Dr Jasmine Hearn Q&A: Pain management
3 December 2018
Dr Jasmine Hearn is a chartered psychologist and lecturer, specialising in pain management for people with a spinal cord injury. She shares her views and experience with us.
What percentage of people with a spinal cord injury experience neuropathic pain and what do we know about it?
Studies vary on an exact number, but around 50% of people with a spinal cord injury experience neuropathic pain.
People describe this pain as sharp and sudden, like a burning or electric sensation, or even like pins and needles. As part of a series of interviews I organised during my PhD research, one person described it as feeling like sitting in a pit of fire, while another said it felt like someone was pouring a kettle of boiling water over their legs.
Neuropathic pain is caused by damage to the spinal cord. The brain sends messages down to the legs and feet, but it doesn’t receive an appropriate response as the pathways are damaged. Some messages might be able to get through, but the brain interprets these as pain. That’s not to say that the pain experienced isn’t real. It’s absolutely real. It’s just that the brain is misinterpreting the signals.
What different factors affect people’s perception of pain?
Quality of life, mental health, social support, physical activity, and where our attention is focused (such as when we are engrossed in a book or watching TV) – these can all influence someone’s perception of pain.
Being able to continue with your life and engage in meaningful activities is very important. If you couldn’t return to work, for example, you might have less opportunities to socialise and feel like you lack a sense of purpose. These factors can all influence your experience of pain. That’s why it’s really important to find fulfilling activities that you can focus your attention on.
Generally, the people who have a good support network, an active life, and a positive outlook, are more likely to accept the existence of pain and find ways to manage it.
Of course, we can’t say for certain that having a positive outlook means you won’t experience severe pain, or that a less positive outlook means you will have higher levels of discomfort.
Everyone’s experience is unique and that’s what makes it a challenge to research. Pain is very complex and we’re only starting to better understand how it affects people.
What different treatments and methods can people use to manage their pain?
Medication often seems to be the first line of treatment. That works for some people, but these treatments can come with unpleasant side effects like drowsiness or nausea. Research shows that acceptance of living with pain can make a big difference. People are often looking for complete pain relief, but by seeing that pain is a part of daily life – not something that can be erased – they often become more resilient.
Using a cognitive behavioural therapy (CBT) approach to improve your mood and change your responses to pain can help to alleviate some of the effects.
Mindfulness can be used for pain management too. In a study I conducted, over 20 participants with a spinal cord injury listened to two ten-minute meditations six days a week over a two-month period. The meditations didn’t focus primarily on pain, but on enhancing awareness of the present moment. The majority of participants felt that the pain was still intense afterwards, but that the effects were less unpleasant. They also felt better able to manage their pain in the long term.
There’s no one-size-fits-all solution though and you just have to try different approaches to see what works for you. One way to discover what works for you is to record the factors that reduce and exacerbate your pain. Over time, you can review what you’ve recorded and start to make changes to accommodate your pain.
How can people manage their expectations about living with pain in the long term?
It’s important to recognise that there are going to be good and bad days. Pain is likely to be a part of daily life too. Going through that trial and error process to identify what helps manage your pain is really useful. It’s important to go through this process with your primary consultant so they can better understand how pain affects you. And the more you can do to manage your pain, the easier it will be to accept long term.
How can people with a spinal cord injury explain pain to their friends, families and healthcare professionals?
As someone who doesn’t have a spinal cord injury, many people have a tricky time explaining their pain to me. But using physical descriptors, like burning or electric sensations, for example, can provoke empathy and understanding in the listener. People have told me that their pain feels like lightning bolts, intense pins and needles, and like constant toothache. I can relate those descriptions to my own experiences and imagine what their pain might feel like. We don’t know what effect these descriptors might be having on the intensity of pain, but it certainly does help to use these lucid descriptions to give people a real insight into what their pain feels like.
An important process in managing pain is helping others, such as your friends, family and GP, to understand what you’re experiencing so that they can better support you. This, in turn, can help improve your ability to cope with pain.
If you’d like to speak to someone about your experiences of pain, please contact our outreach and support team by email or call them on 020 8875 1805.