Dr Rabia Lalani is a Gastroenterologist specialising in the management of conditions of the gut-brain connection. She spoke to the Ampersand Health community on what pain is, the different types of pain that exist and how we can manage chronic pain in our daily lives.
“Pain to one person, may not be pain to another.” Pain is a fundamental, subjective and private experience.
What is Acute Pain?
Acute pain is pain that occurs for under 6 weeks in duration or is new for you. Any new pain, or a change in the nature of your existing pain should prompt you to seek medical attention from a healthcare professional.
What is Chronic Pain?
If you live with a long-term condition such as IBD or Arthritis, you may be more familiar with chronic pain. Chronic pain typically lasts for over 6 weeks in duration and it may be something that a doctor or other healthcare professional has diagnosed you with, but most likely can’t be fully cured or gotten rid of entirely. You may have this type of pain under control if you have figured out a medication routine that works for you.
What are the ABCD’s of pain management?
The ABCD of pain is a mnemonic for the criteria used by the medical community to assess pain.
1. Affect: Pain is influenced by our emotions
Our pain is affected by our “affect” – meaning, our emotions!
2. Bidirectional: The experience of being in pain can make the pain worse
The role of emotion in pain is bidirectional – meaning pain causes us to feel negative e.g. we get irritable or depressed. But did you know that feeling negative can actually worsen our experience of pain?
3. Conditioned: Pain can be a learned behaviour
Pain is a learned behavior from our early childhood via association and anticipation. Ivan Pavlov, a Russian physiologist founded the theory of Classical Conditioning. Simply put, he found that the salivation response of dogs when they smell a piece of meat was also observed when they heard his footsteps walking towards the fridge! This is a bodily reaction to an anticipated treat. He then conducted an experiment whereby he paired a neutral stimulus i.e. the ringing of a bell with feeding them meat. He measured their salivation response. Later, when he would ring the bell, but did not provide meat, he still found that the dogs salivated. Therefore he concluded that a neutral stimulus like a bell can be paired with a physical response like salivation, even in the absence of the stimulus (the meat).
This has been replicated with the gut-brain response in humans. Researchers blew up a balloon in the esophagus to stretch it and simulated a sensation of pain. They then showed participants three circles of three colors (yellow, blue and green). The yellow circle was associated with pain, the blue circle was associated with a puff of air on their wrist, and the green circle was paired with nothing. They found that when they flashed a yellow circle, even without giving pain to participants, the anticipation of pain activated the same area of the brain as when actual pain was administered. This shows how pain can be a learned behavior.
4. Distractible: Pain changes if you do not pay attention to it
Pain requires your attention. If you don’t give attention to your pain, your pain changes. You may not want to ignore your pain or distract yourself from it, especially as pain is a very important cue that our body provides us with when something isn’t right. However, pain is only useful in some circumstances – i.e. if you are in flare up and require medical attention. This type of acute pain is very important to give your attention to. However, many of us live with chronic pain where the constant signal of pain is not useful because we have to learn to live with it. Our attention needs to be modified in order to manage and handle it on a daily basis.
Techniques for managing chronic pain
“There is a difference between our sensations and our suffering”
1. Become Familiar with Your Pain
The first step to take is to accept that you are in pain. This means you are not constantly trying to fight this idea that you are in the pain that you are in. Mindfulness is about acceptance of pain in the moment, and once you do this, you are able to move past it. After you accept your pain, you are no longer striving to achieve a lack of pain entirely. This is when tools like distractibility, mindfulness and other techniques come into play. These tools can be used in combination to help you manage your pain. The next step is to make a shift in how you interpret the pain you experience. As mentioned earlier, there is a difference between our sensations and our suffering. Our sensations may remain the same, but our suffering is what we can shift, impact and change.
2. Explore hypnotherapy and mindfulness to manage pain
Hypnotherapy in its true definition refers to sleep of the nervous system. As pain is an experience of the nervous system, if we reduce the nervous system response, we can heavily influence the way we experience pain. Some refer to Hypnotherapy as ‘Imagination Therapy’, as it encourages a state of mind where you are susceptible to positive suggestions (through using your imagination!) Hypnotherapy can be a great tool for those looking to reduce their pain and feel more empowered in their everyday life with their pain. All your mind needs is the right training and you will be able to change your sensory signals and feel differently.
3. Use distractibility and suggestions.
Take note of the thoughts that run through your head when you are experiencing pain. If you can replace those thoughts with positive ones, you are already taking a great step towards reducing your pain.
Please visit Dr Rabia’s website and Instagram page, where you can learn more about hypnotherapy. Dr Rabia shares relevant, engaging and useful information that can benefit you in your health and wellbeing journey.
Want to attend our next webinar?
Watch the entire session with Dr Rabia Lalani by visiting the Library in the My IBD Care or My Arthritis app.
Learn more about managing your IBD, from pain to medication
The My IBD Care app offers access to talks, courses and resources to help you understand your IBD symptoms and how you can improve them.
Get support to minimise your arthritis flare-ups
Managing your pain, discomfort and flare-ups of arthritis is made easier when you have the resources and tools to know what can help you. The My Arthritis app is a great place to start.