Living With Chronic Pain

Optimism And Hope Can Help Chronic Pain

I wake up every morning wondering what the day will bring. Will I have more or less pain? Will it be harder to get through? Accomplish everything that’s needed? Sometimes these questions keep me up at night. Never knowing, but always hoping it will be easier than yesterday gets me through to another one.

As the song goes-

“When I’m stuck in a day that’s gray, and lonely,

I just stick out my chin and grin, and say, Oh

The sun’ll come out tomorrow so ya gotta hang on

‘Til tomorrow come what may


I love ya tomorrow!

You’re always a day away!”

We all understand what it means to have a sense of hope and optimism when we experience them but neither feeling is concrete or easily measured. There’s no pill to increase it. No test to define it. But if you or someone you care about suffers from chronic pain, or a debilitating disease, understanding and tapping into these powerful emotions can be a game changer.

This idea isn’t necessarily new. In fact, the ancient Greek physician Hippocrates wrote, “The natural healing force within each of us is the greatest force for getting well.”

Optimism and hope are interrelated, they both generate feelings that good things will happen and help us to focus on achieving specific goals. Unlike wishful thinking that is just a passive fantasy something will happen, hope and optimism actually show up and put in the work necessary to make that something happen. Denial on the other hand allows us to ignore reality entirely, making us feel we can’t change anything, so why try?

Today, science is detailing the powerful influence hope and optimism can have on health- our immune systems, wound healing, how we experience pain and even longevity. In his book, “The Anatomy of Hope,” Dr. Jerome Groopman, Harvard Medical School Professor and Chairman of the Department of Medicine, gives remarkable accounts of hope coming from people coping with what are traditionally considered hopeless illnesses and chronic pain.

Dr. Groopman’s research showed that when people are ill, two emotional states in particular, are associated with hope—belief, and expectation. Both of these impact the human nervous system, setting off a chain reaction which increases the likelihood of improvement and recovery. It is believed that positive emotions such as hope and optimism can alter neurochemistry and inhibit pain by releasing the brain’s natural painkillers, called endorphins, which mimic the effects of morphine. (Boy, this little bugger gets around!)

Dr. Groopman developed his thesis that hope can be the basis of healing not only from years as an oncologist, caring for those with a terminal illness, but from his own story of suffering. After a failed back surgery and 19 years of excruciating chronic back pain, he had all but given up on his own medical establishment. Nothing seemed to help his pain. He was ultimately persuaded to see the same doctor who had helped Boston Celtics’ Larry Bird with his chronic back pain.

After a detailed examination, Groopman’s physician told him that it was his fear of pain that was causing him the most pain and that his muscles and tendons were contracted due to lack of use. His physician advised him to “ignore the pain, and as your mind re-orients its beliefs, the pain will lessen.” And it did. As a medical provider and sufferer of chronic pain I see this everyday. No one is denying the pain exists, just the need to move forward as much as possible and learn ways to live with it. As a medical provider and sufferer of chronic pain, I see and experience this everyday. Lack of movement increases pain! But helping patients see this truth, take the leap of faith, believe there’s a better path is a huge challenge.

Optimism may be key to coping with chronic pain, claims a new study of soldiers who served in Iraq and Afghanistan. Among nearly 21,000 veterans, those with a positive outlook before they were sent abroad reported fewer bouts with pain after deployment, including new back pain, joint pain and frequent headaches. “What was striking was that optimism was associated with less pain even when taking into consideration what the soldiers experienced during deployment, such as combat stress and trauma, as well as injury,” said lead researcher Afton Hassett

Obviously the experience of a U.S. Army soldier is incredibly different than that of a civilian, but there is a large body of literature that suggests optimism is protective for everyone who suffers from pain. According to a paper published last month in JAMA, optimistic people have lower levels of pain sensitivity and generally adjust better when they do have pain. The research team also found that even moderate levels of optimism were protective for the development of pain after deployment, which suggests that you don’t need to be a hopeless optimist to still benefit.

Optimism is generally considered a trait, but since it’s estimated that about 25% of our ability to see things optimistically is inherited, optimism can be learned and modified. Many studies have shown that several interventions can result in higher levels of optimism. These include imagining and writing about our best possible self or anticipating positive outcomes, not negative ones. Promoting expressions of gratitude and teaching meditation and mindfulness practices can promote more optimistic thinking. In addition, more structured interventions like cognitive behavior therapy that more directly challenges catastrophic thinking, can impact optimistic thinking.

Wallowing in my pain and circumstances never helps. There’s no question I feel worse when I’m less hopeful and optimistic. The thought of endless days of suffering with no relief in sight is frightening and overwhelming. It effects every aspect of my being, from how I experience pain daily to how I interact with friends, colleagues, staff, or patients. Injecting optimism and hope, even when I don’t believe it at the time, can slowly get me to a better place. The old adage- fake it till you make it- works. And with that attitude adjustment comes empowering changes. As I’ve said in other posts, hope and optimism aren’t a pill, it doesn’t cost anything, and there are no side effects. So why not add it to your daily regimen today, what can it hurt?

dsc_0323    –Dr. Courtney


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