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

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.



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.

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 – 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


Pain reduction

Pain tolerance

High pain

High stress

Can’t sleep


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


Pain reduction Any level of pain

Emotional distress

Can’t sleep


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


Pain reduction Any level of pain

Emotional distress

Can’t sleep


5 to 25 minutes
8 Peaceful imagery Use all the senses to experience or recall a peaceful experience Physical relaxation


Pain reduction Any level of pain

Emotional distress

Can’t sleep


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



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


Pain reduction

Pain tolerance

Any level of pain


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



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


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


Pain reduction Tension


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:

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.


Body sensations Meaning (Physical)
(add your own)
Meaning (Social)
(add your own)
Emotional description (add your own)


I’m adequate


Same as














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

Many health problems do not give up a clear diagnosis. How to live with this?

It’s common.

It’s common not to have a clear diagnosis. Many times a physician does not know the cause or exact nature of the problem, but does know that the body will heal most problems with good general care, sometimes called “non-specific treatment”. “Wastebasket” diagnostic categories exist for this reason. These are categories for conditions that don’t fit the general classification structure. Nature is more complex than our textbooks.

Why we want a diagnosis

Ideally, a diagnosis guides treatment. We know what this problem is, we know how to fix it. With a diagnosis, therefore, we feel more confident that we will be cured and that our normal life will soon resume.

A diagnosis may also bring with it a predicted course, or prognosis. From this, we can plan because we know what to expect. We will not be taken by surprise by changes in the condition. We may know how to make life more comfortable while we are mending, since we will know how long it will take to get better. We can prepare.

A diagnosis helps us to make sense of our symptoms. It begins to explain why some different symptoms go together, for example. This makes our problem less mysterious, whether or not there is a cure or treatment. We find patterns and explanations reassuring. We are prone to fear what we don’t understand, and a diagnosis may be a way reduce the fear of the unknown.

Diagnosis makes us feel safer, cared for. Someone understands this. It is known, and real. Lack of diagnosis on the other hand makes us feel vulnerable. The medical system is shown to be imperfect. It does not know something. This puts us in a less secure position than we thought. If the medical system is imperfect, I might not get help when I need it.

Diagnosis makes us feel not alone. There are others with this condition too, or else it would not have a name. This makes us feel less unique, isolated, and this is reassuring. Who would want to be the only person on the planet with a bizarre and unknown condition?

Diagnosis has financial implications. In order to get a disability claim you need to have a certain kind of diagnosis. Because human beings are not 100% honest all the time, there are checks in the compensation / disability system. One of these it not to hand out money to people who say they are sick without evidence of this. Second, some conditions are only temporary. One does not want to plan long term support for someone who will soon be well. Diagnoses help make this distinction between temporary and chronic conditions.

There is a social stigma of having an invisible condition or one that is not diagnosed. We want a diagnostic label to explain what we have to others. Especially if the condition is invisible to others, we can defend ourselves to those who are suspicious, skeptical, or critical. We can also justify our behaviour, explaining that this not not normal everyday situation. “Yes”, they say, “I get a sore back too sometimes. Don’t be a whiner”. A diagnosis of a herniated disk tells the critic that we are justified in not lifting that heavy load today.

Lack of diagnosis makes people wonder sometimes “Am I imagining this? Is it all in my head? Is this a sign of emotional or mental weakness?” All of these are based on shame and judgement, and also misunderstand how mind and body interface. Interestingly, we are often more prepared to be physically ill than to have some kind of shameful mental condition causing symptoms, especially ones that are invisible to others. That would be a moral weakness indeed. A diagnosis is reassuring. There is nothing wrong with me as a person. I have an illness.

When there is no physical diagnosis, the phrase “All in your head” sometimes is dusted off and thrown at the patient. This is not a diagnosis, nor is it an explanation that makes any psychological or physiological sense. Some people may say this assuming that if there is no gross physical pathology, the condition is therefore not physical but psychological. There are several problems with this. It is illogical, since LACK of evidence is not evidence OF anything. It ignores the fact that mind and body are not separate systems but are integrated. It is unhelpful, since it does not guide treatment in any way or lead to recomendations. It is vague, again not guiding treatment. It is as if a psychologist would meet someone and say “you have a physiological problem”. So what? As an analysis it does not go very far.

Expectations of the medical community have been raised to extremes with publicity of dramatic surgeries, advances in knowledge, high-tech medical procedures, and new drugs always being announced. We have high expecations and are disappointed with lack of diagnosis, and see it as a failure. Patients are not alone in this. Lack of diagnosis makes medical people very uncomfortable. Their training tells them to diagnose in order to do treatment.

Why diagnosis sometimes does not matter

Some diagnoses are really just descriptions, rather than explanations. A case in point is being diagnosed with a “syndrome” as opposed to a disease. Common conditions like fibromyalgia, chronic regional pain syndrome, chronic fatigue, etc are really just describing what the person experiences. Even where a cause is implied, as in ‘repetitive strain injury’, it’s just describing how it came about, without being able to say what the prognosis is. The same goes in a different way with something like ‘tendinitis’, which means literally, inflammation of the tendon. Having such a diagnosis does not guarantee any particular treatment will work, or how long it will last, or how disabling it will be.

Another reminder about the limits of diagnoses is that we can have one, and still not have treatment for the condition. We sometimes assume that what we can identify we can treat, and this is not always the case. If it were, there would be no chronic diseases, and no one would die from illnesses. Then there is the opposite case when we know what to do to help without a diagnosis. In the case of some pain problems, having or not having a specific explanation may not even change the treatment. It is evident what the person needs to do, or have done, based on the symptoms and pattern of behaviour.

How many people do we need to go and see before deciding to let the issue go? This is an individual choice. There are some dangers involved in focusing for too long on getting a diagnosis. If you have symptoms that disable you in some way, but no one is labelling them, we may feel life is on hold – we don’t know what the progress of the symptoms will be. Will I feel worse or better next year? Waiting for the diagnosis can make us stuck as well as sick. Meanwhile there may be some health-giving things we could be doing. Seeking a diagnosis can take a lot of energy, and can distract from making pressing adjustments.

If there has been reasonable medical investigation without a clear diagnosis, we can now rest assured that there is likely nothing life threatening. Some people fear that because there is no diagnosis, that this leaves open the possibility that some dreadful condition has been missed. However, physicians are trained to look first for the really serious things, and rule them out. No diagnosis likely means that the condition is not life threatening, as these usually can be diagnosed. Knowing this, we can let go of some of the fear, even without a diagnosis.

How to live with lack of diagnosis?

As I noted above, there are many reasons why having a diagnosis is important to us, and a few reasons why it can become too important. Sometimes, despite everyone’s best efforts, though, there just is not a clear diagnosis. What then? Here are a few suggestions.

Acknowledge that the medical community does not at present have a solution for you, and seek solutions in some other form. This may involve life style changes, getting support from friends or family, focusing more on adapting to the condition than on curing it, working with healers outside the orthodox medical system, or just deciding to get on with life as it is. And don’t think that this is somehow an unusual situation.

Be clear within yourself that your symptoms are real, even if they don’t have a name. Don’t be bullied by others who in well meaning words or in judgment invalidate you. Study your symptoms, see what affects them for good or ill. As you learn about them from experience, you will learn better how to manage them and how to manage your life.

Figure out what it is that you are are most afraid of – what are the fears that a diagnosis would put to rest? See if these fears can be allayed in other ways. Maybe you already have some of the information you need to answer your questions and decrease your fears. Also look carefully at the things you are concerned about or afraid of, and see if the fears are are realistic. Maybe you already have solutions for some of the problems that you think you might have to face.

Find ways to get on with your life in as many ways as possible, and do not let the uncertainty stop you from making whatever plans you are able to. Even a clear diagnosis would not confer 100% certainty what will befall you in future. Be prepared to be flexible and make changes as you go, but do not let uncertainty stop you from living your life.

Do whatever you can to make your body feel good, to minimize symptoms, and to maintain your body – for example, eating nutritious food, reducing stress, exercising, getting enough sleep. You need to do your part to make the body’s condition optimal for healing. Once you are doing this, let it go, acknowledging that you are doing all you can and the rest is up to nature.

Brian Grady, Ph.D.

University Of Alberta
Date: February 27, 2004

Depression Can Lead To Back Pain
It is well documented that physical pain can lead to feelings of depression, but a new study from the University of Alberta shows the reverse can be true, as well.


Dr. Linda Carroll, a professor in the U of A Department of Public Health Sciences, led the study that shows depression is a risk factor for onset of severe neck and low back pain. The study is published in the journal Pain.

Carroll and her colleagues followed a random sample of nearly 800 adults without neck and low back pain and found that people who suffer from depression are four times as likely to develop intense or disabling neck and low back pain than those who are not depressed.