Pain Management

[Suebee]

Hi all, I’ve finished up a PT 8 week course to address back, torso, and hip pain related to my MS and frustratingly, it aggravated my problems. So lately I have been exploring different approaches to dealing with chronic physical pains (and emotional worry) and came across a mindfulness approach I hadn’t tried before. The technique is rooted in Buddhism to acknowledge “unpleasant sensations” in your body - but think about these sensations in an objective outside observer way. This is supposed to be preferable to resisting or avoiding thoughts about the pain. The concept is formulated as pain plus resistance equals suffering, therefore remove resistance and treat yourself with compassion and kindness. If you observe “reactive” emotions in Addition to the pain, such as worry or anger, one is to acknowledge this too (as an objective outside observer ) and recognize this is part of the human condition, and give yourself compassion for it. (Excuse all run ons ) Here is link to article by psychologist Dr. Tara Brach explaining this pain management technique and she also lists multiple resource links for mindfulness pain management at bottom of the article. She links an audio meditation but I haven’t had a chance to try that out yet.

https://www.tarabrach.com/working-pain-mindfulness/

Any of you get benefits from this kind of meditation or mindfulness in dealing with MS? What have you found works best to deal with constant pain and tightness? Any advice helpful, thanks!

[LivWell]

Suebee, first I want to say that I appreciate you posting this. I have benefitted a great deal from utilizing mindfulness practices to cope with pain. There are a lot of people out there proclaiming the effectiveness of mindfulness for all manner of maladies. It's nice to hear that you found Tara Brach.

In the spring of 2019 I was fortunate enough to be accepted into a research study on pain management in MS. The study was conducted by the University of Washington and supported by grants from the National MS Society. Three groups were created; mindfulness-based cognitive therapy, cognitive behavioral therapy and "usual care." The researchers then compared the outcomes between the groups to determine which one felt they were better able to manage their pain as a result of participating in the study.

I had been practicing meditation consistently since 2014 and elements of meditation were included in the study's sessions and home practice assignments. But in addition to calming the mind and learning how to relax, we also really focused on how we thought about our pain. Just as you describe, we were taught to take a step back and look objectively at our thoughts related to pain. All the automatic thoughts and knee-jerk emotional responses that pop up when you're hurting.

We kept thought records as a home practice exercise. Tracking our thinking about our pain this way, we could then decide whether thoughts were helpful, unhelpful or neutral, and how much we believed them. Then we were encouraged to counter an unhelpful thought with an alternative that was helpful. This had the effect of halting the downward spiral of negative, catastrophic thinking.

The study sessions were done virtually, since participants attended from all over the United States. I think including strategies like these are a great addition to traditional approaches to treatment of pain.


Keep on Moving

[Suebee]

Livwell, thank you for detailing your home practice exercises! I never heard idea of thought records and i think it really takes “mindfulness” to the next level. It is almost like a two step approach: recognize thought patterns especially automatic negative thoughts AND consciously plan/seek to counter unhelpful thoughts with helpful ones. Great advice! Now, the work begins...

[AMFADVENTURES]

Great topic Suebee! My exposure to "mindfulness" has been through yoga where mindfully distinguishing between "sensation" and potentially damaging pain was the focus of many of the stretches. Of course, even yoga done properly can result in increased pain, at least it normally did for me. But the dual beliefs that; 1) there was physical benefit from the stretching and 2) the knowledge that the increased level of pain would subside relatively soon, made tolerating the additional pain possible, perhaps even almost enjoyable.

You guys might hate this but I've found that a temporarily higher but more beneficial level of pain helps me manage the chronic base level of MS related pain that I live with. I transferred the concept of "sensation" to my cycling where, although some of the rides resulted in a huge increase in pain later in the evening, I was able to tolerate it in the belief that it did me an equally tremendous amount of good and that the pain would be significantly less in the morning. I also noticed that the temporary increase in exercise related pain somehow made the normal MS related pain seem much more tolerable. And recently. I've noticed that, as a result of Covid restrictions, not being able to get the exercise I'm used to has made me much more aware of and more annoyed by the chronic MS related pain.

One more pain management technique I've noticed. My yoga teacher was also one of my best bike buddies and on occasion I would have the opportunity to turn the tables on her. Sometimes, on particularly arduous climbs, she would begin to complain and I would gently remind her to distinguish the "sensation" from true damaging pain. At this point she generally berated me with a barrage of highly unladylike expletives and rode determinedly on up the hill. Her discomfort was my fault and having decided that fact enabled her to endure it, redouble her efforts and keep on going. I believe psychologists refer to this technique as transference. Best not to use it too much on a spouse.

Larry

[LivWell]

Larry, I'm glad you mention exercise induced pain and I can certainly relate to what you've shared. The key word there is temporary. And I can understand the way the pain of a strenuous workout offsets MS related discomfort. In fact, my first neurologist believed that I was "managing" my MS long before diagnosis because of my participation in triathlon, my training regimen and marathon running. The recovery period after an event or a brick workout was to be respected and accommodated. The coaches in my training group were clear about including recovery in the training plan. The chronic pain that I experience is just more persistent. It's a daily thing.

I want to throw into the mix here, Mindfulness Based Stress Reduction (MBSR). Jon Kabat-Zinn was a pioneer in this approach to managing the stress and pain of chronic illnesses of all kinds. Kabat-Zinn includes yoga along with meditation, and offers more constructive ways to think about pain. His books and CDs are all pretty great and there are many MBSR teachers, students of his philosophy, out there to connect with. MBSR was my first exposure to mindfulness.

Good topic. Thanks again Sue Bee.

Keep on moving

[LivWell]

I thought I'd check with UW and received this today. The ADAPT study is currently recruiting. When I did it, participants were paid. I can forward the consent form and brochure to you if you're interested. Here's the contact info:

Thank you for you previous participation in the MS ADAPT Study. We are currently recruiting for our final cohort. Treatment runs from Wednesday, May 5^th – Wednesday, June 23^rd from 2 – 4pm PT (5-7 pm ET). I have attached copies of the study’s consent form and brochure if you would like to forward this information along. I encourage anyone you know who is interested in the study to reach out via email to msadapt@uw.eduin the next couple weeks. Thank you!

Sincerely,
Leah

MS Adapt Study Team
UW Medicine
Department of Rehabilitation Medicine
UWMC Multiple Sclerosis Center | Box 358815 | Seattle, WA 98133
OFFICE: 206.598.0501 EMAIL: msadapt@uw.edu WEB: rehab.washington.edu

[Suebee]

Thanks Livwell and Larry for sharing specifics of dealing with “sensations”, pain, which is often under discussed. Especially like idea of using good exercise pain in a constructive way to deal with chronic pain. I’m going to explore this idea more. I’ve found that the pandemic has not only made me more physically idle but also mentally idle. To combat this, I’ve recently taken to listening to audio books from public library throughout the day as I do whatever around the house. I got idea about pain management from Current audio book : Radical Acceptance by Tara Brach. I’ve found I can replay a chapter or section and don’t mind the pace, which can be accelerated or s l o w Ed very easily. I also sometimes make little notes about my take away in a notebook if I want to. I did it more to reassure myself that I absorbed and understood material. It took away angst that I was wasting my time or cognitive reserve.
If any of you or others are looking for a great listening book, I also discovered and highly recommend The audio Book of Joy by the Dali Lama and Archbishop Desmond Tutu. It is narrated with both their voices so one actually feels as if she is sharing tea and listening to their conversation together discussing how one finds joy among life’s difficulties. Very enjoyable and concepts are very easy to understand and uplifting.