You may hear some people say that “pain is all in your head,” but health care and mental health providers would agree that this is an obsolete philosophy.
Just because you can’t see pain, doesn’t mean you can’t treat it.
Psychologist Kate Hennesy-Keimig is here to talk with us about ways to manage and treat pain with lifestyle changes.
Selected Podcast
Managing Chronic Pain
Featured Speaker:
Learn more about Kate Hennessy-Keimig
Kate Hennessy-Keimig, PsyD, LP
Kate Hennessy-Keimig is a doctor of psychology at Allina Health Mental Health – United Clinic.Learn more about Kate Hennessy-Keimig
Transcription:
Managing Chronic Pain
Melanie Cole (Host): You may hear some people say that pain is all in your head but healthcare and mental health care providers would agree that this is an obsolete philosophy and just because you can’t see pain doesn’t mean that you can’t treat it. My guest today is Dr. Kate Hennessy-Keimig. She is a psychologist at Allina Mental Health United Outpatient Clinic. Welcome to the show, Dr. Hennessy-Keimig. Tell us a little about chronic pain. How does it differ from acute pain and why do some people having trouble believing people are in pain?
Dr. Kate Hennessy-Keimig (Guest): The differences between chronic pain and acute pain sometimes can be kind of subtle. The common feeling in the pain community is that chronic pain occurs when something happens in the nervous system that causes those pain pathways that transmit pain sensations to become oversensitized. So, patients might be experiencing a pain response to a stimuli that we might not normally see as painful. It differs from acute pain in that when we hurt ourselves, typically, with acute pain it’s kind of mechanical. We smash our thumb with a hammer and it hurts where we hit it, maybe it goes on and it hurts for a while, but it’s time limited. It gets better. With chronic pain, it’s pain that goes on and on in duration beyond the expected healing period. It might not be localized. While originally, there might have been an injury to a specific place, that might not be the place that keeps hurting. It may not be the kind of thing where like, if you break your leg, you shouldn’t move it for a while but with chronic pain, a lot of times, if the provider has diagnosed chronic pain, they’ll say the best thing that you can do is keep moving so that people don’t have that downward spiral of being inactive and isolated and deconditioned. One of the reasons why it’s really hard for my patients with chronic pain is, a lot of times it is invisible. Other people around them, their family members, their associates, and even sometimes their caregivers can’t really see what’s happening and so that makes it really hard. Sometimes, you can’t discover exactly why it’s happening.
Melanie: That’s my next question. What are some of the causes of chronic pain and as an exercise physiologist, doctor, I have people with back problems and they have chronic pain from various places and we don’t always know what it’s from. How do you even determine where it comes from?
Dr. Hennessy-Keimig: A lot of times that can be really difficult because, while it can be triggered by an injury, or it can be triggered by a medical procedure; it can be because of a degenerative process--like I would imagine lot of people you see; it can be caused by side effects from medication. We have people that have ongoing chemo pain. Or, it can be neuropathic pain like people with diabetes. We really may not know what sets it off in some conditions. I know I have patients that are very frustrated because they keep going to specialist after specialist and nobody can say, “This is really the cause” and yet we know that their pain is real pain and they are truly suffering from it. Sometimes it seems like it moves around and that gets really frustrating for them as well sometimes for their providers.
Melanie: Is there a way to measure someone’s level of pain besides asking them, “Is your pain a 9 or a 10”? Is there actually anything to monitor that pain level?
Dr. Hennessy-Keimig: It gets tricky because pain is perceptive. My 8 might be somebody else’s 4. There is actually a pain scale that the chronic pain providers tend to like. It takes that one to ten scale but it puts some little qualifiers on it. Like, if pain is from 1-3. Well, it’s there but it doesn’t really bother me. If it’s a 4-5, it bothers me but I can handle it. If it is a 6 or 7, it’s really intrusive and it’s interfering with my life. If it’s higher than a 7, I can’t think about anything else. By being able to put some of those qualifiers on it, it makes it a little bit easier for the patient as well as the provider to understand it. What we find is, with a lot of people who come to us for treatment of chronic pain, they’re consistently 6 or above. It’s really intrusive and they can’t think about anything else. Our hope is by treating the chronic pain or by helping people learning to manage it, rather, that we can get them down to below that 6. It can bother them, it’s there, it’s not going away, but they can still handle it.
Melanie: Are there certain factors that make a person more susceptible? As you said, it’s really subjective and if certain people feel more pain than others, some women can have a baby without any kind of an epidural and some women absolutely ask for it at the first little sign of labor. Is there any factor that makes a person more susceptible than another?
Dr. Hennessy-Keimig: I don’t know that there is one particular factor, but, as you said, it is an experience that is both sensory and emotional and we all have different pain tolerances for various reasons. People’s emotional relationship with pain can certainly have an impact on the way they experience pain. Then, there’s also all of the lifestyle things. I talk with my patients a lot about having an energy budget. Just like we have our checking account and if you have chronic pain, it’s like having a daily automatic withdrawal from your energy budget. We all know what happens if we overdraw our accounts, we get in trouble. In addition to that automatic withdrawal, there are things that people can do or they have habits of mind that either take from or add to what we bring to the table to deal with our pain. Things like fatigue and stress and changes in the weather and people’s level of self-care and their coping skills and their support level and their relational stressors. All of those kinds of things can absolutely contribute to how well people are managing pain. That is really a lot of what I deal with as a psychologist with people with pain. Not so much trying to reduce the pain itself because that may not be possible at least by me, but by attending to all of those other factors, we can reduce the suffering that they are experiencing.
Melanie: We have been seeing pain places -- and really this is a burgeoning field in pain management--cropping up all over the country. Tell us about some of the therapy approaches that have been effective in treating chronic pain. What do you do for people that are in chronic pain?
Dr. Hennessy-Keimig: My approach, obviously, is a psychological approach. Generally, my goal is to help people improve their functioning and be able to manage their pain better. A lot of times, the way we do that is by helping people become more psychologically flexible by helping them learn some coping skills that might help them accept that fact that this is chronic. It’s not going to be fixed. It’s not going to go away. By helping them to learn to pace their life better. By not doing this all or nothing thing that a lot of people – all of us with or without chronic pain tend to do. A lot of times, patients will do the feast or famine thing. If they are having a good day they will just kill themselves with activity and then they will pay for it for days. Trying to help them either learn that skill or if there is something underlying to them having trouble practicing that skill. Like, maybe they haven’t accepted the fact that their pain is chronic or by working on understanding that they have to grieve and deal with some of the emotions that go with it. A lot of my personal experience, my personal approach is based on mindfulness which really helps people develop the ability to take a little bit of a step back from their experience and not be so locked in and just responding and reacting to every stimuli as it rises and falls. Otherwise, they can become very psychologically rigid which makes it even more difficult to deal with pain. Mindfulness helps people direct their attention to chosen sensory or cognitive types of events like the breath or something that they are doing so they can lean into the pain and lean away and refocus their attention away from either the experience itself or their emotions about the experience.
Melanie: Traditional approaches and alternative, or integrative, as you say mindfulness. This is huge today, people are using mindful medicine for so many different things. How does this help for them if they are more mindful of the pain? Do you want them to take charge of it and feel this pain and acknowledge it or do you want them to try and forget that it’s there?
Dr. Hennessy-Keimig: Actually, it’s not really either one of those things. What I tell people about mindfulness is it gives you an option in between either pushing something away or falling off the deep end into it in that you can selectively direct your attention towards – say, for example, your breath. You’re following your breath and then you notice that you are distracted and you go back to the breath. Over time, this gives you the ability to take a step towards something. Take a step away from something. With pain, what this helps people to do is to realize that it’s not the central focus of action; that they can disengage from maybe the idea that they are going to be able to fix the pain and learn to kind of live in the presence of it. They can move toward it. They can move away from it. It gives them more of a sense of control.
Melanie: That’s absolutely fascinating. In just the last minutes, please, doctor, tell us a little bit more about your chronic pain management group.
Dr. Hennessy-Keimig: The group is a six week group. It focuses exactly on the things that we have been talking about. It is totally mindfulness based. I teach the mindfulness skills to the patient. We do a practice every week. I ask them to practice at home. It also gives them an opportunity to share how things are going in their life. We talk about things like pacing and staying in the present moment and self-care and support and self-management, acceptance, grief and loss – all of those things that people are dealing with; as well as just lifestyle things that might help manage pain better. People who have attended the group have indicated that has been really helpful to them as well as the fact that they have group support. They’re in a room with other people who actually really do get it. A lot of times, being in chronic pain is very isolating for people so having that opportunity to just share with other people who are going through similar experiences is very powerful.
Melanie: It’s such great information. Thank you so much, Dr. Kate Hennessy-Keimig, a psychologist at Allina Mental Health United Outpatient Clinic. You’re listening to The WELLcast with Allina Health and for more information you can go to AllinaHealth.org. That’s AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.
Managing Chronic Pain
Melanie Cole (Host): You may hear some people say that pain is all in your head but healthcare and mental health care providers would agree that this is an obsolete philosophy and just because you can’t see pain doesn’t mean that you can’t treat it. My guest today is Dr. Kate Hennessy-Keimig. She is a psychologist at Allina Mental Health United Outpatient Clinic. Welcome to the show, Dr. Hennessy-Keimig. Tell us a little about chronic pain. How does it differ from acute pain and why do some people having trouble believing people are in pain?
Dr. Kate Hennessy-Keimig (Guest): The differences between chronic pain and acute pain sometimes can be kind of subtle. The common feeling in the pain community is that chronic pain occurs when something happens in the nervous system that causes those pain pathways that transmit pain sensations to become oversensitized. So, patients might be experiencing a pain response to a stimuli that we might not normally see as painful. It differs from acute pain in that when we hurt ourselves, typically, with acute pain it’s kind of mechanical. We smash our thumb with a hammer and it hurts where we hit it, maybe it goes on and it hurts for a while, but it’s time limited. It gets better. With chronic pain, it’s pain that goes on and on in duration beyond the expected healing period. It might not be localized. While originally, there might have been an injury to a specific place, that might not be the place that keeps hurting. It may not be the kind of thing where like, if you break your leg, you shouldn’t move it for a while but with chronic pain, a lot of times, if the provider has diagnosed chronic pain, they’ll say the best thing that you can do is keep moving so that people don’t have that downward spiral of being inactive and isolated and deconditioned. One of the reasons why it’s really hard for my patients with chronic pain is, a lot of times it is invisible. Other people around them, their family members, their associates, and even sometimes their caregivers can’t really see what’s happening and so that makes it really hard. Sometimes, you can’t discover exactly why it’s happening.
Melanie: That’s my next question. What are some of the causes of chronic pain and as an exercise physiologist, doctor, I have people with back problems and they have chronic pain from various places and we don’t always know what it’s from. How do you even determine where it comes from?
Dr. Hennessy-Keimig: A lot of times that can be really difficult because, while it can be triggered by an injury, or it can be triggered by a medical procedure; it can be because of a degenerative process--like I would imagine lot of people you see; it can be caused by side effects from medication. We have people that have ongoing chemo pain. Or, it can be neuropathic pain like people with diabetes. We really may not know what sets it off in some conditions. I know I have patients that are very frustrated because they keep going to specialist after specialist and nobody can say, “This is really the cause” and yet we know that their pain is real pain and they are truly suffering from it. Sometimes it seems like it moves around and that gets really frustrating for them as well sometimes for their providers.
Melanie: Is there a way to measure someone’s level of pain besides asking them, “Is your pain a 9 or a 10”? Is there actually anything to monitor that pain level?
Dr. Hennessy-Keimig: It gets tricky because pain is perceptive. My 8 might be somebody else’s 4. There is actually a pain scale that the chronic pain providers tend to like. It takes that one to ten scale but it puts some little qualifiers on it. Like, if pain is from 1-3. Well, it’s there but it doesn’t really bother me. If it’s a 4-5, it bothers me but I can handle it. If it is a 6 or 7, it’s really intrusive and it’s interfering with my life. If it’s higher than a 7, I can’t think about anything else. By being able to put some of those qualifiers on it, it makes it a little bit easier for the patient as well as the provider to understand it. What we find is, with a lot of people who come to us for treatment of chronic pain, they’re consistently 6 or above. It’s really intrusive and they can’t think about anything else. Our hope is by treating the chronic pain or by helping people learning to manage it, rather, that we can get them down to below that 6. It can bother them, it’s there, it’s not going away, but they can still handle it.
Melanie: Are there certain factors that make a person more susceptible? As you said, it’s really subjective and if certain people feel more pain than others, some women can have a baby without any kind of an epidural and some women absolutely ask for it at the first little sign of labor. Is there any factor that makes a person more susceptible than another?
Dr. Hennessy-Keimig: I don’t know that there is one particular factor, but, as you said, it is an experience that is both sensory and emotional and we all have different pain tolerances for various reasons. People’s emotional relationship with pain can certainly have an impact on the way they experience pain. Then, there’s also all of the lifestyle things. I talk with my patients a lot about having an energy budget. Just like we have our checking account and if you have chronic pain, it’s like having a daily automatic withdrawal from your energy budget. We all know what happens if we overdraw our accounts, we get in trouble. In addition to that automatic withdrawal, there are things that people can do or they have habits of mind that either take from or add to what we bring to the table to deal with our pain. Things like fatigue and stress and changes in the weather and people’s level of self-care and their coping skills and their support level and their relational stressors. All of those kinds of things can absolutely contribute to how well people are managing pain. That is really a lot of what I deal with as a psychologist with people with pain. Not so much trying to reduce the pain itself because that may not be possible at least by me, but by attending to all of those other factors, we can reduce the suffering that they are experiencing.
Melanie: We have been seeing pain places -- and really this is a burgeoning field in pain management--cropping up all over the country. Tell us about some of the therapy approaches that have been effective in treating chronic pain. What do you do for people that are in chronic pain?
Dr. Hennessy-Keimig: My approach, obviously, is a psychological approach. Generally, my goal is to help people improve their functioning and be able to manage their pain better. A lot of times, the way we do that is by helping people become more psychologically flexible by helping them learn some coping skills that might help them accept that fact that this is chronic. It’s not going to be fixed. It’s not going to go away. By helping them to learn to pace their life better. By not doing this all or nothing thing that a lot of people – all of us with or without chronic pain tend to do. A lot of times, patients will do the feast or famine thing. If they are having a good day they will just kill themselves with activity and then they will pay for it for days. Trying to help them either learn that skill or if there is something underlying to them having trouble practicing that skill. Like, maybe they haven’t accepted the fact that their pain is chronic or by working on understanding that they have to grieve and deal with some of the emotions that go with it. A lot of my personal experience, my personal approach is based on mindfulness which really helps people develop the ability to take a little bit of a step back from their experience and not be so locked in and just responding and reacting to every stimuli as it rises and falls. Otherwise, they can become very psychologically rigid which makes it even more difficult to deal with pain. Mindfulness helps people direct their attention to chosen sensory or cognitive types of events like the breath or something that they are doing so they can lean into the pain and lean away and refocus their attention away from either the experience itself or their emotions about the experience.
Melanie: Traditional approaches and alternative, or integrative, as you say mindfulness. This is huge today, people are using mindful medicine for so many different things. How does this help for them if they are more mindful of the pain? Do you want them to take charge of it and feel this pain and acknowledge it or do you want them to try and forget that it’s there?
Dr. Hennessy-Keimig: Actually, it’s not really either one of those things. What I tell people about mindfulness is it gives you an option in between either pushing something away or falling off the deep end into it in that you can selectively direct your attention towards – say, for example, your breath. You’re following your breath and then you notice that you are distracted and you go back to the breath. Over time, this gives you the ability to take a step towards something. Take a step away from something. With pain, what this helps people to do is to realize that it’s not the central focus of action; that they can disengage from maybe the idea that they are going to be able to fix the pain and learn to kind of live in the presence of it. They can move toward it. They can move away from it. It gives them more of a sense of control.
Melanie: That’s absolutely fascinating. In just the last minutes, please, doctor, tell us a little bit more about your chronic pain management group.
Dr. Hennessy-Keimig: The group is a six week group. It focuses exactly on the things that we have been talking about. It is totally mindfulness based. I teach the mindfulness skills to the patient. We do a practice every week. I ask them to practice at home. It also gives them an opportunity to share how things are going in their life. We talk about things like pacing and staying in the present moment and self-care and support and self-management, acceptance, grief and loss – all of those things that people are dealing with; as well as just lifestyle things that might help manage pain better. People who have attended the group have indicated that has been really helpful to them as well as the fact that they have group support. They’re in a room with other people who actually really do get it. A lot of times, being in chronic pain is very isolating for people so having that opportunity to just share with other people who are going through similar experiences is very powerful.
Melanie: It’s such great information. Thank you so much, Dr. Kate Hennessy-Keimig, a psychologist at Allina Mental Health United Outpatient Clinic. You’re listening to The WELLcast with Allina Health and for more information you can go to AllinaHealth.org. That’s AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.