TO YOUR HEALTH
Understanding Persistent Pain... ...continued from page 17
experiencing was due to a loss of femininity. Years earlier she had also undergone bilateral mastectomies for breast cancer. However, her sexual identity was not affected by the loss of her breasts, but rather to that of her leg; when she was a young woman, she stated the men all admired her legs. Without asking about what it means to have a particular illness or injury (or amputation), we cannot know what is driving a person’s suffering. Emotions and Beliefs We first learn about pain as infants during the birth process. Later on as children and growing into adulthood, we experience only acute pain from injury or illness that dissipates over time. However, from our experience with that, we conclude we were leaking somewhere (bleeding), or broke something, or had an unseen bacteria or virus eating away at our body. We learn early on to interpret pain as an alarm that something is wrong. With chronic pain, for the most part everything has healed over, scarred over, but the alarm continues to ring away, even though there is no acute threat.With chronic pain, we sound the alarm of an immediate threat to our existence, when really it is much more of a hellacious nuisance. Yes, it is possible to be hurt - ing without being harmed. Hurt and harm are not the same thing. The problem of chronic pain compounds further when we try avoiding activity or movement for fear of experiencing or aggravat- ing the pain. Developing kinesiophobia, the fear of movement, leads to deconditioning, which leads to an intensification of pain as endur - ance, stamina and flexibility are lost, leading to further decondition - ing and avoidance of activity. Simultaneously, the pain may trigger anger, anxiety, fear or distress that can lead to depression and hope- lessness, which leads to increased awareness and perception of pain.
low back and pelvic areas. In an effort to reduce pain, she had altered her biomechanics, which in the end created more pain. And by avoid- ing weight bearing for a longer than necessary time waiting for the pain to subside, her leg and foot continued to hurt when she did start to bear weight due to loss of strength and endurance. Suffering “Suffering” is all about being in a state of resistance or aversion to what is; and suffering, of course, is what leads you to get help. Our suf - fering comes from being scared, anxious, depressed, or even sad about being in pain. It is the beliefs about the pain that drives the emotions, which leads to suffering. Seeing the pain as something foreign, or as a punishment from God or a harbinger of future pain, only leads to more suffering. People suffer with pain when: they perceive a threat to their existence and integrity; it evokes fear involving the future; and when it is associated with social isolation and distrust of one’s own perceptions of one’s body, especially if a physician or relative fails to affirm the experience as being transitory — or worse yet — fails to pro - vide the individual with a reason for the pain. Sometimes the pain is more than just what is going on physically in the body — it can be the pain of a change in the experience of self. To illustrate, I consulted on an elderly woman who had sustained a below-knee amputation as part of an integrative approach to her pain management. Her physical therapist wanted assistance as the wom- an’s reaction to the pain was interfering with what they wanted to ac - complish. During my evaluation I learned part of the suffering she was
18—PATHWAYS—Fall 24
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