I believe emotions are relevant to the development of chronic pain and therefore need to be included in the management of chronic pain. When we experience stressful life events we have to contend with a range of emotions. Those emotions can be within ourselves, and we are also exposed to the emotions of others.
This cacophony of emotions can be overlooked in chronic pain management programs, in fact ignored may be a better description.
Some of you may disagree, as don't we have psychologists or counsellors who provide psychological treatment for chronic pain patients?
That's what I thought too.
When I recently studied with Howard Schubiner, I learnt that patients’ actual emotions were not truly addressed in most chronic pain treatment. Therefore, I decided to investigate further.
o Firstly, I’ve reviewed basic strategies used by two therapies cognitive behavioral therapy and acceptance and commitment therapy.
o Following this I found research that linked emotions in the development of ulcerative colitis of which abdominal chronic pain is a symptom.
o Then, the life crises of a group of patients were chronicled and showed a greater propensity to develop ulcerative colitis, an inflammation of the bowel than those of healthy controls.
How does Acceptance and Commitment Therapy Engage Past Emotions or Trauma?
In acceptance and commitment therapy (ACT) it seems to me that patients learn or are taught to stop avoiding or dwelling on inner emotions and to accept these feelings as appropriate for whatever is happening in their lives at the time.
These emotions and feeling should not interfere with your life. Again, the word accept arises, accept their difficulties and to make necessary changes in their behaviour.
So, to my mind this is actually saying that yes, we have: -
o Inner emotions we are carrying around,
o Emotions due to past trauma,
o Emotions due to past challenges
o Memories due to accidents or operations
o Emotions and reactions from childhood trauma
However, to me, acceptance and commitment therapy seems to be saying we should effectively keep emotions bottled up, somewhere? Not really acknowledging our emotions and certainly not releasing or letting them go.
Consequently, this is in fact asking clients to store emotions somewhere. Could this imply or say to them that their past reactions and feelings are perhaps not significant.
Emotional Release Improves Chronic Pain Treatment
Personally, from my clinical experience, I would argue for exactly the opposite. I've found that when clients learn to recognize relevant times in their lives when emotions mattered, sometimes hidden emotions. Then, for example, they allow themselves to open up a ‘box of emotions’, examine them and to be able to figure out for themselves: -
o Why emotions are there?
o What to do with these emotions?
o How are emotions involved with their chronic pain?
How if these, negative thoughts, emotions, and past memories are impacting daily life can we expect chronic pain patients to accept them and not allow them to impact, particularly their pain levels.
“Isn’t it better to actually get rid of these emotions?”
They can hopefully, visualise throwing emotions, memories, or thoughts off a cliff into a raging sea below!
The raging waters will sweep them away, drown them, smash them to pieces and sink, or whatever our imaginations choose to do – with joy!
Relevant article: Does anger stop you letting go of your pain
Cognitive Behavioural Therapy – What does this Therapy do with Emotions?
Now let's look at cognitive behavioural therapy (CBT), very popular with a lot of chronic pain management programs and certainly has been a mainstay of psychological treatment for chronic pain for perhaps decades.
Cognitive behavioural therapy focuses on what is happening in a client’s life at the present time which certainly can make sense to a lot of chronic pain patients.
They can give you the opportunity to: -
o Discuss the way you think.
o How you feel.
Then to reflect on how that influences how you behave. And as I said this is all in present time what is happening at the moment.
Treatment strategies appear to involve: -
o Problem solving.
o To also change thought patterns,
o Enable us to change our response to difficult situations.
This may also involve emotional reasoning and making a strong emotional change. However, to me a lot of this sounds very much in our heads - more of an academic solution that doesn't seem to even consider our emotional state at the present time. Unfortunately, nothing to do with what has been happening to us in life.
At this point I'd like to bring in a piece of research. Interestingly, it was done 50 years ago – this research showed how life impacts our health even then!
This study into ulcerative colitis (inflammatory bowel disease) is relevant to chronic pain treatment as abdominal pain can persist, even between flare ups of the gut symptoms. At times there is more focus on management inflammation of the lining of the gut, rather than pain. (Pain)
Research by Doctor Ian Hislop and Doctor Andrew Paull, gastroenterologists, from South Australia in 1974. However, to me it is very, very relevant to this article. It is unfortunately, again to me, very depressing having just covered two of the main psychological therapies used in treating chronic pain patients.
The information above about ACT and CBT is general in nature, taken from the information I found on the website of the New Zealand Association of Counsellors.
Dr Hislop Research on Causes of Chronic Ulcerative Colitis.
His idea behind the study was to investigate the incident of life crises that occurred in the year preceding the onset of symptoms of ulcerative colitis. He compared this with a control group.
What he found was rather startling - in the previous 12 months preceding that onset of illness, life crises happened to 94% of the cases. Also, he found that the life crises were found to occur more than twice as frequently in the ulcerative colitis cohort than in controls.
In this research there were 50 patients with ulcerative colitis (UC) who were interviewed between January 1971 and April 1973.
o 20 males mean age 40 years (range 16 to 77)
o 30 females mean age 41 years (range 15 to 87 years)
During the interviews attention was paid to events proceeding and around the onset of illness, especially changes in life settings and interpersonal relationships.
The challenge with this research occurs in many clinical sessions when you're looking at personal aspects of a client’s life. The results from the interviews were varied and obviously could not be matched with control subjects.
I’ve included many of the findings from the research subjects. I believe it does raise the question about why we are not looking at what has happened to chronic pain patients in their life or their “pain story” before they come to us for treatment.
Results Reveal Life Crises of Patients with Chronic Abdominal Pain.
Death of a family member
Bereavement preceded the onset of ulcerative colitis ranging from 1 to 12 months after the death of a family member.
Marriage
Three patients had married within the 12 months.
Separation
A female patient aged 17 years and a male patient aged 20 years developed symptoms of colitis within a month of breaking off their respective engagements.
Pregnancy and childbirth
Colitis had developed within nine months of childbirth in four patients. However, only one control subject had given birth to a child in the last 12 months.
Immigration
In three patients’ colitis occurred within 12 months of immigration to Australia, one control person had migrated.
Bereavement or illness
34-year-old woman developed symptoms two weeks after the death of her pet dog. Six patients within six months of the onset of severe illness in a parent.
Marital problems
Two mothers with colitis, three and six months after their daughters had undergone marital separation. Colitis occurred in one man two months after commencing an extramarital affair.
Pregnancy and childbirth
In two patients, bowel disease followed within three months of a suspected pregnancy and a male aged 44 presented with colitis one month after his 19-year-old married daughter had a legal abortion. Three men developed symptoms at the 5th, 7th, and eight months of their wife’s pregnancy.
Intra family relationship problems
Colitis developed in two women within four months of their mother-in-law's coming to live with them.
Moving house
To another suburb or city 12 months before symptoms in four instances.
Institutionalisation
Symptoms started for two patients after admitting their parents to an aged care home. A male, 77 years old four months after entering an old person's home and conversely a 74-year-old female had fatal colitis one month after institutionalising her husband.
Parent child relationships
Two mothers aged 32 and 36 developed colitis after their sons aged 9 and 15 years had been caught stealing, a father became ill three months after his 15-year-old daughter eloped, a 40-year-old mother six months after her third child began school.
A 15-year-old girl who was told by her mother that she had an an illegitimate sister suffered bloody diarrhea within a week.
Vocational change
Three patients within three months of starting work.
Trauma a car accident
In recent months by three patients although, none were injured they were all distressed by the event.
Finally, within this we have two other things of note: -
o Several instances there was a cluster of events in the 12 months that were being investigated.
o There were three patients who could find no significant life event that occurred in the 12 months before the onset of ulcerative colitis.
o One patient a woman aged 50 had been divorced three years previously but admitted to no more recent stress,
o A single man aged 43 had recently felt his life to be futile and lonely.
This research did not specifically try to match up the actual timing of the development of symptoms though most occurring within six months, and the average interval between the most recent life event and illness was just over three months.
Significant Life Events and Chronic Illness
However, in this article we are not looking at timelines but to show significant life events can actually lead to physical illness. I found this research because I have a book written by doctor Hislop “The Feeling Being” writing about the importance of talking to patients about what is happening in their lives.
I'm not sure of other research carried out in such a specific manner. To me this is an argument for addressing any emotions connected with various life occurrences for chronic pain patients and other chronic diseases.
Although knowing emotional release is a powerful and natural therapy for chronic pain, I have to leave you with these questions: -
o Why emotional release isn’t a standard inclusion in chronic pain treatment?
o Could addressing their previous life crises improve patients pain levels.?
Conclusion - Emotions
In my clinical practice I found allowing clients to recognize past emotions, and being able to use emotional release techniques, resulted in an improvement in their chronic pain. Therefore, I was surprised to learn emotional treatment was not included in the psychological component of chronic pain management. Then I confirmed this when I found a basic explanation of acceptance and commitment therapy and cognitive behavioral therapy.
When I searched for reassurance that my ideas of acknowledging a client’s ‘life story’ are relevant, I noted considerable variety in patients’ life crises. Hislop’s Research showed 94% of patients had a personal crisis within twelve months before the onset of ulcerative colitis.
References
Chronic pain in patients with inflammatory bowel disease – Pain
Increased chronic pain in patients with ulcerative colitis is mostly associated to increased disease activity. A cross-sectional case-control study. - Scandinavian Journal of Gastroenterology
New Zealand Association of Counsellors Website
Jean Jordan
After over 20 years of having my own pain clinics pain I started Natural Pain Solutions online business to reach more people, rather than one person at a time. Therefore when I completed my postgraduate pain management studies I wanted to spread the word about holistic self-help techniques that people can use at home.
Learn more about me here.
Ideas can be found in the articles on my website. You can sign-up to regular updates or spend time using some of the collection of self-help techniques.
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