Managing Chronic Pain, Part 1: Understanding a Shift in Perspective

Pain and suffering are not the same. An internet search for “difference between pain and suffering” yields dozens of sites for writers and practitioners, like Ashley Pennewill and Ann Marie Gaudon, who extol the benefits to be gained from this conceptualization. The repeated message is that pain is the physical experience connected to insult and injury, while suffering is the “story” we tell ourselves about the pain experience. Our total pain experience is the sum of physical pain and suffering, with each affecting the other.

Shifting my perspective on chronic pain to one that understands the role of suffering in the total pain experience has helped me to better manage my chronic pain (including discontinuing opioid treatment), decrease the occurrence of dysregulated emotions, and achieve an overall improvement in well-being.

The difference between pain and suffering is an encyclopedic topic that has been the focus of writings since at least the time of the Buddha. A focus on the mind-body link examines how we can use that information to reduce suffering so that we can better manage chronic pain.

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The mind/body link as an attention-to-stimulus process was partially described in my column on irritability. The process of pain stimulus creates the need for attention to the stimulus. The feelings and thoughts associated with the stimulus escalate. It is a feedback loop that helps us in the face of danger, but as the feedback cycles out of control, emotions often become unregulated and out of control. The spiraling loop can become a barrier to well-being. The experience of emotion dysregulation (see figure) is one link between the pain, feedback, attention processes, and suffering.

(Graphic by Dr. C)

The figure illustrates emotion dysregulation as an experience connected to exceeding one’s emotion dysregulation threshold (EDT) due to increasing emotional intensity over time (dysregulation delay, or DD). Once the threshold is crossed, we experience emotional dysregulation (EDE). This is followed by a cooling of the emotion intensity (CD). The goal is to reduce the intensity and duration of the emotional dysregulation. This is where the shift in perception is applied.

It is a shift from feeling like we can’t do anything to keep our emotions from getting out of control to an understanding and belief that we can change the escalation. It is adopting the perception that we have some control over this dysregulation and that, given the nature of neural plasticity, there is the possibility of reducing the intensity of dysregulation experiences and lengthening dysregulation delay times. This success can lead to less suffering and make it easier to manage chronic pain.

Pain is reported by many Parkinson’s patients. “Among the different forms of PD-related pain, musculoskeletal pain is the most common form, accounting for 40%–90% of reported pain in PD patients,” according to a paper by Orjan Skogar and Johan Lokk.

“Individuals with Parkinson disease (PD) frequently suffer from pain that interferes with their quality of life but may remain under-recognized and inadequately treated,” reports Neurology Times, citing a study published in the Journal of Neurology. I am one of these individuals. I have good days and very bad days — the ugly days.

The Neurology Times article continues, “’We found pain to be highly frequent, quality of life-impairing but insufficiently and unsystematically treated,’ wrote first author Carsten Buhmann, MD, of the University Medical Center, Hamburg-Eppendorf (Hamburg, Germany) and colleagues.”

When we live with Parkinson’s and experience pain, we are not alone. The Parkinson’s Foundation says, “Chronic pain is twice as common among people with PD as it is in people without it. In fact, more than 80 percent of people with PD report experiencing pain and say it’s their most troubling non-motor symptom.”

I am in pain most of the time. I cross the threshold when I am having difficulty managing the pain and the connected feedback loop. If I add some additional stressor — emotional, physical, or situational — that feeds the emotional turmoil, and I cross the threshold sooner. Accepting that I can do something about it (and have the skills) is the shift in perspective. It is a shift from being a servant to the whims of my emotions and their consequences to presenting as a calm, centered being who seeks continued progress on his wellness map.

I am still learning and practicing techniques to help me shift my perspective so that I can manage my chronic pain more successfully. I will discuss some of these techniques in Part 2 of this series. Attempts to change human practices are only as effective as the intent behind them. The shift in perspective allows us to firmly establish this proper intent.

What are your thoughts about emotion dysregulation and human suffering? Please share in the comments below.

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