In my many years of working as a counselor in a cancer center, I’ve had many conversations with mesothelioma patients and their caregivers about pain.
Many of those discussions dealt with encouraging patients to take their pain medications as prescribed, educating them on communicating their pain experience to their health care team, listening to their fears about pain control and their concerns about potential addiction.
While great improvements in the pharmacological treatment of pain have been made in the past few decades, patients still complain about the lack of additional means of pain control besides medication. Their concerns are the side effects: Sedation, constipation and nausea.
But research shows that our emotions and thoughts can also manage cancer pain.
Thoughts and Emotions Can Control Pain
One of the first theories about pain is called the specificity theory. It shows that injuries produce messages in the nerves associated with the damage. Those messages travel along the peripheral nervous system to the brain where the pain message is interpreted.
But that theory doesn’t consider psychological factors that affect the perception of pain. For example, do you recall a time where you injured yourself while doing something fun or exciting and did not notice the pain until after you saw the injury?
However, Ronald Melzack, a neuropsychologist, and Patrick Wall, a neuroscientist, in 1965 developed a different model, called the gate control theory of pain. Their theory states that pain messages travel along two kinds of nerve fibers to the spinal cord, which contains a gate mechanism that amplifies or blocks pain messages before they reach the brain.
It means that our thoughts, feelings, behaviors and other psychological factors influence how those gates open and close. The theory also helps provide strategies to help minimize our experience of pain.
What Affects Our Pain Experience?
There are many personal factors that affect how we feel and interpret pain.
Our own past experiences with pain and injury can lead to anxiety or expectations about future pain. If we are depressed or worried, we are more likely to experience pain more intensely. If we grew up with a family member who had uncontrolled pain, then we are more likely to have hopeless expectations of effective pain management.
If we fear that we or our loved one will become addicted to pain medications stemming from previous addiction issues, then we are less likely to use pain medications properly and suffer needlessly.
There are also myths about pain management.
For example, a common misconception is that if a psychological intervention works at reducing pain, then the pain is not real, physical pain.
Before discussing nonpharmacological methods of managing pain, it’s important to acknowledge that effective pain management doesn’t mean taking pain medications or using psychological and behavioral strategies. Both pain management strategies work to improve a mesothelioma patient’s quality of life in unison, not separately, and certainly not against each other.
Strategies to Reduce Pain
There are a variety of proven psychological and behavioral strategies that reduce the experience of disease-related pain:
- Attention diversion
- Changing activity patterns
- Adjusting negative thoughts about pain
Researchers have investigated how paying attention to pain actually worsens our pain experience and distraction minimizes our feelings of pain. Diverting our attention can be done physically or psychologically.
There are many ways that we can physically divert attention from a pain. For example, when athletes walk off a twisted ankle or someone shakes their finger after hitting it with a hammer. Nurses typically rub the muscle after an injection to provide interference of the pain signals from the shot.
Physical distraction from pain involves adding some other type of nerve stimulation (massage, rubbing or shaking) to the area around the pain to create more nerve signals that distract the brain from the original source of pain.
Nonphysical distractions also help manage pain. These are called psychological diversions. There are many ways to distract our mind:
- Watching a funny or engaging movie or TV show
- Socializing with others
- Puzzles, computer or video games
- Hobbies (cooking, woodwork, crafts etc)
- Relaxation exercises
- Reading a good book
Changing Activity Patterns
Understanding pain and what makes it better or worse allows mesothelioma patients with pain to adjust their activity patterns to minimize pain and maximize their quality of life.
Many people with chronic pain find they need to incorporate rest periods into their day as fatigue can exacerbate their pain experience. Some people find pain is worse in the morning after getting out of bed. Meanwhile, others find that as the day wears on, their pain increases.
Knowing your good and bad times of the day allows for scheduling activities accordingly. One of the most difficult adjustments to make when pain impacts your life is to have realistic goals of what you can accomplish when pain limits your energy and activities.
Many people believe they should accomplish all the tasks and activities as they did before they became ill. But, there are times when we will feel better about ourselves when we have realistic expectations of what we can do.
Adjusting Negative Thoughts
Emotions and pain are closely related. Fear, anxiety and depression amplify the way our brain processes pain signals. Clinical studies have proven that treating anxiety and depression helps to reduce (not eliminate) disease-related pain.
When I counseled mesothelioma patients struggling with pain, I found that supporting them and exploring their fears behind the pain is helpful. Sometimes, patients and family members have pre-existing beliefs about pain management or irrational fears of addiction to pain medication. These emotions respond well to cognitive behavioral counseling that challenges negative thought patterns.
Patients may experience helplessness, and are sure that physicians will not be able to manage their pain properly. Others may catastrophize (irrationally overreacting) their future pain experience which increases anxiety and pain. These cognitive distortions respond well to counseling, which helps patients feel better emotionally and physically.
Best Combination to Manage Pain
Research shows the best way to manage pain is combining pharmacological and cognitive behavioral strategies. It is the most the most effective way to help patients with disease-related pain.
Most pain management specialists and clinics incorporate many of the nonpharmacological strategies in addition to the pain medications they prescribe.
A great resource for more information about pain management and the latest research is the American Academy of Pain Management. Although the organization offers the most benefits for members, it contains a news blog and other resources for visitors.
Questions and Answers from the August Online Support Group
Q: All the pain medication prescribed by my doctor seems to make me nauseous. Is there anything that could help the nausea?
A: Let your doctor know about the nausea and any other side effects you notice after taking pain medication. Your doctor may change the dosage or medication and offer other helpful tips, such as suggesting that you always take the medicine with a meal. You may also request an appointment with a pain management specialist. These physicians are highly experienced with managing pain effectively.
Q: How long after the last chemotherapy treatment is the checkup imaging scan scheduled?
A: Soon after your last chemotherapy treatment an imaging scan will be performed to see how you responded to the therapy. The appointment for the scan is often scheduled within a few weeks or within a month of your last chemotherapy treatment.
Q: There seems to be less fundraising for mesothelioma than other cancers. Why is that?
A: The most common cancers, such as breast cancer and prostate cancer, tend to receive the most attention and funding. Because mesothelioma is a relatively rare cancer it receives less funding.