Nov. 17, 2000 -- Sprain your ankle playing soccer and you are going to be more careful next time. Get into trouble for saying something stupid and next time you will measure your words. Go through a bad relationship and next time you are going to be less trusting. It seems natural to avoid doing what has caused pain in the past. Yet, what if you suffer from a chronic painful condition that affects everything you do -- one like rheumatoid arthritis?
According to a Western Washington University study recently reported in the journal Behaviour Research and Therapy, avoiding pain in rheumatoid arthritis patients can become a vicious cycle. They often stop doing activities they enjoy or need to do, which in turn may make them anxious that you can no longer cope with such activities. The anxiety makes them withdraw from activities even more and so the cycle continues.
Therefore, the researchers recommend that it's important that pain treatment or management programs for these patients focus on enhancing their ability to actively cope with life's daily situations.
"Anxiety about pain makes patients more dysfunctional," says one of the study's researchers, Ronald Kleinknecht, PhD. "The general fear of pain makes them avoid anything that will make them hurt more. Those who treat arthritis should be aware of this."
Kleinknecht tells WebMD that in order to function, patients dealing with pain must override that fear.
"Not giving into pain gives patients more options and thereby more emotional and social support because they are out doing something," he says. However, those who let the pain rule their lives miss out on the opportunity to participate in life and get the support they need," says Kleinknecht, who is chairman of the psychology department at Western Washington University in Bellingham, Wash.
Carl Noe, MD, medical director of the Baylor University's Pain Management Center in Dallas, says that pain can drive anxiety while pre-existing anxiety over life issues -- such as worrying about bills or children -- can make the situation worse.
"The definition of pain is an unpleasant sensory and emotional experience," Noe tells WebMD. "So it's not just a [sensation]. It's also emotional."
In fact, Baylor University Medical Center has a multidisciplinary program, called the Healing Environment, that uses some alternative therapies to help patients deal with pain. These include breathing techniques, visualization, aromatherapy, soothing music, clowns, foot massages, meditation, aquariums, murals, and 24-hour relaxation television.
"We try to address all the mental health problems that occur when a patient's life is disrupted by illness and pain," says Lucy Aguirre-Kelley, an occupational therapist at Baylor who helped develop the program.
She tells WebMD that using these techniques, they have been able to coach patients from a 9 down to 2 on a pain scale of 0 to 10, with 10 being the worst pain -- all without using drugs.
The researchers suggest that further studies should investigate ways to promote coping strategies and reducing pain anxiety.
As Noe says, "If someone says their pain is a 7, part of that is emotional. If you relieve the anxiety, the sensory component may still be a 7 but the pain feels less because the emotional component has been reduced."