Fight the Pain: Chronic Pain Resources

Recognizing the unique challenges that persons with chronic pain face, Health Canada established the Canadian Pain Task Force in 2019. Over three years from 2019 to 2021, the Task Force delivered 3 reports to Health Canada, outlining their findings for three mandates. The first report assessed how chronic pain is currently addressed in Canada; the second report had experts review the findings to identify best practices and areas for improvement; and the third and final report provided recommendations on priority actions to ensure people with pain are supported and treated effectively across Canada.^[1] The reports can be found on the Government of Canada’s Website here. The Government of Canada and the Canadian Pain Task Force (CPTF) have provided an extensive list of supportive resources that are available to Canadians. The list is available here.

As a result of Health Canada’s 2021 report An Action Plan for Pain in Canada, Pain Canada was formed, a multi-stakeholder initiative that connects people, organizations and resources for both individuals living with pain and professionals helping them. This cross-country collaboration gave rise to LivePlanBe and LivePlanBePlus. LivePlanBe contains an extensive library of articles, videos and podcasts for people to browse at their own pace, and LivePlanBePlus is a guided, interactive, self-paced program to learn about practical tools and strategies to cope with pain.

In British Columbia there are two notable pain resources worth mentioning.

Pain BC “aims to enhance the well-being of all people living with pain through empowerment, care, education and innovation”^[2] via health care providers, government, researchers, and other non-profit organizations. Pain BC offers support programs to help individuals manage the effects of chronic pain, such as Online Pain Support and Wellness groups; Coaching for Health, a free telephone coaching program to help people learn self-management skills; as well as the Pain Support Line that offers free information and someone to talk to. They have a podcast called Pain Waves where people can listen to leading chronic pain experts and individuals living with pain discuss the latest research and trends. Pain BC also offers education for health care professionals to learn more about their patients who live with pain. Pain BC is one of the key contributors to Pain Canada.

CHANGEpain is a pain center located in Vancouver that is comprised of a variety of experts in integrated health and pain care, including doctors, nurses and allied health professionals.^[3] They offer both MSP (medical services programs) and non-MSP services ranging from medicine, nutrition, brain health, and movement including chiropractic, physiotherapy, acupuncture, kinesiology and yoga. They also have a wide range of online services such as pain coaching and self-help seminars, in addition to yoga and Pilates classes.^[4]

Mindfulness Meditation

Recent research has shown the benefit of mindfulness meditation in managing chronic pain, such as migraine^[7] and chronic low back pain,^[8] the top leading causes of chronic pain.

One major study investigated the impact of mindfulness meditation on pain relief. Looking at pain perception and brain activity by using MRI scans, researchers found that mindfulness meditation greatly decreased the “intensity of pain by disengaging the pain-processing part of the brain (the thalamus) from the brain regions responsible for self-reflection.”^[9]

This is consistent with mindfulness practice, where one detaches themselves from their thoughts and emotions to relieve emotional pain or discomfort. Other studies have supported the theory that just learning to comfort yourself on an emotional level and decreasing your reactivity with practices such as mindfulness or cognitive-behavioral therapy (CBT – a modality that focuses on challenging and changing negative thoughts, beliefs and attitudes) can help teach your brain that you’re safe, thus reducing symptoms.^{[10] [11]} A 2014 study using CBT as a way to ‘unlearn’ chronic pain found that in those that participated in the study, CBT was effective in changing neural pathways.^[12]

The 18 minute TED talk “A Different Approach To Pain Management: Mindfulness Meditation” by Dr. Fadel Zeidan is a worthwhile watch. Fadel’s research work examines the mechanisms of action supporting mindfulness meditation on pain.

Mindful.org has a list of the best mindfulness books of 2021, and one of them concentrates on mindfulness and chronic pain. Outsmart Your Pain, written by physician turned mindfulness and meditation teacher Christiane Wolf, “features stories from patients, 10- to 15-minute guided practices designed for those coping with pain, and straightforward, research-supported advice to shift how we experience chronic pain—from battling it toward accepting it, tuning in to the body with self-compassion.”^[13]

There are additional pain self-management techniques that can help people with their chronic pain.

We know that exercise is great for general health and stress, but for many people with chronic pain, it feels counterproductive as it appears to increase their pain. However, as those with chronic pain learn more about the science behind it, they can understand how exercise can help to fight fear avoidance, boost mental health and also strengthen muscles. While all types of exercise have a beneficial effect on mood, anxiety levels, and experiences of pain, researchers have found that the benefits of yoga are superior to some other types of fitness,^[14] as it not only includes physical postures, but also meditation and breathing techniques. Yoga has been found to cause lasting shifts in how our brain functions, perhaps preventing or even reversing chronic pain pathways.^[15] According to a recent study, yoga changes the brain in the opposite way that chronic pain does, by increasing gray matter rather than decreasing it.^{[16] [17]} Increases in gray matter helps to increase pain tolerance and decease depression and anxiety.^[18]

Another important technique in the chronic pain fight is called pacing. Pacing is a way to keep active while still taking structured time rests. This means that when an individual has a low pain day, not trying to do everything all at once can help to avoid pain flares from pushing the body too far. It also means finding a healthy balance and trying their best to continue to function on those days they have pain. This 2 minute video gives a quick overview of What is Pacing?

Guided imagery is also a self-help tool that benefits many people with pain. Guided imagery, also known as visualization, is a process that can be practiced in virtually an unlimited number of ways. It is creating auditory, visual, tactile, olfactory, gustatory, and kinesthetic experiences in the mind,^[19] as imagining specific scenes, words, colors, and other imagery can help lower stress hormones like cortisol in your body. By decreasing stress hormones, guided imagery can calm your sympathetic nervous system, thus it can help decrease blood pressure, heart rate, respiratory rate and pain. The concept behind guided imagery for chronic pain is that if you envision your pain leaving your body, the mind-body connection will create new mental pathways, assisting your brain to decrease or even stop your pain.

Guided imagery can be practiced on one’s own, using just your imagination or an audio recording, or facilitated by a practitioner. It involves finding a quiet, comfortable place, closing your eyes, relaxing and imagining a scene that makes you feel peaceful or happy, such as on a beach, walking in the forest, sitting on a mountain, or just doing something that you love to do.  Visualize and feel yourself within that scene – utilizing all your senses – hearing, smelling and tasting everything in that scene around you. The purpose is to imagine yourself doing those things without any pain. This process increases relaxation, reduces stress, and decreases pain perception.

Graded motor imagery is a visualization technique that involves imagining doing painful movements pain-free, helping to break the association the brain has made between movement and pain.^[24]. It has shown effectiveness in decreasing pain and disability in musculoskeletal pain.^[25] There are 3 stages of graded motor imagery. The first step involves left-right discrimination practice of painful body parts. Persons with chronic pain tend to be slower to identify the painful side of their body,^[26] so using flash cards to identify the side of the body pictured can help increase the speed of identification. The second step is explicit motor imagery. Did you know that 25% of the neurons in the brain are called ‘mirror neurons’, which means that they start sending signals out even when we start thinking about moving or when we see another person move?^[27] Therefore, if we can imagine making certain movements that usually causes pain without actually doing the movement,^[28] this will help the brain to learn that this action shouldn’t be associated with pain. The final step is mirror therapy. Mirror therapy is a technique used to trick our brain into reducing pain sensitivity. For example, if you have left-hand pain, you can put your left hand behind a mirror and right hand in front, thus to your brain, you are exercising your left hand when you start to move your right hand.^[29] The mirror therapy technique is also commonly used to help with the phantom pain that amputees experience.^[30]

There are also numerous other visualization methods utilized in pain management. The Canadian Cancer Society speaks to the Simonton method,^[31] which has people with cancer imagining their bodies fighting the cancer cells or breathing in a cloud of soft healing energy. The website also refers to the palming method,^[32] which involves imagining different colours surrounding your body that represents a positive connotation for you. For example, if you picture an area of your body with pain as being a searing red colour, you would visualize replacing that colour with a calming and cooling blue. Other pain controlling images might be imagining a pain switch that you turn off, or transforming the image of the pain (a burning hot knife) into something benign (a vibrant flower). Another visualization is to gather all of your pain into a red ball. Start to make it smaller and move it slowly further and further away from your body each time you exhale. You can think of different methods to get rid of it – you can explode it, you can crush it or do whatever comes to mind to obliterate it away.

Guided Meditations for Pain

Here are a few free guided imageries for pain relief resources. There are tons available for you to choose from on platforms such as YouTube.

Body Scan Meditation for Chronic Pain 12 minutes

Mindfulness Meditation for Pain Relief by Jon Kabat-Zinn 10 minutes

Guided Mindfulness Meditation on Coping with Pain 20 minutes

Pain Relief & Healing guided meditation “The Cleansing Pool” 20 minutes

There’s an App for That

In 2019, scientists in New Zealand performed a systematic review of 939 smart phone apps promoting self-management in people with chronic pain.^[33] Of the 14 item measures the authors set, only 19 apps met the criteria. 3 apps met 8 out of 14 items that help to foster self-management of pain. Those apps were Curable, PainScale, and SuperBetter.

Let’s overview each of these.

Curable is a popular subscription app that uses a biopsychosocial approach to pain management by helping address pain from multiple angles: physical, emotional, and psychological. Curable utilizes clinical science with input from doctors, pain psychologists, physical therapists and neuroscientists. The website states “The Curable program guides users through engaging audio lessons about modern pain science and teaches them how to apply a wide range of science-backed techniques to reduce their symptoms, including: somatic tracking, graded motor imagery, cognitive behavioral therapy techniques, guided meditations, pain reduction visualizations, expressive writing techniques, and more.”^[34]

PainScale was listed as one of the best fibromyalgia apps of 2019. It is free to use, and offers education from clinically reviewed information. It also provides condition tracking for things such as pain, sleep, activity and mood, as well as personalized reports to help individuals and their doctors spot trends and patterns.

SuperBetter is super different in that it utilizes a gameplay framework to build resilience and promoting success in real life, not only for chronic pain, but other challenges like anxiety and depression. The website states the free app is “backed by randomized controlled clinical trials to build resilience and improve mental health”,^[35] and that using a gameplay method promotes personal growth as a result of stress and change. The game involves challenges, battles and quests, building resilience by encouraging motivation and optimism even in the face of a tough challenge.^[36]

Clearly with the dramatic scope and individualized experience of chronic pain, there will never be one-size-fits-all cure. But knowledge brings power and understanding that chronic pain does not have to be a life sentence can start a person on the journey to self healing.

Learning to accept your pain leads to understanding your pain:

What is the pain’s purpose? Is it to warn you, punish you, protect you? Is it time to heal unresolved emotional trauma that is causing you to hold onto your pain?

We know that the concept of pain has gone from being thought of as purely physical to the knowledge that it is made up of psychological and neurological factors as well. A high percentage of chronic pain is emotion. Managing negative feelings such as fear, anger and guilt by expressing the feelings and letting them go versus holding them in can decrease the overall stress response, leading to a stronger sense of control over your pain. You don’t have to suffer; learning how to engage the power of your mind to manage chronic pain is a real strategy that can help. The bottom line is to develop self-compassion – stop judging yourself and start loving yourself! Accept your limitations, living life at your pace. Unlearning painful patterns takes time; keep hope and trust that your subconscious will respond to your efforts in its own time.