published March 14, 2012
Managing the Stress of Chronic Pain
One woman shares her drug-free strategies and tips for living with pain.
Maureen Healy

Maureen Healy is a health and fitness freelance writer in Portland, Ore., and author of The Reluctant Health Nut blog. After spending 10 years on staff at Shape and Fit Pregnancy magazines and working her way up to a senior editor position, Maureen escaped the hubbub of Los Angeles and relocated to the Pacific Northwest. She enjoys nature walks, yoga and watching live music.

Pain, in its simplest definition, is a signal from the nervous system that something is wrong in the body. Chronic pain is the persistent manifestation of this natural signal, and it can linger for weeks, months or years, and have any number of causes, from past injury to long-term illness to psychogenic pain--pain with no apparent physical cause. Regardless of how it originates, it's widely documented that people with chronic pain suffer effects that are far more than physical. The mental and emotional side effects may be even more debilitating and can include stress, depression, hopelessness, feelings of worthlessness, anger, divorce, abandonment by family and friends, and even suicidal tendencies.

Cynthia Toussaint, a former professional ballerina from Los Angeles, Calif., has lived with chronic pain for the past 30 years due to a condition known as complex regional pain syndrome. She likens the feeling of this pain to being doused with gasoline and set on fire. In addition, she suffers from a host of autoimmune issues, including chronic fatigue, fibromyalgia and more. It has left her without a voice for five years, as well as bedridden at times and dependant on a wheelchair for going long distances. And she has experienced all the stresses and emotions that chronic pain brings. She even contemplated suicide. But she chose to live and, over time, has found several effective coping strategies.

Currently, her health is better than it has been for most of the past 30 years: She is in remission and only has to use a wheelchair occasionally. She spends time sharing her lessons learned as she crusades for better treatment of women in pain through a non-profit organization she founded in 2002, For Grace. Reinventing herself and finding a deep passion for her new work have had a huge positive influence on her life and kept her going.

"I'm a very positive person now," Toussaint says, "but I was angry for so long. I lost my identity and didn't know who I was for so many years; I was the ex-ballerina, but after 10 years, I had to give that identity up." Toussaint explains that after 20 years, she also learned to befriend her pain. "It's better that we're allies," she says. "I made peace with it. It was literally the idea of 'I love Cynthia and want the best for Cynthia.'"

What Worked for Toussaint

  • Giving permission. Allowing herself to grieve the loss of her former self, and working with a therapist to process the feelings. Narrative therapy, journaling, and writing a book about her experience have been instrumental for Toussaint in reaching a more positive place.
  • Going integrative. Working with an integrative-medicine doctor in addition to her team of Western-medical physicians, and taking charge to ultimately make her own choices for care.
  • Staying active. Toussaint touts this as the absolute No. 1 most helpful thing in living with pain; even when all she could do was crawl on the floor, she did it. Now, she continues to do a hybrid of ballet and Pilates, and swims to keep moving.
  • Acupuncture and acupressure. These ancient Chinese treatments can provide pain patients with physical and mental peace and relief.
  • Practicing mindfulness meditation. "I send out thoughts of loving kindness and positive energy to all the people who hurt me and doctors who said I was crazy," Toussaint says.
  • Working with a pain psychologist. Toussaint is working with a pain psychologist at University of Southern California Medical Center, who helps her practice self-care techniques such as deep breathing and deepening her mindfulness meditation practice. Perhaps the most important tool: Helping Toussaint how to identify catastrophic thinking (which chronic pain patients are often prone to) and break the cycle with positive mental cues. They also plan to try biofeedback to help control her fight or flight response, a main driver in pain perception.

Pain psychology
Beth Darnall, Ph.D., a pain psychologist and assistant professor at Oregon Health & Science University in Portland, works with Toussaint's For Grace organization. In her practice, Darnall helps patients understand how daily habits and lifestyle choices can actually contribute to chronic pain, and how to eliminate them. She has suffered chronic pain herself, making her an effective resource for aiding others with pain. She helps patients understand the direct link between pain and stress.

"I come at it from the perspective of 'It's critical that we gain an exquisite understanding about how your life stress is functioning. What factors are increasing or contributing to stress in your life?'" Darnall explains that stress and pain work on similar channels; that they come from the same area of the brain. "Stress is a lightning rod that catalyzes the pain experience and actually has the potential to contribute to pain."

Once she assesses a patient's lifestyle habits, relationships, work environment and daily choices, she helps them figure out exactly what the stressors are and diminish the pain/stress connection. Constantly pushing yourself too hard and going to bed late, for example, can contribute to stress and exacerbate chronic pain, even if you don't realize it. "The curious thing with humans is that we're not good at noticing our own choices and connecting the dots. That's why it can be so helpful to work with a coach or pain psychologist and work as a team," she says.

Equally important, Darnall says, is instructing  people on how to strengthen the mind/body connection. "I teach people how to shift their responses--mental, emotional and physiological responses to stress and pain," she says. "Simply by learning to use their mind to their advantage, people can really take control of their pain."

Above all, the main concept to understand about managing chronic pain and the stress that comes with it is that you do have some control and you can help alleviate your suffering. Even if the pain persists, the suffering you feel because of it can be greatly diminished. "If people truly want to put in the time to make changes in their brain and their body, they can get results, but it does require work," Darnall says. "It's not a passive endeavor."