Reduce Use of Pain Medication with Cognitive Strategies

Reduce Use of Pain Medication with Cognitive Strategies

Traditional treatments for pain relief have not changed much in the past 100 years, and we continue to use anti-inflammatories, sedatives, muscle relaxants and opiates. When taken properly, these medicines can be lifesavers. However, the increasing use of powerful opioid pain medications (hydrocodone, oxycodone and Fentanyl are some of the most common), particularly in older adults, is concerning as they decrease cognitive abilities and raise the risk for traumatic fall.

Opioid prescriptions in the United States have increased by more than 600 percent in the last 20 years, and the current use in older adults is estimated to be at 25–50 percent for those living at home and as high as 70 percent for those living in long-term care facilities. 

In recent years, pain specialists have began to offer alternative treatment options for pain, including hot and cold therapy, topical rubs, physical therapy, epidural injections and TENS (Transcutaneous Electrical Nerve Stimulation) units that many people find helpful.

Chronic pain has been defined as an unpleasant physical sensation lasting more than three months that reduces daily functioning and well-being, including mental and social health. Approximately 116 million older adults in the U.S. live with chronic pain. Being in pain every day decreases our ability to deal with life’s other stressors and can lead to a feeling of being chronically overwhelmed. The successful treatment of chronic pain requires treatment on multiple levels. The goal is to keep chronic pain from becoming the entire focus of your life.

The good news is that the brain can learn how to manage the sensation of pain. Many people living with chronic pain are starting to add mental strategies, such as biofeedback, relaxation, guided imagery, deep breathing and cognitive behavior therapy to feel less dependent on pain medications and more able to control pain.

The first step in coping with chronic pain is to receive a thorough medical evaluation to determine the cause of the pain. Pain can serve as a warning signal from our brain of impending damage and injury. Once it is determined why the pain is happening, these two cognitive behavioral therapy strategies can help you to start to reduce pain as early as today: cognitive re-framing and mental distraction.

Cognitive Re-framing

Cognitive strategies are based on the belief that our thoughts and behavior shape our reality. In the case of chronic pain, the way we think about our pain, the way we “make sense” of the experience of pain determines how much the pain affects us.

Changing well-worn ways of thinking and acting takes practice and effort but can pay off in a big way. First, you need to become aware of the messages you habitually give yourself, the dialogue you have with yourself in response to any situation. This tends to be so automatic and routine that we may not even be aware of our self-talk. Spend a day asking yourself, “What am I feeling right now?” Define the exact emotion. And then, ask yourself, “What am I thinking right now that is making me feel angry, frustrated, sad, ashamed or joyful?” You will be amazed at what happens in the quick gap between a thought and an emotion. Common themes related to chronic pain include, “I feel so overwhelmed and hopeless. This is never going to end, I can’t do anything, so I might as well just stay here in bed.”

Next, ask yourself, “What is my evidence that this is true? Am I considering all of the possibilities? Is it really true that I can’t do anything?” When thinking becomes negative and all-or-nothing, try to offer yourself a positive and balanced coping thought, such as, “Today might start off not so great, but if I can get in a hot shower and stretch a bit, I always manage to have a better day.” See the difference in behavior that happens when we think differently?

The Power of Distraction

Research has shown a significant relationship between focusing on the pain (how bad it hurts) and poor sleep, more anxiety and, in turn, a worsening of pain. When we focus on pain, we have a tendency to catastrophize and only focus on the hurt with thoughts like, “This is so bad, I can’t stand it, this will never go away.” By changing our focus away from painful bodily sensations to something engaging or pleasant, we can reduce the sensation of pain.

Instead, try to focus on parts of your body that aren’t in pain and other senses, like taste and smell. Listen intently to your favorite music, talk to a friend who cheers you up, watch birds gather at a bird feeder or spend time with a pet. Make sure you talk about other topics with friends and family, not just your physical health.

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