Taken from Trigeminal Neuralgia Association UK Newsletter June 2002
Dr Toby Newton John Clinical Psychologist


painAt the risk of stating the obvious, coping with pain – and in particular, trigeminal neuralgia pain – is one of the more difficult tasks in life. Pain is often conceptualised as a “warning signal”, alerting us to the fact that there is something wrong in our bodies. Severe pain therefore is an alert of something very wrong, which needs urgent attention in order to be put right. This is of some value when the pain is telling us we have broken a limb, or have an appendicitis, or are about to give birth. We have some idea of how to use the information that the pain is giving us in these situations – we know what to do, or at least what we should be doing. 

Chronic neuropathic pains such as TN defy such rational explanations – what is the pain telling us to do in these cases? This urgent, insistent message from our bodies alerting us to the fact that something is very wrong doesn’t convey the same information about how to respond. After all, other than taking medication there doesn’t appear to be very much that we can do to stop the pain. One of the most upsetting aspects of chronic pain can be the sense of helplessness that accompanies it. You feel as though you must do something to make it better, but there is no obvious resolution to the pain that you can apply.

Pain psychologists and physicians have put together a list of potential “coping strategies” for managing these flare-ups of pain. The value of these strategies lies mainly in how realistically they are used. The first thing to remember is this: once your pain has flared-up, it is virtually impossible to shut it down rapidly (unless you get good relief from your pain medications). Although it is quite natural to want the pain to stop immediately, when it doesn’t stop you can feel even more distressed and panicky. So, it is perhaps better to change your expectations from the outset.

One of the ways in which you might think about changing your approach to the pain is to think of a flare-up of pain not as a disaster, but as a challenge. How are you going to respond to this – with an increase in anxiety and frustration and distress, which will inevitably worsen the pain; or with as much calmness and rational thought as you can muster? Coping well with a flare-up of pain is a bit like riding a wave: you can’t stop it, but you can stay on your feet and flow along with it until it eventually subsides (which it always does, even though it often doesn’t feel like it at the time!)

Having made a decision that this flare-up is a challenge that you are going to attempt to meet, the following strategies can be useful. They are not presented in any particular order, you can try them in any sequence that you like. The main idea is to keep yourself occupied by moving from one strategy to another, alternating between rest and activity. You need to be aware that overdoing things when you are in pain is tiring, and will reduce your resources for coping, whereas doing very little at these times will not leave your brain sufficiently distracted and you become at risk of focusing more on your discomfort. Try out the following ideas for coping with flare-ups of pain:

  • Don’t panic: try to think of the pain as a challenge, and you are going to experiment with different ways of coping with it.
  • Prioritise: coping with this pain is going to mean that you don’t necessarily do all the things that you were planning to do in the next hour or two (or even longer). What can you leave until later, or ask someone else to do, or cancel completely? For example, is it really so important that you do the vacuuming today, or can it wait until tomorrow?
  • Communication: although coping with pain is a personal event, it may be useful to let those close to you know what is happening at this time. This is especially important if you prefer to be alone, or if you tend to become quieter so that you can concentrate on dealing with the pain. It is easy to misinterpret someone leaving the room or “going quiet” – family members will often think they have done something to upset you. Communicating about pain doesn’t mean endlessly complaining about it: something like this can be useful - “Listen, I am just going upstairs to manage this pain for an hour. You (husband, wife, kids) keep doing what you are doing, I am OK but I just need to concentrate on this for a bit. I’ll ask you if I need any help”.
  • Relaxation (5-10 minutes): doing some deep, controlled breathing can help to keep you feeling reasonably calm and in control. There are many techniques for relaxation, from yoga to meditation to hypnosis. They all share a common element, which is that you are doing something quite active even though you may not be moving at all. Relaxation isn’t the same as doing nothing, you do have to concentrate. But be realistic – being in pain is about the least “relaxing” state you can be in, and very few people are able to drift off into a completely comfortable state. Whenever the pain intrudes on your thoughts, just gently bring your mind back to your controlled, regular breathing. Your aim is to try and keep as calm as possible, rather than to go to sleep. Sleeping during the day can seriously interfere with your sleep at night, and that can compound the situation.
  • Light activity (10-15 minutes): even though you are in pain, you should still attempt to do some non-vigorous activity. Things like watering the plants, paying a bill, simple cooking, polishing shoes, gentle ironing, and so on. The activities must be physically and mentally undemanding, and you should not attempt to do them for any longer than about 15 minutes. However, you will discover that even when in a bad way with the pain, you can still achieve things that need doing – and that can bring some satisfaction.
  • Rest (any time up to 20 minutes): this is complete time out, where you don’t need to concentrate on anything other than giving your body a chance to recoup some energy. You might lie down on the bed or floor, or sit in a comfortable chair. Having a cup of tea, listening to music or watching TV can all be restful activities, but remember not to “do nothing” for too long because the pain will begin to dominate your thinking if you aren’t sufficiently distracted.
  • Gentle stretching (10-15 minutes): pain can often result in increased muscle tension, which will then make the pain worse. Simple, gentle stretching of the neck, upper back, shoulders, arms and lower back can all help to keep you from getting too tight
  • During a flare-up. Going for a slow, gentle walk can also be helpful. As long as you do the stretches slowly and gently, and don’t try to overstretch, you won’t do yourself any harm.
  • Distraction (5-10 minutes): all of the activities above have a distracting element to them, but you might also try and divert your mind away from the pain as an activity in itself. Distraction requires concentration, so think of an activity that you get really absorbed in such as sewing, or model making, or painting. Have these activities at the ready, so that you can just pick them up when the flare-up requires them. Talking to someone can also be excellent distraction – provided that you don’t talk too much about the pain! You might say: “Hi, I am in a pain flare-up at the moment. No need to worry, I’m OK, but I need you to take my mind off it for a while. Tell me what you did today/movie you saw recently/holiday you are next going on etc”. Try and involve yourself in the conversation as much as possible.
  • Reflection and Reinforcer: once you have gotten through the flare-up, having tried out these various strategies, have a think about how it went. Did the pain last as long as it usually does? Did you feel more in control of the pain? Were you still able to achieve a few things, even though you were in pain? Is there anything that you could do differently next time – change the order in which you do things, do certain activities for longer or shorter, get partner/friend involved more? Whatever you decide, it is very important that you give yourself a “reinforcer” for having tried to cope with the pain in this way. A reinforcer is a small treat that you give yourself for your own hard work in coping with pain, such as a magazine, pot plant, makeup, special food (chocolate is often used!) or video. It is a small pat on the back that you give yourself for your efforts, because only you really know how tough it is to cope with the pain.

This is a brief run through of different ways in which you might cope with a flare-up of pain. It is by no means an exhaustive list and there are no absolute rules, so be creative and experiment with different ideas. Each flare-up gives you the opportunity of learning something more about the pain, and something more about your capacity to cope with it, so good luck!

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