Lisa decides to go on a hike as a part of her New Year’s resolution to be more active. She is feeling pretty good and decides to jog a little on the way back. Everything is great until a bug flies into her mouth. Within seconds she turns her ankle and hears a snap. A trip to the ER results in a surgery followed by weeks in a cast and physical therapy. At her final visit with the surgeon she is told the surgery was a success and no follow-up visits are needed.
The problem is, her pain hasn’t gone away. What is even more upsetting is that none of her doctors has been able to diagnose what is wrong. She spends the next several months visiting other specialists hoping to find out what is wrong with her foot. An additional exploratory surgery finds nothing.
Lisa’s pain has become chronic. Chronic pain is pain that doesn’t go away after an injury has healed. It is usually diagnosed after three to six months of pain. Unfortunately chronic pain causes complications that go well beyond the physical symptom of pain. These complications are far-reaching and can affect almost every part of a chronic pain patient’s life. No patient is fully prepared for the impact chronic pain has on quality of life. It has a disruptive influence on relationships with friends and loved ones as well.
The Three Phases of Coping
In my work with chronic pain patients I have found that there are three phases most patients go through in adjusting to chronic pain. Knowing what to expect can help patients better understand what they are going through and open a dialogue with friends and loved ones.
Phase I
First phase occurs in response to the initial injury. Patients focus on getting a diagnosis and treating the injury. There’s an expectation that the pain is temporary. The goal is to reduce and eliminate the pain and restore functioning as quickly as possible.
Phase II
In this phase there is a mental shift from, “I’m doing what I need to do to get better” to “Why is my pain not going away?” The expected timeframe for recovery has passed and medical interventions are not effectively reducing the pain. There is an understandable increase in emotional distress and patients look for what to blame. The most common culprits are; wrong doctor, wrong diagnosis, wrong treatment or something must have been missed. When the diagnosis is chronic pain none of these is the right answer, the pain is here to stay. The duration of this phase varies but as time passes pain-related emotional distress goes up. Irritability increases and there are usually periods of discouragement and anxiety. Friends and family may be confused about the lack of progress.
Phase III
This phase is emotionally challenging and risky. The patient has been diagnosed with a chronic pain condition and is in a tailspin. Logically the patient knows chronic pain means the pain is not expected to go away completely, but emotionally the patient stirred up and at a loss for what to do about it. They may have a hard time understanding why things haven’t gotten better. They are at risk for blaming themselves for not trying hard enough to get better, feeling like a burden and isolating themselves. For friends and family there maybe frustration about the pain patient not being able to do things they used to do and even suspicion that the patient is exaggerating or is not tough enough to deal with the pain and get on with life. As this emotional distress persists, patients are at an increasing risk for developing negative pain thinking and diagnosable anxiety and depression. If not treated properly these feelings can undermine quality-of-life, relationships and interfere with effective coping.
It is important to know that every chronic pain patient goes through some version of the process outlined above. It is a normal response to a very challenging medical condition that needs to be monitored and managed carefully because of the emotional risk factors that come with it. Experiencing strong emotions related to living with chronic pain does not mean you’re weak or not trying hard enough. Nor is it the best choice to “go it alone.”
Dealing with chronic pain requires a different set of coping strategies. Most patients can benefit from tips and strategies that are particularly beneficial for dealing with chronic pain. My future blogs will focus on providing information that chronic pain patients can use to improve their coping skills.
Petra E. Peper, Phd 