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1 Recognise your emotions. Your mind and body are one. Many people are afraid that their pain is only in their bodies. Others fear that it is only in their heads. Both are half right. As pointed out throughout this book, pain affects both the mind and the body. It is impossible to separate your physical sensations from your emotional ones.

Recognise that certain cycles occur during emotional highs and lows. When you are happy you laugh, and your entire body experiences this happiness. When you are sad your body feels weighed down and heavy. The emotional self directly affects your physical wellbeing.

Anxiety causes you to tense up all over. Every muscle in your body will contract, and sore muscles will ache even more. What you experience in your everyday life has a bearing on your degree of pain.

You must begin now to recognise your emotions, understand them and start to deal with them. With the help of the pain clinic and your support group you will be able to attempt to deal with issues you have been afraid to tackle before.

2. Relaxation. You can learn to control to some degree how your body feels. By practising the relaxation techniques outlined in this book or in the ACPA manual, you can tell your body how you want it to feel. Learning relaxation takes practice. When you have mastered it, relaxation will help you to live your pain.

3. Exercise. People with chronic pain often allow themselves to become physically unfit by avoiding actions or exercises that may have temporarily increased their pain.

It is to your benefit to begin to retain control over your body. After following a regular programme of mild stretching exercises (which your doctor must approve) such as the ones outlined in this book, you will notice that your pain level may have decreased. Good muscle tone will decrease the amount of pain you experience.

4. A new outlook. If you review all of the previous concepts you will see exactly how your life can improve. You can understand that it is possible to be in charge of your life again.

5. Outreach. Some estimates put the incidence of chronic pain at one in three people. Many manage to function despite their pain. Many others slowly, or sometimes rapidly, withdraw into a world of their own. This is a world with which the person with chronic pain is familiar. The idea of ACPA is to assist you to share what you are able to learn with others. Learning to live with pain is an ongoing experience, and as you help others you will be reinforcing yourself.

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Many of those with chronic pain suffer from insomnia both as a consequence of their night discomfort and the associated depression that accompanies their pain. The proper use of the anti-depressant drugs as stressed throughout this book, may greatly help to restore normal patterns of sleep to the person experiencing chronic pain.

Where minor tranquillisers such as Xanax, Tranxene, Ativan and even Rivotril have been used for any length of time caution must be taken that they are reduced gradually. Sudden withdrawal of these medications may lead to prolonged periods of sleeplessness, nightmares and increased feelings of anxiety.

For chronic pain sufferers it is even more important than for persons free of pain to ensure that mattresses and pillows are comfortably firm. If neck pain is present, sculptured pillows are available to aid normal sleep.

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Imagery is playing a greater role in the treatment of disease in areas as diverse as chronic pain, cancer and dermatology. Many of the following are taken from the excellent texts on the subject of hypnosis and imagery, some of which are listed in the reading list at the end of this book.

Imagery techniques

A typical imagery technique is as follows: ‘Imagine you are in a sleeping bag. It’s very warm. Very humid. Now it’s getting light. You sit up. All around you is dense tropical foliage. Giant tree ferns and lilies. You are in a rainforest. ‘In the distance, you hear small animals chattering. Birds are calling. As you look through the canopy of leaves, you see the blue sky with wisps of fleecy white clouds. The light is filtering through the leaves forming pools of light on the forest floor. It’s time to get up and start packing. Now you’re making your way through the steamy forest. After a while, you come to a clearing with a hot mineral spring bubbling out of the rocks which surround it. There’s a large pool of sulphur-smelling water large enough to bathe in.

‘You take off your clothes and glide into the inviting water. The warmth of the water and the sulphurous smell combine to have an instant effect on your body. You feel all the pain and discomfort draining away. Gently draining into the bubbling water as your muscles loosen and let go of any tension. The bubbles of gas escaping from the bottom of the pool have an effect similar to a whirlpool. Your muscles continue to loosen and relax.

‘Now you notice a curious thing. The pool is getting larger. It’s growing to the size of a basketball court. Now it’s as big as a small lake. You look up. The trees now seem to stretch miles up into the sky. You realise that the pool hasn’t been getting larger. You have been getting smaller. You are shrinking. Getting smaller and smaller. As you shrink in size, the area of your pain is also shrinking. It’s becoming smaller and smaller. A large orange and black butterfly alights on the water beside you. You climb on to his back. He soars high into the blue sky. The dipping and soaring is like being on a gentle roller coaster ride. It’s an exhilarating ride.

‘You continue shrinking until there’s no pain at all. When you return to your normal state of alertness, all sensations and feelings will return to normal.

But you will be free of all pain and discomfort. And you will be able to return to the sanctuary of this jungle pool whenever you wish.’

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Symptoms Most people are aware of the pain spasm and tenderness due to trigger points, either locally or at a site far removed from the actual point.

But a trigger point is often overlooked as the cause of such symptoms as dizziness and buzzing in the ears and visual problems.

Diagnosis The simplest way is by pressure over the site to find the area of tenderness, and often, the area of referred pain. When more accurate measurements are needed, an algo-meter is used. This mechanical pressure device measures the skin’s response to the electrical resistance. Such instruments are often used for the confirmation of a diagnosis in medico-legal cases.

Treatment The trigger point is treated by stimulation. This can involve injecting salt water (normal saline) to reduce discomfort. The same effect can be obtained by using a local anaesthetic such as procaine. This is used most commonly in pain clinics, the advantage being that procaine has specific pain-relieving effects due to its local anaesthetic effects. Also effective is electrical stimulation with acupuncture needles or by superficial electrodes as in TENS.

Another form of treatment that may be useful for home use is the cold spray developed by Dr Janet Travell. A cold pressure pack of gas is used to spray the muscle where the trigger points are. The muscle is then stretched as the muscle spasm is reduced.

Prevention Where possible, efforts should be made to prevent the build-up of further trigger points by:

• Muscle relaxation during the day.

• Good sleep patterns and posture.

• Using mild antidepressants as a sedative pain-killer at night to help prevent muscles being ‘knotted up’.

Availability This ‘spray and stretch’ treatment is available from certain medical practitioners and would possibly be charged as a consultation.

Physiotherapists are using spray and stretch techniques because this therapy can be easily taught to patients. Trigger point injections are also available through some medical practitioners who would charge an applicable fee for the time spent with the patient.

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