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Loneliness and Future Pain

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If you’re lonely today, if you’re missing out on social interaction, face to face contact – does that increase your risk of future physical pain?

Does loneliness cause future pain?

It’s certainly a relevant question. Actually, the connection between loneliness and pain is well known, but a recent study published in the journal Pain brings the discussion to a new level.

Taking a sample of 4906 people, the study took a look at the relationship between loneliness and pain over four years. It confirmed again that pain today may increase your risk of loneliness in the future. But also, loneliness today increases your risk of increased pain four years later.

Why? We might immediately think that a lonely person may be less likely to be active, or get exercise. Sure, that is a factor, and the study checked for that as well. Of course, if you’re inactive, there’s no doubt that your chances of future pain are increased.

But this study also tried to filter out various possible direct causes. For example, what if you take two people that are equally active, but one is lonely and one is not? It turns out that the lonely person is still significantly more likely to have more pain four years later.

What about actual depression? Yes, that’s a factor. But again, even if you’re lonely but not technically depressed, you’re still at risk for future pain.

Inflammation was also addressed in the study. Although inflammation at the beginning of the study did not increase chances of future loneliness (as pain in general does), it did, unsurprisingly, increase odds of more pain.

Social interaction is a very complex reality. There are so many factors – hearing a voice, laughter, touch, smell, empathy. Designing a study to nail down exactly what loneliness has to do with pain would be, in the end, virtually impossible.

But this and other studies to point out the importance of our social lives.

There are many reasons for loneliness. But we need to remember that it’s not just a temporary sad feeling. It can have consequences years later – consequences that may include more headaches, literally.

So don’t stop reaching out to others any way you can. You may not be a doctor, but you still may be able to alleviate pain in their lives. And remember that, even in your own life, loneliness should not be ignored.

Read the full study and discussion here: Bidirectional longitudinal associations between loneliness and pain, and the role of inflammation

Why Am I In Pain?

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We know that migraine is a biological and genetic reality. We can even see much of the migraine chain-reaction taking place in the body, through modern technology.

But that doesn’t mean we know everything about migraine, and it doesn’t mean that we can explain simply what exactly is causing the pain. In fact, pain is incredibly complex.

TED-ed video on PAIN

For example, we also know that the way we think about pain influences how much pain we feel, and how persistent it is (see, for example, Pain Catastrophizing and Your Headache).

Recently TED-ed posted a little introduction to some of the complexities of pain. Take the time to watch it below. It’s critical that we start thinking about these things, so that we don’t over-simplify either our condition or our treatment.

The video is just 5 minutes long.

How To Really Rate Your Pain

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“How bad is the pain, from 0 to 10?”

What does that question even mean? And if you’re not sure, how can you know it means the same thing to your doctor? Or your family?

Pain scalesSometimes this isn’t a big deal. When I was in the emergency room with a migraine attack, I was asked the question over and over. The doctor was most interested in the change, in the possible improvement. So if a “7” to me meant the same as an “8” to him, it didn’t matter too much, as long as I was relatively consistent. Then again, that’s not easy either, when you’re stupid with agonizing pain.

There are whole studies out there that try to find the best way to measure pain – which is incredibly hard with something so objective.

In fact, the type of pain, and other symptoms, can make a huge difference. For example, if I said,”I’m in so much pain, I can’t move”, what does that mean? If I had a severe laceration, I might still drive myself to the hospital. If I had comparable pain all over my body, I might be writhing in pain. With cluster headache, I might be pacing. If it was pain + nausea, even moderate pain could be incapacitating.

Ok, so here are some quick tips. Don’t make it too complicated, but do try to be as accurate and consistent as you can. Thinking about this before you’re in severe pain could be a big help.

  1. Pick a pain scale and stick with it. I’ll link to some ideas below. There are pain scales for certain diseases. There are also pain scales that work better with children. Or, you can have a child draw their pain. Whatever you choose, understanding it and sticking with it will help you measure changes in your condition over time.
  2. Make sure you and your doctor speak the same language. I don’t mean English or Spanish, but make sure you both understand what’s expected from the pain scale. In a recent article, Beth Skwarecki discovered that a simple question or two can clarify a whole lot. In my case, I have always thought of a ten as a theoretical maximum before passing out. But that’s not what many doctors think. This could be hard in the emergency room, but for a doctor you regularly see, it’s worth getting on the same page.
  3. Become increasingly aware of other symptoms. And with migraine, there can be a wide variety. As in the nausea example above, nausea can totally incapacitate you – as can dizziness, muscle weakness, and so on. The disability of many migraine attacks is not just from the pain. We often are not aware of other symptoms because we focus on the pain. If your symptoms are fairly consistent, you can even explain the “type” of headache you have (I used to use 6 classifications of my own, based on symptoms I experienced).
    If you’re aware of those three things, you’ll be way ahead of most people when it comes to explaining your pain.

    Now, Beth’s article above leads to some great links, but this is one you really should take a few minutes to read: 15 Pain Scales (And How To Find The Best Pain Scale For You)

    These can give you some very useful ideas. Don’t miss #2 (common) #11 and #14. Similar to #11 is the Stanford PainScale, which would be a great thing to print out or put on your phone and show your doctor (that might even work in emergency – keep it with any papers you might bring along).

    Now you’re armed and ready to really explain your pain – hopefully that will lead to better treatment ASAP!

Yes, Migraine Pain may be Worse than the Pain of Childbirth (and more migraine statistics)

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Earlier this year, Eli Lilly and Company announced the results of a survey on the impact of migraine – appropriately called the Migraine Impact Report. The poll was conducted by The Nielsen Company, a well known data-gathering company in the USA.

So, let’s look at some of the data that they collected. Perhaps one of the most interesting is pain comparison.

So – you’ve experienced childbirth? Broken bones? Kidney stones? How did that compare to your migraine pain?

Now, a typical migraine attack was rated as 7.1 (out of 10) for pain. But what about your worst migraine attack?Pain Comparison ChartRemember, these are just averages from people who have experienced both migraine and the other type of pain.

The impact of the pain and of course other symptoms was the key part of this survey. Over the past month, migraine patients said that there had been almost a week when they couldn’t do what they wanted. That’s 84 days a year, or 2.5 to 3 months of the year!

Take a moment to think about the important events you’ve attended over the past year. Going to the kids’ play. A birthday party. A wedding. Now, cross out 7 or 8 of those events. That’s how many events the migraine patients said they had missed due to migraine attacks.

Now, of course migraine affects you at work. You’re concerned that you might miss that promotion, or simply not be as productive.

Now here’s an irony. 58% said “I worry that my coworkers think I’m faking or exaggerating when I have a migraine”. So, are there thousands of people out there exaggerating their pain at work? Well, 62% said,“I try to hide the true impact of my migraines from people at work or school”.

Hmmmmmm.

So actually, as other answers on the survey indicated, people without migraine actually underestimate how bad migraine is – and it’s partly because we (migraine patients) are generally trying not to make a big deal of it.

So no wonder most people with migraine said that their attacks make them feel “frustrated”. Interestingly, only a little over half said that the attacks usually made them feel “depressed”. (Depression is common in migraine, but not universal by any means.)

People who were not connected with people with migraine generally understood less about the disease – not a surprise. In fact, most were not aware that migraine is a neurological disease.

There is a lot more information in the survey – I encourage you to take a look. For a quick summery, there’s an infographic. Just click the image below:

Migraine Impact InfographicIf you want to go more in-depth, read Survey Reveals Many People with Migraine Live with Pain Nearly Half of Every Month, and then click on the blue Migraine Impact Report on the right side of the page.

Pain Catastrophizing and Your Headache

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Some people have strange ideas about – well, people. Human beings.

Some people seem to think that we’re just MINDS. And since we’re just MINDS, if we think we have no pain, we have no pain.

Other people believe that we are merely SOULS. Perhaps, then, the pain is not even real.

And other people think we’re just BODIES walking around. If we have pain, we have pain. It’s just the way our BODIES work. Period.

But many people realize that we’re complex beings. It’s just not as simple as “just deal with it”. It’s not going to work to “just take a pill”.

And that brings us to one of the current “cool” terms in pain treatment, pain catastrophizing. (Say it out loud once or twice. It’s fun.)

Thinking about painPain catastrophizing has been defined in various ways, but here’s the basic idea. Everyone seems to think differently about pain (and think differently at different times, in response to different types of pain, and so on). Some thoughts may be positive (“It will be over in a few hours”) and some thoughts may be negative (“There’s nothing I can do to make things better”).

If those thoughts are on a basically negative path, it can make things even worse than the pain would by itself. That’s pain catastrophizing.

I’ve often said that how you think about pain is directly related to disability. In other words, if I’m constantly thinking about my pain, I am more disabled. I may have more pain another day, but if I find a way to think about it less, it affects how disabled I am.

This may not mean that thoughts affect the pain – actually making it more or less. But it does affect – as I said – disability. It affects behaviour. It may change even the treatments I choose, or how productive I am, to some extent.

Because thoughts are so personal, and pain is so personal, this is a very slippery topic. Many researchers believe pain catastrophizing exists (let’s call it PC from now on in this article), but here are some of the big questions that we have.

  1. What causes PC? Is it simply caused by too much pain too often? Or is it more a matter of culture, or point of view, or behaviour?
  2. Can PC actually directly make symptoms worse? How?
  3. Can PC actually be treated directly?
  4. Do different types of pain change how PC works?

Various methods have been used to measure PC, or related things like your anxiety regarding your pain, or fear avoidance. For example, PC is measured using rumination, magnification and helplessness. Rumination is a focus on your symptoms, causes, and consequences (for example, continually thinking about the pain). Magnification is an exaggeration of your symptoms or circumstances (“what if I’m dying?”). Helplessness is – well, you can guess! Things like saying “there’s nothing I can do about these symptoms!”

But trying to measure responses to pain are difficult when someone else can’t really measure your pain. And how accurately do we even understand our thoughts over the past 24 hours?

Treating Pain Catastrophizing?

That’s the question, isn’t it? Can it be treated?

Some researchers thought, if it’s all about positive attitude, could an anti-depressant pill treat it? Results have been less than positive on that front.

No silver bullet has been found to “treat” PC. As Dr. Steven Z. George (associate professor of physical therapy at the University of Florida in Gainesville) put it,

Other studies have shown SSRIs [common antidepressants] not to be very effective or to be less effective. For now, the mainstay of treatment is cognitive-behavioral therapy (CBT). This may include learning better coping skills, and practicing acceptance and mindfulness. But we still have to treat the pain. It is a bit of the chicken and the egg. Which comes first? If we reduce that pain, catastrophizing gets better. If we reduce the catastrophizing, pain gets better. [source]

In other words, it’s just what we’ve been saying all along. You have to treat the whole, complex, human being. Positive thinking doesn’t generally make pain vanish (and would we want that? If you convince yourself you have no pain, you put yourself in serious danger of not listening to your body’s warning signals). But your thoughts do work together with your behaviour to make your treatment work.

It’s also tempting to rely on the power of placebo. “Who cares if xyz isn’t a treatment with any scientific evidence whatsoever? If you think it works for you, it does.” But – wouldn’t it be all the better if you “thought” that a treatment with good evidence behind it worked?

In the end, both doctors and patients need to be aware of PC. We need to stop ignoring the fact that our thoughts do make a big difference in our level of disability. No, that’s not the answer to all our problems. But it is a part of the complex picture.

If you’d like to learn more, check out these articles:

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The articles on Headache and Migraine News are © 2004-2024 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.