CRPS and Mental Health- Stress and Other Elements
By Roderick Borrie, Ph.D.
The last thing Penny expected was to be seeking help from a psychologist. She had always been a fiercely independent person who could take on most problems and solve them on her own. Penny was the one who took care of others, not the other way around.
An accident at work in January, 2015 changed all that. After some convalescing and physical therapy, Penny assumed that she would be able to bounce back to her old self. But that didn’t happen. At first she was merely frustrated by the tenacity of the pain in her neck and shoulder, but it evolved into fear as her pain worsened and spread into her left arm and down her left leg. Her skin often felt on fire and excruciating to touch.
After about a year of pain medications and physical therapy that had no ameliorative effect, Penny was referred to a new orthopedist who diagnosed her with Complex Regional Pain Syndrome (CRPS). At first she felt relief. Now that they know what it is, she thought, there will be an obvious treatment and I will be able to recover. But she soon learned from her doctor that there was no single treatment of choice. Instead she could choose from a array of experimental treatments that had worked for some. Penny did her own research and she discovered that CRPS is poorly understood, and that there was no clear-cut treatment regimen. She joined a support group where she met people living with CRPS who had tried many different therapies with mixed results.
Am I Crazy?
Penny had become deeply demoralized and depressed. Her personality changed. She was irritable, impatient and overwhelmed. Her family walked on eggshells around her. She had begun to doubt her sanity.
She had lost her love of life and desire to do anything. She began to feel that any time she attempted to do something normal, like clean the house or do the laundry, she paid a heavy price, so why bother?
A friend with CRPS suggested that Penny seek counseling with a psychologist who was familiar with chronic pain. She found that talking with someone who had experience helping other people in pain helped her see that she wasn’t crazy. Her pain was real. Her life had been turned upside down by it. Together they began to salvage her old self from the wreck her life had become.
Stress Can Exacerbate the Pain
An often-overlooked element of chronic pain is the enormous surge in stress that comes with it. Stress is our automatic physical response to almost any demand we encounter. Called the “Fight or Flight Response”, the stress reaction occurs naturally to large and small demands alike. The morning alarm clock, a looming deadline, a change of plans, or a family crisis all receive some of this same response. All the stressors of our daily life join forces to increase the response, revving our bodies to be at the ready to do battle or run. This would be fine if you are a caveman.
Stress becomes dangerous, because we become accustomed to our usual level of stress and tend to stop noticing the constant muscle tension and heightened anxiety. Then when we hit stress overload, we can have intense physical reactions. Headaches, panic attacks, digestive problems, aches and pains, increased susceptibility to illness, heart attacks or strokes can be triggered by stress overload.
And Pain Can Cause Stress
Life is full of stress and in our society most people function at their maximum tolerance to that stress. And then along comes Pain. Chronic pain is a particularly onus stressor for which there is no clear-cut response. In addition to this extra stress, pain makes dealing with the usual demands of the rest of life much more difficult or at times impossible. As a result stress overload is common for sufferers of chronic pain. Typical symptoms include increased anxiety and many changes usually connected with depression, like, social withdrawal, irritability, loss of interest, poor concentration, easy tears, lack of energy and sadness.
The Big Unknown
Once a person receives the diagnosis of CRPS, she/he has already been on a painful journey of medications, treatments and doctors’ visits. For many illnesses, diagnoses can add clarity to understanding what is wrong and therefore how to fix, or treat it. But this is not the case with this little-understood syndrome. For many people, CRPS is more of a “life sentence” than a diagnosis. There is no cure and no consensus on how to treat it. Some doctors even refuse to treat it. And so rather than finding it helpful, a CRPS diagnosis can add a sense of helplessness and hopelessness, critical components of depression. The endless struggle with pain can obscure your sense of who you are. It is difficult to recognize this sad, grumpy, withdrawn person as the same person you used to be.
Body and Mind Connection
While chronic pain is most definitely a physical phenomena, the way we think about, feel and understand our pain can make a huge difference. Talking with a professional can help untangle you from your current situation and become someone you recognize again. Pain is inevitable in life, but suffering is optional. Pain is a sensation, and suffering is all the things we say to ourselves about that sensation. What happens to the sensation of pain when we add, “This is killing me”, “This is never going to end”, “Why did God do this to me?” or “This has destroyed my life”. All of this can quickly amplify the pain. But pain without these kinds of judgments, or suffering, is actually more manageable. And so becoming aware of your thoughts about pain is the first step.
Working with a psychologist specializing in stress and pain management can be crucial for persons with CRPS. Learning skills that make stress manageable can help you regain a sense of control and hope. The ability to reduce stress involves developing increased physical and mental self-awareness. This can include:
- Relaxation techniques, including diaphragmatic breathing and meditation
- Learning to monitor your mental and physical capacity to pace every day activities
- Recognize the judgments about your pain and choose to not engage them
- Begin to accept that your ability to function is in flux, and that this is normal and okay
- Become comfortable with letting go of planned activities, without beating yourself up about it
Develop a New Relationship to Your Pain
Developing a new relationship with pain is a critical factor. With a new awareness of what is going on in your body and your mind you are on your way to finding a self that you can recognize again. Penny discovered that learning to manage her stress and acknowledge the thoughts that worsened her pain enabled her to be less frequently incapacitated. With sensible pacing she was able to do more and be more of her old self. Once she became more accepting of her present condition, it was easier to normalize her relationships with those around her and be an active part of her family and social circle again.