Go back to TBI and Chronic Pain: Part 4
Infocomic Main Characters
Max: A middle-aged White man with full, dark hair and a long dark beard.
Mohammed: A middle-aged man of Middle Eastern descent with straight, dark hair and a clean shave.
Husband: A middle-aged White man with blonde hair and a clean shave.
Therapist: A middle-aged White woman with shoulder-length, wavy blonde hair.
Infocomic Story Description
TRAUMATIC BRAIN INJURY AND CHRONIC PAIN Part IV: Pain and Anxiety
Pain and Anxiety
Anxiety is closely related to pain, and each can make the other worse. Anxiety can add to memory or sleep problems. It may lead a person to believe that a bad outcome is likely or certain. This type of thinking is known as catastrophizing.
Pain can change your thinking. Often, we have thoughts that we’re not fully aware of called automatic thoughts. They can influence our emotions and the things we do, even if we don’t realize it. Pain by itself or with depression, anxiety, or Post Traumatic Stress Disorder (PTSD) can make people have more negative automatic thoughts. These thoughts can make people do things that may make their pain worse. A therapist who practices cognitive behavioral therapy can help change these thinking patterns.
Max talks with Mo and his chronic pain management support group. He admits, “Wow! You all manage your pain so well. I think mine makes my anxiety worse and I don’t know what to do. I had TBI and hurt my neck at the same time, and I still get nerve pain. Sometimes I get anxious about pain even when I’m not having any.”
“When I’m anxious or in pain,” Max continues, “it’s hard for me to think clearly and remember things.”
Max reflects on being at a grocery store and realizing that he forgot something. He pats his pockets and says, “Oh no, I think I’m forgetting something… the SHOPPING LIST!” He begins searching his grocery cart and says to himself, “I know there were more things I needed!”
Pretending that he doesn’t have anxiety and pain hasn’t helped Max. When his pain is bad, he gets anxious and little things become huge issues inside his head.
Back home, he and his husband are unpacking the groceries. His husband asks, “Where is the pasta?” Max becomes upset and responds, “Oh no! I panicked and forgot the most important thing!”
He turns to his husband and says, “Sorry, my anxiety got really bad while I was shopping, and I panicked! Now what are we going to eat?”
Small, negative thoughts can grow into disaster scenarios.
His husband calmly responds, “I’ll order some food. Don’t worry about it!”
Finding What Works
Keep in mind that pain and ways to manage it are personal. Something that works for you may not work for someone else. You should not feel discouraged if you don’t find the right method to manage your pain right away. At the end of this infocomic, there is a log that you can use to record your pain. Tracking your pain for 2 weeks and showing the log to your doctor is a great way to begin managing your pain.
Back in the support group, Max says, “You’ve all found different strategies for dealing with your pain. I’ve learned a lot from talking to you but I’m not sure where to start!”
His friend Mo says, “Keeping an activity log, and going over it with your doctor is a great way to start.”
Max responds, “I’ll do that! Thanks, and I’ll see you all at the next meeting.”
Later, Max is sitting at his therapist’s office. She tells him, “Max, from the activity log, I can tell that your pain is related to anxiety. Autogenic relaxation can help you learn to control your pain and anxiety.”
She begins to guide him. “Sit in a comfortable position in a place with few distractions. Close your eyes and picture your right arm. Tell yourself, ‘My right arm is warm and heavy.’”
Max thinks, “My right arm is very heavy and warm.”
His therapist then advises, “Now, feel that arm relax. Repeat this exercise with your left arm, shoulders, jaw, back, right leg, and left leg.”
His therapist then tells him, “Relaxing is a skill. It takes time to learn. Many people can reduce their pain and gain confidence as their ability grows.”
Max admits, “I really do feel a difference. I wasn’t even aware of a lot of that tension.”
His therapist says, “I think it would be best if you made a routine of doing autogenic relaxation before bed every night and using it throughout the day as needed. There’s another exercise that will help too. It’s called controlled breathing.”
Max asks, “Ok, what’s that?”
His therapist tells him, “Just like before, sit in a comfortable place with few distractions. Place one hand over your stomach and the other on your chest. Close your eyes. Turn your attention to your breath. Notice how the hand on your stomach rises when you inhale and falls when you exhale. Exhale for longer than you inhale. Your heart beats more slowly as you exhale. Slowing your heart tells your body to be calm.
Breathe in through your nose, counting to 2 in your head. Feel the hand over your stomach rise as you inhale. Breathe out through your mouth with your lips pursed. As you do this, count to 4 in your head and feel the hand on your stomach fall.”
Max breathes, with his one hand on his chest, and another over his stomach, and counts, “1… 2… 3… 4…”
His therapist continues, “When you’re ready, open your eyes and give yourself a moment to be aware of your surroundings.”
She says, “Do the controlled breathing at the same time every morning, and when you need it throughout the day.” Max puts on his coat and then leaves.
Later that same week…
Max is at the chronic pain management support group and welcomes another member in. “Hey! You made it!”
While talking to the group, Max says, “Now that I have some tools to manage pain, I worry about it less. Different things work for different people. You may have to try a few before you find the right one.”
You can use the activity log at the end of this comic to track what causes your pain and the ways you manage it.
On-Demand Pain Management Strategy #3
COPING THOUGHTS. When you’re in pain, it can be helpful to think encouraging thoughts to yourself. Grounding yourself with coping thoughts can help you get through a stressful or painful time. It may be a good idea to make a list. Some examples are:
- “I know I can handle this.”
- “It could be worse.”
- “This is tough, but I will survive.”
- “I am strong enough to do this.”
- “I have gotten through more difficult things.”
Authorship and Illustration
Source: This infocomic was written by Silas James and Ayla Jacob and illustrated by David Lasky and Tom Dougherty in collaboration with the Model Systems Knowledge Translation Center. This infocomic is adapted from the factsheet series Chronic Pain After Traumatic Brain Injury (https://msktc.org/tbi/factsheets/traumatic-brain-injury-and-chronic-pain) developed by Silas James, MPA; Jeanne Hoffman, PhD; Sylvia Lucas, MD, PhD; Anne Moessner, APRN; Kathleen Bell, MD; William Walker, MD; CJ Plummer, MD; and Max Hurwitz, DO, in collaboration with the Model Systems Knowledge Translation Center.
The content in this infocomic is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Traumatic Brain Injury Model Systems (TBIMS), funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), as well as experts from the Polytrauma Rehabilitation Centers (PRCs), with funding from the U.S. Department of Veterans Affairs.
Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. The contents of this infocomic were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers 90DP0031 and 90DP0082). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this infocomic do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.
Copyright © 2021 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.