Traumatic Brain Injury and Chronic Pain: Part 2
What You Can Do About Your Pain
In the same way that pain is personal, so too are strategies for managing it. Learning to manage pain is a process that takes practice. Don’t get discouraged if the process is difficult at the start.
In this document, you’ll find some common strategies for dealing with pain, but there are others. You may have to try a few approaches before you find the right one. Using a combination of many techniques may work best for you. Most pain medicines do not work well for chronic pain, and many are habit-forming. This factsheet explores ways to manage pain that do not involve taking medication. Most people with pain will benefit from seeing a psychologist or other health care provider for help. At the end of this factsheet is a log that you can use to record your pain and how you are working to manage it. Tracking your pain for two weeks and showing the log to your health care provider is a great way to begin.
There are many different strategies that people use to manage their pain. Some of them are:
- Exercise
- Cognitive behavioral therapy (CBT)
- Scheduled rests or pacing
- Meditation
- Biofeedback
- Breathing exercise
- Hypnosis
- Visualization
- Art therapy
- Acupuncture
- Massage
- Heat or ice
- Social activities
Exercise
Exercise is a proven way to manage pain. It prompts your brain to release serotonin and endorphins. These chemicals are strong pain killers and elevate your mood. If you have limitations, talk with your health care team about exercise. Your team can help you plan a routine that is safe for you.
Yoga
Yoga is usually a low-impact exercise that involves timing movements with your breath. There are many different styles of yoga, and some can be adjusted for people with disabilities. Regularly doing mind-body exercise, like yoga, can help with strength, function, and mood, all of which can improve pain. The stretching and slow movements can also decrease painful muscle spasms
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) helps you change your thoughts or actions. It helps you make the voice in your head work for you instead of against you. CBT usually means you will set goals and work with a counselor to plan for how to achieve them. CBT is often used to manage anxiety, depression, post-traumatic stress disorder, and pain. If you are interested in learning more, ask your health care team to help find a provider who practices CBT.
Coping Thoughts
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.”
Managing Your Activity
Pacing will help you shift from stopping an activity after you feel pain to pausing before you feel pain. Pacing helps you to do the things that are important to you while conserving your energy. Taking short breaks throughout your day, or even during an activity, will allow you to do more over time. Pay attention to how your body feels during and after activities. Learning to pace takes practice. You can use the log at the end of this factsheet to track your activity and help you start pacing.
Delegating is finding ways to have other people do some things so you can save energy, which is likely to help with your pain.
- Use a grocery service or app instead of going to the store yourself.
- Ask your partner to carry the laundry to the washing machine before you wash and fold it.
Adjusting is finding different ways to do things that might be draining or time consuming, which can also help lessen pain.
- Instead of cooking every night, you might use a slow cooker to make several meals at once.
- Lay your clothes out and iron them before you go to bed to save time in the morning.
Distraction
Pain needs an audience. If you’re not paying attention to your pain, it will trouble you less. Some things you can try to take your mind off of pain include:
- Read or watch TV.
- Listen to music or a podcast.
- Do some cleaning.
- Focus on your breathing.
- Call a friend.
- Go to a park, museum, or library with someone who you enjoy spending time with.
- Play cards or a game with friends.
- Do some gardening
Relaxation Strategies
There are many ways that you can help your body relax. Reducing tension in your body can reduce your pain. You may need to try a few things before you find the one that is right for you.
Mindfulness
Mindfulness is a type of meditation. The idea is to be present in the moment. Do not worry about what has already happened or may happen in the future. This practice centers on being aware of your breath and observing yourself. Notice your thoughts, feelings, and emotions without judging or placing value on them. This calm attention leads to awareness of things that we often ignore. Mindfulness gives many people a new understanding of their pain and more control over it. Mindfulness can also help with anxiety and improve focus, both of which can help with pain.
Acknowledge your pain and examine it as you would something that you’ve just discovered. Study how it feels, the emotions you have in response to it, and how your body reacts to those sensations and emotions. Then direct your attention to the sounds around you. After you’ve examined those, repeat this with your other senses (sight, smell, touch).
Biofeedback
There are many kinds of biofeedback. The idea is to understand the signals in your body related to pain or anxiety and learn to control them. For example, fast heart rate and rapid breathing are connected to anxiety. Slowing your breath and heart rate can tell your body it’s alright to relax. A trained therapist can teach you biofeedback.
Controlled breathing
Controlled breathing is one type of biofeedback. It uses the fact that your heart beats slower while you are exhaling than during the inhale. Drawing out your exhale can help you slow your heartrate. Breathing into your belly can stimulate digestion. Controlled breathing does both of these things, signaling your body to return to a calm state.
Sit in a comfortable place with few distractions. Place one hand over your stomach and the other on your chest. Breathe in through your nose while counting to two 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 in your head to four and feel the hand on your stomach fall.
Autogenic relaxation
Autogenic means “self-regulated.” During autogenic relaxation, you tell yourself that you are relaxed. While you do this, picture different parts of your body relaxing. Learning how to relax takes practice; be patient and treat this like any other skill you have learned. It’s normal for this to be challenging in the beginning.
Sit in a comfortable place with few distractions. Close your eyes and picture your right arm. Tell yourself, “My right arm is warm and heavy”; then feel your right arm relax. Repeat this exercise with your left arm, shoulders, jaw, back, right leg, and left leg
Finding What Works
Remember that both pain and how to manage it are personal. Something that works for you may not work for someone else. Don’t be discouraged if you don’t find the right method to manage your pain right away. At the end of this factsheet, there is a log that you can use to record your pain. Tracking your pain for two weeks and showing the log to your health care team is a great way to begin.
Many of the techniques discussed in this factsheet can help you reach your pain-management goals and live a more functional and satisfying life. When you do find the right strategy or strategies, practice them daily even if you don’t have pain. Controlling your pain is a skill, and it takes time to develop skills. There are many apps, video tutorials, and websites that can help you build these pain management skills. You can also use the log at the end of this factsheet to track your pain-management progress.
Consider asking your health care team about a pain rehabilitation program. This is a more intensive program where many different specialists work with you. They will teach you ways to manage pain without medication. Treatment may last for several days or weeks
Authorship
Traumatic Brain Injury and Chronic Pain: Part 2 was developed by Silas James, MPA; Jeanne Hoffman, PhD; Sylvia Lucas, MD, PhD; Anne Moessner, APRN; Kathleen Bell, MD; William Walker, MD; CJ Plummer, MD; Max Hurwitz, DO, in collaboration with the Model Systems Knowledge Translation Center.
Source: The content in this factsheet 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 factsheet 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 factsheet do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.
Copyright © 2020 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.
