Pain management and resilience

From the Winter edition of InTouch Magazine.

Amy-Lee SeselDr Amy-Lee Sesel is a Psychologist and PhD graduate from the University of Sydney. She has clinical experience treating chronic pain and is deeply committed to this area of health psychology. In 2019, she received a co-funded post-graduate scholarship from MS Research Australia and the NMHRC to develop and evaluate an online mindfulness program for people with MS. We spoke to Amy-Lee about pain management, mindfulness, and practical solutions we can access in order to help build our resilience whilst experiencing pain. 

Pain is something that people with MS must often deal with. What is pain management and what does it involve?

Pain management refers to the assessment, diagnosis, and treatment of pain conditions through the use of pharmacological and/or non-pharmacological approaches, which include or exclude use of medication. Whilst acute pain is often solely managed by a medical practitioner, chronic pain is best managed using a multidisciplinary approach. If you have MS, your neurologist or pain specialist may refer you to a psychologist for pain management, not because “it’s all in your head,” but because pain is both a sensory and emotional experience. Non-pharmacological interventions such as psychological therapy and physiotherapy play a pivotal role in the breaking down of neural “pain pathways” that are thought to perpetuate chronic pain and can help to re-train the brain. 

How does pharmacological pain management interfere with resilience?

Relying solely on pharmacological pain management can interfere with resilience because most of the strong pain medications (e.g. opioids) have side effects, are highly addictive and over time, lead to increased tolerance such that people find themselves needing to take higher and higher doses, in order to achieve the same effect. On the other hand, having a holistic approach to pain management, and being open to the use of both pharmacological and non-pharmacological approaches can certainly promote resilience as long as you go with the evidence base (you should be able to be pointed in the right direction by your doctor).  

What are some of the holistic things people can do in order to help build their own resilience whilst experiencing pain?

In the moment, focus on your breath, relax every muscle in your body, and practice taking a neutral, non-judgmental stance to your pain. Some people find it helpful to think of a soothing phrase they can repeat to themselves when they notice their body tensing, or their mind catastrophizing. 

In the short-term, don’t let your pain rule over you. Move your body, do what you can, and do what you love, but pace yourself. Plan your day with scheduled breaks and practice self-compassion. 

In the long-term, check-in with your treating doctor about your pain, regularly review your pain management plan, look after your body by exercising and eating well, and look after your mind. Learn to meditate!

What’s the role of mindfulness in pain management?

Mindfulness can teach you to relate to your pain differently, so that you become less bothered by your pain, and it no longer interferes with your life as much as it did before. It works because pain is not just a physical experience, it is an emotional one too. Whilst practising mindfulness probably won’t change the physical component of pain, it can certainly reduce the amount of distress that you feel. By sitting with your pain through meditation, allowing it to be in your moment-to-moment awareness without trying to avoid or resist it, you can change your experience of pain entirely, and it can become a lot more manageable.

If someone wanted to develop mindfulness for pain management, what would be your top tips for getting started?

Mindfulness is living in the moment, and not worrying about the past or stressing about the future. 

  • One can cultivate mindfulness by meditating every day. Even five minutes of meditation is better than nothing!
  • Meditation can be as simple as becoming aware of one’s breath. By focusing on one’s breathing, one can calm the chatter in one’s mind. 
  • Gentle muscle relaxing exercises such as tensing and isolating different parts of your body in a systematic way can also help to release tension and help you to sit in the present moment.
  • Allowing one’s thoughts to gently pass you by like a cloud moving across the sky can help you to let go of your troublesome worries.  
  • Mindfulness can also be manifested in activities that are focused and all-encompassing, such as cooking and following a recipe, knitting and following a pattern, or even taking a daily stroll and simply noticing the warmth of the sun or the coolness of the air against your skin. 

To learn more about living well with MS, please check our Education & Wellbeing section.

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