Coping with Physical Pain

A plan for coping with pain should include both the physical, as well as the emotional/social aspects of pain's effects.  After all, physical pain wears a person down emotionally and effects his/her social relationships.  In a previous post on Coping, I had addressed the emotional/social aspects of pain. This part will address coping with the physical aspect of pain.  

Endometriosis can cause pain in several different ways, and thus may best be dealt with through using a combination of different therapies.  How does endo cause pain? Well for starters, the endo cells themselves produce and release prostaglandins, which are inflammatory substances which can cause the healthy tissue around the implant to go into spasm and feel "scorched".  As the endo cells respond to the hormones each month and begin to shed, any deep "infiltrated" cells can become engorged and lead towards what might be medically termed as "congestion" or essentially internal swelling of the areas around the cells.  If these tissues swell enough they can put more pressure on other areas.  Endo cells also tend to be "sticky" so the possibility exists for them to form adhesions which can pull and mis-shapen the pelvic organs.  These are just a few of the examples of the ways that endo can cause pain for women with the disease.  Regardless of how it happens, it's important to understand that your pain is very real, even if others will suggest that you shouldn't be in pain at all.  Don't distrust in your body's messages!

Here are a few ideas for helping you to cope with the physical aspect of pain.  Even though they are numbered, this doesn't have any bearing on how important these ideas are.

1. Keep a pain diary.  When you set out to deal with your pain, you are going to want to know just how effective your treatments are working on your pain levels.  You will also want to be able to easily see any patterns over time that occur with your pain, such as a spike in pain levels at ovulation time.  A pain diary also communicates the message to your doctor that you take your pain seriously.  For women, a good pain diary is going to also track where you are at on your cycle.  This is important information to know, as you'll want to learn when exactly your pain tends to flare up from month to month and how it is different than at other times.  For example, perhaps the pain is more sharp just prior to your period.  This might also mean that a different form of treatment for your pain might help you better at this specific time.  

I have grown quite fond of a FREE online pain diary program provided by ReliefInSite.com. Here you can track your menstrual periods, use body maps to enter the location of your pain(s), record what treatments you are currently taking and also have a chance to rate their effectiveness of treating your pain.  You can track any alternative healing practices that you engage in as well, and how they effective they are for treating your pain.  Over time this nifty program will allow you to print out a graph of your pain, which helps you to see patterns that might occur.  You also have the opportunity to e-mail the results to your doctor, assuming that he/she accepts patient e-mails.  For online programs, this is likely one of the most comprehensive ones currently in use.  

The one thing that is missing from this site which I find to be of importance as well, is food tracking.  Many of us with chronic illnesses have food allergies or sensitivities.  The Endometriosis Association's research has noted that there is an increase in these allergies among women who have the disease.  Even if it's a "sensitivity" it can still lead to just as much discomfort as an actual allergy.  For example, if I were to have red meat, I'd be in pain for up to 3 days.  I'm talking bent over, writhing in the fetal position pain.  Avoidance is the only thing that works in this case.  Other common food products that people react to include wheat/gluten, dairy, nuts and certain fruits.  Sometimes the only way to find a food allergy/sensitivity is through the complete elimination of the suspected food product.  Regardless, it can help to track what you eat with your pain diary, as then you can notice if there is an increase in pain when you have certain products.  I also track bowel movements.  

For anyone who is interested in an Excel spreadsheet form of a pain diary, complete with a fertility tracker, I have one of these drawn up on my computer and would be happy to send it over.  I'm having problems posting it to google to post to this blog entry though.  

2. Consider pain management.  A Pain Management specialist is often an anaesthesiologist, although a few other disciplines (such as palliative care) may also have these special docs.  Many of us will be stuck with the "regular pain treatments" when we see our GPs or GYNs.  A Pain specialist is just that, a doctor who specializes in treating pain.  What is even better is if you can find one that specializes in treating pain caused by your specific condition.  The International Pelvic Pain Society is a good place to start to look for one of these doctors.  A good pain doctor will be concerned with how your pain effects your overall quality of life and will work with you to find the right combination of treatments to effectively lower your average pain score.  

3.  Have a plan to deal with your pain.  How you treat your pain when it is rated at a 2 might be drastically different than how you would treat your pain should your rate it a 7 or above.  For example, at 2 you might take a plain tylenol/advil, etc., whereas at a 7 you might be reaching for a prescription and going for a rest.  This is something that is important to discuss with your doctor.  Having a clear plan on how you will treat your pain can help to better manage some of your overall anxiety/fears about the pain.  

4.  Don't be afraid to try different approaches for dealing with pain.  Massage therapy, acupuncture, herbal/homeopathic remedies, cranio-sacral therapy can all be of benefit when dealing with the symptoms of illness.  Diet and lifestyle changes can also be helpful for minimizing symptoms.  These approaches may not take the actual disease away, but they can help to make the symptoms a touch more bearable.

5.  Try a different temperature.  Sometimes moist heat can relieve some muscle tension, while at other times icing/coolness might be of help.  Many of the ladies in the online support group that I manage have talked about using a rice sock for this purpose, that they can heat up in the microwave.  Just be sure to replace the rice from time to time.

6.  Consider alternative reasons for your pain.  A lot of women with endo have other potentially painful conditions alongside their endo diagnosis.  If you assume that the pain is due to endo, and treatment fails to help, possibly the pain isn't being treated appropriately because it comes from a different source in the first place.  For example, since my endo diagnosis I have been diagnosed with fibromyalgia.  If I only treated the pain as though it were endo pain, I'd still have my fibro pain to deal with!

7.  Try to get some form of exercise.  Easier said than done when you live a life of chronic pain.  However, exercise releases endorphins, or "feel good" chemicals in our bodies which can help to trick the body against the pain signals.  Personally, I like yoga as this I can tailor to how I am feeling at any specific time.  These gentle stretching exercises can also help to keep adhesions loose, which might help to reduce the overall pain.  

8.  Don't push yourself!  When you are feeling better, there is a tendency to push yourself to do more in fear of not being able to do ___ tomorrow.  Unfortunately, through pushing ourselves to do more, we're at the same time interrupting our healing processes.  All things in moderation.

9.  Combine your coping with physical pain plan with your emotional/social coping skills.  No Coping plan is complete without combining ways of managing your physical pain with managing the social and emotional pain that having a chronic illness can bring.  If you need ideas on how to cope emotionally with a chronic illness, you can see my earlier blog post on coping.  

I hope that you find these suggestions to be helpful.  They are by no means meant to be inclusive of all the pain treatment options out there, just enough to get you started on your way!