. BUILDING RELATIONSHIPS: I build or heal my relationships with others.

6. NO BLAME: I forgive anyone I have blamed for my condition or for mistreatment.

7. RECOGNIZING HABITS: I acknowledge any old habits that do not serve me or my condition, and am willing to develop new, healthier ones.

8. ACKNOWLEDGING RESISTANCE: I acknowledge ways I am held back – by myself, by others, by fear, or by reinforcement for staying where I am.

9. INDEPENDENCE: I understand how I can become dependent in unhealthy ways — on people, on medications, drugs, alcohol, on organizations, on objects, on ideas. I am willing to release these things and regain my power and control over my life

10. TAKING IT FORWARD: I am ready to make positive choices and to see them through. I am open to new ideas and ways of living. When I have made these changes part of my life, I can also help others.

Brian Grady, Ph.D. is a registered psychologist in Victoria, BC who has been working with people with chronic health problems since 1992.

last edit: 12 June 2008

 

Summary of Pain Management Techniques

Summary of Pain Management Techniques – Brian Grady, Ph.D

	Technique	What	Purpose	Effect on symptoms	When	How long
1	Diaphragmatic breathing	Deep and slow breathing, using the belly.	Physical Relaxation Calming	Pain reduction Pain tolerance	High pain High stress Can’t sleep Tension During activity While stretching	5 to 25 minutes, daily Duration of high pain episode
2	Activity pacing	Alternate difficult and easy activities	Prevents pain flare-ups while increasing productivity	Preventive Conserves energy	Any task	Duration of task.
3	Persistence / non-avoidance	Keep doing an activity	Learn not to let pain control activity	Neutral	When continuing will create no long-term problems	While symptoms are manageable
4	Thought stopping	Noticing persistent negative thoughts, halting them, and changing focus	Calming Decrease worry	Neutral	Can’t sleep Worry, uncertainty	10 seconds, repeated as needed
5	Sensory transformation	Feel “itching”, “pressure”,”heat” or “numbness” instead of pain	Makes sensations more bearable	Pain tolerance	Moderate to high pain	10 to 25 minutes
6	Progressive muscle relaxation (active)	In sequence, tense, hold, and then release muscles with an out-breath	Physical relaxation Calming	Pain reduction	Any level of pain Emotional distress Can’t sleep Tension Too tired to concentrate on another relaxation method	5 to 25 minutes
7	Progressive muscle relaxation (passive)	In sequence, be aware of muscle groups, and soften with an out-breath	Physical relaxation Calming	Pain reduction	Any level of pain Emotional distress Can’t sleep Tension	5 to 25 minutes
8	Peaceful imagery	Use all the senses to experience or recall a peaceful experience	Physical relaxation Calming	Pain reduction	Any level of pain Emotional distress Can’t sleep Tension When able to concentrate	5 to 25 minutes
9	Be with pain	Non-resistance. Don’t fight it. Just let it be there.	Makes sensations more bearable Reduces distress	Pain tolerance	Any level of pain	Any length of time
10	Self-hypnosis (imagery, counting)	Deeply relaxed, absorbed in what you experience, while open to what may happen as you use images and suggestions for healing	Pain relief Calming Relaxation Building confidence Making behaviour changes	Pain reduction	Any level of pain When able to concentrate	10 to 25 minutes
11	Quick-cued relaxation / debracing	Using a cue previously connected with the relaxation response to relax quickly	Relaxation Calming	Pain reduction Pain tolerance	Any level of pain Stress	2 to 5 minutes
12	Defusing negative emotions	Notice negative emotions building, and short-circuit them early	Calming Makes sensations more bearable	Pain tolerance	As soon as stress begins to build	1 to 10 minutes
13	Exercise	Strengthening Stretching Fitness	Build fit, flexible, strong body	Long term pain reduction	Daily routine	30 to 60 minutes
14	Biofeedback	Getting feedback about a body function helps you control it	Gain control over tension, breathing	Long-term Pain reduction	In office with clinician Thermal: on own, daily routine, as part of relaxation practice	10 to 20 minutes
15	Stretching	Stretching muscles, joints	Relieve tension Improve flexibility	Pain reduction (immediate and long term)	Daily routine With increases in pain When tension is noticed Before activities	2 to 20 minutes
16	Distraction	Put mind on something other than symptoms	Reduce distress, pain awareness	Pain tolerance	Any pain level Can’t sleep	As long as necessary
17	External focus	Focusing on environment around, not body	Reduce distress, pain awareness	Pain tolerance	Any pain level	As long as necessary
18	Positive self-talk	Coaching oneself through stressful experience	Reduce distress, improving coping	Pain tolerance	Moderate to high pain Stress Can’t sleep	As long as necessary
19	Cognitive rehearsal	Preparing oneself to cope before a situation	Reduce distress, improving coping	Pain tolerance	Before possibly painful or stressful experience.	5 minutes
20	Posture correction	Maintain balanced posture and gait (walking pattern)	Relieve tension and fatigue	Pain reduction long term	Daily, frequently.	Ongoing.
21	Pressure point release	Press classical acupuncture points	Release tension Increase energy Calming	Pain reduction	Tension Pain Can’t sleep	15 minutes
22	Micro & mini breaks	3 second to 30 second breaks in activity	Release tension Conserve energy Re-establish circulation	Preventive	During activities. Micro breaks every minutes, mini breaks every 5 minutes.	Duration of activity

 

How we talk and think about pain

How we talk and think about pain:

We talk about pain and injury, meaning different things.

There are the physical sensations in the body. There is the meaning we give pain and this includes both possible physical effects, and social effects or meaning. There is the emotional experience (“Misery Factor”) that goes with the pain and what it means to us.

Circle your own experiences:

Body sensations	Meaning (Physical)	Meaning (Social)	Emotional description
Throbbing	Injury	Embarrassed	Tiring
Pounding	Ambulance	Failure	Unbearable
Sharp	Unemployment	Inferior	Agonizing
Aching	Paralyzed	Useless	Punishing
Burning	Collapse	Lonely	Killing
Dull	Disabled	Humiliated	Wretched
Tender	Forever	Ridiculed	Dreadful
Sore	Emergency	Ignored	Exhausting
Gnawing	Attack	Insecure	Nagging
Hurting	Crippled	Ashamed	Sickening

When we feel body sensations, we interpret these, and are prone to predict or guess the possible physical effects and social effects of what is happening. This is what the pain means to us. Depending on the interpretation, we will also have a different emotional experience.

Part of the job of people in chronic pain is to learn to identify (be aware of) and change excessively negative interpretations of body sensations.

Alternatives

Body sensations	Meaning (Physical) (add your own)	Meaning (Social) (add your own)	Emotional description (add your own)
	Temporary	I’m adequate	Manageable
Same as	Minor	Understanding	Coping
above	Healing	Compassion	Tolerable
	Inconvenient	Strong	OK
	Adjustments	Helped	Challenging

Self study

When you are in pain, how often do you think of the kinds of possible physical effects noted above? How often do you think of the social effects or meaning noted above? Which emotionally loaded words do you use to yourself and others? How could you begin to think and talk about your symptoms that might be better?

Brian Grady, Ph.D