Defining Your Path to Wellness:
Multiple Pathways to Chronic Pain Management
Linda Ruehlman, PhD
June 27, 2013
PainPathways: Dr. Ruehlman is the founder of Goalistics, as well as a social and health psychologist. She writes a blog that is published on our magazine’s website. Her perspective is based on research demonstrating that pain can be effectively managed using a variety of coping strategies. Her belief is that you can still live a happy and full life, even though you have chronic pain.
Here’s Dr. Ruehlman’s website: http://pain.goalistics.com/.
PainPathways: Now, please join us in welcoming Dr. Linda Ruehlman!
Dr. Ruehlman: Hello everyone and welcome! It is a pleasure to be here tonight and to respond to your questions regarding pain and wellness.
In general, if you have pain symptoms, or your primary care physician gives you a diagnosis of a pain condition, you should see a specialist for further evaluation.
Medication, surgeries, or medical procedures may be helpful. What psychologists can add to the medical treatment of chronic pain management is to help people to realize that emotions, thoughts, behavior, and the responses of other people can impact the sensation of pain – to “turn the pain signal down”.
So, let’s get started with your questions! Please post your question as a comment to this status, and I will begin creating responses.
Sue D: How to stay positive with your family/caregivers and avoid always being irritable and angry?
Dr. Ruehlman: I think the main thing is to try to manage your emotions by using relaxation as a way to calm your body down. When your body is quiet it is easier to calm your mind and manage irritability.
Selena H: I think using group in Facebook or the computer to vent is best. Only other people that are going through it can understand.
Pain Camp: I try to “step back” if I feel myself getting too close to “reacting” in a negative and ineffective way. I think part of healthy relationships is amends and acceptance for when we do make mistakes and our understanding for our family and friends’ perspective too. Sometimes it takes just a good old “pretend as if” face to be put on. If I don’t have energy for that sometimes I skip the family/friend activity.
Maryann O: Hi my name is Maryann I’ve had RSD for 18 yrs. I live in Bellleville, NJ. There are no doctors down here that know anything about RSD; I’m in pain every day.
PainPathways: I’m sorry you don’t have easy access to pain management. We built our online Chronic Pain Management program for folks like you. Visit us at http://pain.goalistics.com
Pain Camp: I am a clinical social worker and have worked as an outpatient mental health therapist in the past. I’m also a person living with chronic pain. I have reviewed the Goalistics site and credentials of the Co-Founders as well as contributors and I think that this is the BEST online support program out there for chronic pain! Especially for those in rural areas or without specialists in their area.
Linda T: Dr. R—can you share some info on sleep as it relates to improving pain?
Dr. Ruehlman: It is kind of a vicious cycle – pain worsens sleep, worse sleep worsens pain. But, you can stop the cycle by following good sleep hygiene as much as possible. No caffeine after 3 PM, get exercise but not late in the day. Try to get up and go to sleep at the same time. Try to avoid sleep meds, they can make insomnia worse over time.
Susan V: I had a sleep study test and haven’t slept for years. They told me I was awake multiple times and never hit a restful sleep. I was taking Ambien Cr 12.5. Even when I had the test, sleep doc said bye-bye, can’t help you but my arthritis doc was the one who had me on Ambien CR 12.5. We added Amitripline (not spelled correctly) 4 months ago. We messed with the dose, started at 25 and added more till I found the right dose at 150 mg/night. I slept the best I ever had! So glad I found this combination. Don’t give up, you can play with doses till you find the correct dose that works for you…… speaking of that, time for eye drops and bed meds.
Pain Camp: I agree! I have narcolepsy as well so it is hard for me to not nap during the day. When I exercise too late in the day I am more prone to Painsomnia, which makes the narcolepsy REM issues more challenging.
Terry W: How do I go through life in pain with a firm belief that this is not how I want my life to be? I refuse to accept that I have become somewhat disabled. I am seeking help from a new surgeon.
Dr. Ruehlman: Psychological approaches can help you cope with the changes that may occur in connection with your pain. They can work in conjunction with medical/surgical procedures.
Terry W: Can you give me an example when you refer to “psychological approaches”?
Dr. Ruehlman: Monitoring and challenging overly negative or pessimistic thoughts; using relaxation techniques; learning to pace yourself so that pain doesn’t control you – just some examples.
Terry W: That’s just it! I am NOT letting it control me. I have my days when I am so tired of being in such severe pain and I whine. But …most days, I have the attitude I am not going to let this situation take away my life! I do as much, and sometimes too much as I can physically. But what do you tell your brain when you know there HAS to be an answer/a fix, but it is still not happening after 4 years and 4 surgeries.
I try to always tell people I encounter, “It could be worse!” I think of someone who truly is worse off than myself and I always feel ashamed for having a pity party. “There, but for the Grace of God, go I.”
Pain Camp: Someone one time encouraged me to allow myself a “timed pity-party”. I find that stuffing/ignoring my emotions is not helpful. I find that acknowledging them, accepting them for what they are (just emotions not always facts) and then moving through them (that’s the painful part) has been helpful. If I am feeling sorry for myself or just sad, I feel that and move on without trying to judge it. I know sometimes will set a kitchen timer (literally) for 15 minutes and allow myself to cry and feel however I want to feel without judgment and then when the 15 mins are up I distract and move on. Also, I found that when I came to accept my chronic pain conditions, I was able to grieve my losses and start moving on with the “new” life that I am creating. This was challenging and scary but I think I became more free once I “accepted” that my body is not going to be what it once was.
Jennifer G: Dr.R, I suffer from CRPS/RSD what are some foods that may trigger my pain that I can eliminate or herbal supplements besides same I can take to help alleviate some of my pain? I currently do not take pain medications. Also what are some relaxation techniques to help when the pain is most intense?
Dr. Ruehlman: There are a lot of brief relaxation sessions that you can use. You can find them on iTunes. I think those that focus on breathing and mindfulness may be most helpful. I am not a nutrition expert so I can’t comment on foods.
PainPathways: Jennifer and others, we have an article on our website about some relaxation and breathing techniques developed by Dr. Dawn Buse – you can check this out and link to her website.
We also recommend the Power of Pain Foudation. They are a great resource on RSD/CRPS. The founder, Barby Ingle, has RSD and is a leading expert.
Rini S: I usually use BTD (blood type diet) for pain (from experience). Because the avoid food in BTD mostly causes inflammation. When your body is inflamed, the volume (as in a radio) / intensity of pain usually goes up as well.
Pain Camp: I started seeing a naturopath for help in that area Jennifer.
Bart C: How does one find out if a doctor is certified in a particular area? For instance my Cardo doctor wants to do a procedure of vein ablation in my legs. I know he is a Cardiologist but I cannot find where he has a specialty in this procedure, which he says he does in the office.
Dr. Ruehlman: You can look at state board of medical examiners and also ask the office staff for information on training.
PainPathways: Also, the American Academy of Pain Management has a search feature, by specialty and location. Please note, the listing only includes “members” of the AAPM and therefore non-members are not on the list.
Cindy R: What is the best way to coordinate care when pain is a predominant factor in multiple diagnoses?? (Neuropathy, osteoarthritis, fibromyalgia and multiple sclerosis)
Dr. Ruehlman: You would benefit from seeing a pain management specialist to help coordinate care.
PainPathways: You might also try contacting The American Chronic Pain Association’s website for assistance.
Pain Camp: Thanks for this great link! I have found that pain management specialists have different approaches. I think my experience has been best where the last place I ended took more of a rehabilitative approach.
Maryann O: I also have panic attacks.
Dr. Ruehlman: Panic attacks can be effectively treated by cognitive-behavior therapy. Reductions in anxiety will also help to reduce pain.
Pain Camp: I’ve struggled with anxiety and have had some panic attacks. I agree with Dr. Ruehlman that reduction in anxiety helps with pain. I have had success from CBT and also exposure and trauma processing. I’ve also heard that somato-sensory work is good for people with pain and anxiety.
Sue D: How do you know if your doctor is giving you the right treatment when there are so many schools of thought to treat pain. I have RSD/CRPS and my doctor won’t give me a nerve block because he says it isn’t warranted. However on most websites on the subject, the experts say beginning nerve blocks early could actually lead to remission…Any ideas?
Dr. Ruehlman: I think it is important to trust your doctor’s opinion while also staying informed. Be careful to use sources that are evidence-based. That is, based on information from scientific evaluations of treatments. Also, don’t be afraid to talk with your doctor about why he/she doesn’t want to do a procedure. Ask why it isn’t right for you.
Sue D: OK thanks, I probably just needed to vent a little.
PainPathways: Sue D. we all need to vent! This is a good place to do it!
Nancy N: The RSDSA website may be helpful in recommending physician(s) in your area.
Alayne G: And, remember: if you’re not getting the treatment you feel you want to try, perhaps the doctor you’re with isn’t the doctor for you. Not every doctor and patient are a good fit. It is perfectly okay to find a new doctor… or twelve! Too many people don’t really understand that.
Pain Camp: I have a friend with RSD/CRPS and she has two spinal cord stimulators in. They haven’t worked that well and neither have her RFAs. This is a great link though so thanks for sharing it!
Susan G: Don’t get epidural steroid shots. I did for eight years and got cataracts on both eyes. Just had one removed yesterday getting other one off July 8th.
Gerard H: I look healthy but I’m not. I feel that is the toughest challenge.
Dr. Ruehlman: That is difficult for many people with pain! I think a good way to handle it is to make sure that the people close to you understand your issues and not worry too much about the others.
Linda M: I know people who do the triage work at hospitals and they have such a limited view of what pain looks like. If your blood pressure is not sky high, heart rate majorly elevated, crying or screaming, sweating, shaking or other major symptoms, then you are not in pain and just drug seeking. I have given up trying to explain the “I look normal and my vitals may be good but that doesn’t mean I don’t hurt or my pain level is low”. I have learned to tolerate what is happening and not react.
Pain Camp: This has been very hard for me in my journey. I had to come to a point where I knew people would accept me for the new “me” (after I did work with a professional in sorting that out and going through the grief/loss process)…or they wouldn’t accept me. It is hard to understand chronic pain/illness when you don’t have it. I used to be judgmental too until I ended up with chronic pain etc. I think that my best approach now is to keep an open line of communication, share my “new” self as authentically as I can and then accept where the other person is at. I’ve also given caregiver resources and websites to family and friends so that they can look up the information if they would like to make that move in being supportive.
Sue D: Good comment….I too am on pain meds, and may be for a long time.
Pain Camp: I’m wondering if you can describe what a “pain behavior” is and what doctors are looking for when they see this.
Dr. Ruehlman: It can mean a number of things: verbal expressions, nonverbal expressions such as facial or body positions, activity level, medication use, social behaviors such as asking for help.
Pain Camp: Thank you Dr. Ruehlman! I’m always paranoid that I’m exhibiting these behaviors.
Pain Camp: Thanks for the first Facebook chat! That was a fast hour! Dr. Ruehlman was busy! I’d like to see information about the different types of pain treatment approaches out there and education on that. I wish I would’ve had that when I first was diagnosed with chronic pain. It would’ve been so helpful for me in choosing a direction for treatment. Also, what is the current research that is being done on alternative approaches such as mindfulness/meditation, yoga, tai chi, horticultural therapy, animal assisted therapy (and other natural/alternative treatments) for rehabilitative approach to pain management.
PainPathways: Hi everyone! This is Amy North, editor of PainPathways Magazine. On behalf of Dr. Richard Rauck, we’d like to thank Dr. Ruehlman and those who participated in tonight’s chat! If you want to read more about what she has to say on the topics discussed tonight and others, please check out her blog on our website, https://www.painpathways.org/category/blog.
Have a good night everyone!
Pain Camp: Thanks Amy, Dr. Rauck and Dr. Ruehlman! I look forward to more of these chats!
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Disclosure: The information provided in this transcript is intended for use as general health and wellness information. It is not intended to replace the personal medical advice of your health care provider. Please discuss all treatment, lifestyle, and diet choices with your health care provider.
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