Ashlee Williams, MD (Host): Living with chronic pain is a complex experience that goes far beyond physical discomfort. It can affect our emotional well-being, our relationships, and our overall quality of life. So, how should we think about chronic pain and mental health? And what options are available to alleviate both the physical and emotional toll of chronic pain?

Welcome to the Healthier You Podcast. I am Dr. Ashlee Williams. And today, I'm talking with Dr. Gregory Khan-Arthur, a board-certified pain management specialist at Kaiser Permanente, about the relationship between chronic pain and mental health and our options for treating both. Dr. Khan-Arthur, thank you so much for being here to discuss this important topic.

Gregory Khan-Arthur, DO: Thank you very much for having me, Dr. Williams. It's great to be here.

Host: I really appreciate it. So, let's start out talking about chronic pain, mental health, struggles like depression and anxiety, and how does chronic pain and mental health go together?

Gregory Khan-Arthur, DO: Yeah. So, the most widely accepted definition of pain is not only a physical sensation, but also an emotional experience. It really is a lived experience. At its essential core, pain is really a function of our body to warn us when something is damaged or maybe dysfunctional. And it causes us to focus our attention on what is causing that pain. So in essence, pain is really a way for our body to get us to change our behavior and our attention towards something that possibly needs addressing.

Host: Right. And it can be different for everyone, right? It's very subjective.

Gregory Khan-Arthur, DO: Yeah, absolutely. I mean, there are many different reasons for pain, and many people experience pain in different ways. Depending on what the underlying cause is of the pain, it can be sometimes constant, or it can be intermittent, it could be seasonal, or it could be related to very specific activities. So, it is important to kind of understand and appreciate how each person's experience with pain is different in order to approach treatment.

Host: So as a chronic pain specialist, how do you go about treating patients with chronic pain?

Gregory Khan-Arthur, DO: I think the most important first step is to get a very good idea of how the pain is impacting not only their body, their biological domain of living, but also how it's impacting their psychological function, how they feel, their emotions, and how they're able to operate socially in terms of relationships or perhaps their occupation and whether or not the pain is causing very significant interference with things that they value, things that they want to do or even just get through the routine of their day.

So in assessing pain, we try to assess its impacts on the biological, the psychological, and the social domains of somebody's lived experience. And sometimes, even if we cannot directly address the underlying cause of the pain, or if the way that we treat that pain is not going to completely extinguish the physical sensation, we can often direct treatment towards the psychological suffering, the emotional unrest, and also the social dysfunction associated with that pain.

Host: Are there any lifestyle changes that you recommend for people suffering with chronic pain that can help with their chronic pain and their mental health?

Gregory Khan-Arthur, DO: Absolutely. I think that's probably one of the most important things to address with patients, especially when suffering with chronic pain. After a long time of feeling distress and painful sensations, it is typical for people to start having feelings of depression and anxiety and withdrawal from activities that they usually love to do or want to do.

So, oftentimes we have to address lifestyle adaptations and changes so that the patient can concentrate on the fundamentals of their well-being. And these things include the very basic functions of living, including how we eat, so diet can be very important. I often tell patients that medicine is probably overrated because the most important medicine is the food we eat. So, sometimes addressing our diet can have a profound impact on how pain feels in our body and whether things get inflamed or not. There's also movement. Changing the way that we plan our activities and the exercises that we choose to do is very important because oftentimes if we stay still for too long, the pain can sometimes feel overwhelming. But by movement and by practicing regular exercise, you often can reprogram the nervous system to feel pain less and to feel the sensations of the movement and the strength that you get from that activity more.

And then, there's also, of course, calming strategies, things like mindfulness practices or meditation, going for a long walk, sitting quietly in a park, observing nature. These things have been shown to be very effective in helping to reduce the intensity of pain and also help to improve the ability of the person to function in their day to day.

And lastly, I'll mention sleep, because that is often the first thing that gets disrupted by pain. And oftentimes, for reasons we don't quite understand, pain tends to get worse in the evening. I think it's very important to address pain effect on sleep quite early on in pain management, because without good sleep everything seems to be a lot more stressful and a lot more difficult to deal with.

Host: Wow. It's good to know that there are lifestyle changes that we can make, including going for a walk and meditating. I know at Kaiser Permanente, we offer our members the Calm app, which is a great app to help with meditation. That's really helpful information. Is there any advice that you would give to a patient when talking to their physician about their chronic pain or advocating for themselves about their pain or how to partner well with their physician when coming up with a good regimen for them to manage their chronic pain?

Gregory Khan-Arthur, DO: Yes, absolutely. I think it's important, first and foremost, to prepare for your visit with your doctor, to provide them as much information as you can about the quality of your pain, what it feels like, using descriptive terms, like maybe it's a burning sensation or a sharp sensation. Be as descriptive as you possibly can about what the pain feels like to you and where you're feeling that pain.

I often recommend patients keep a pain diary. So, writing down on a calendar or in a date book your experience living with that pain, and maybe even a little bit about what that pain is keeping you from that you want to do. Because oftentimes, we can find ways to adapt our behaviors and help to strategically treat that pain during times that you want to do certain activities.

Host: Yeah. That's great advice to keep a diary, because I think a lot of times we have trouble describing what symptoms we're having. So like, keeping a diary in the moment to describe it will help set you up better for your appointment.

Gregory Khan-Arthur, DO: Absolutely, because our memory is not perfect. We often forget, you know, experiences and even what I ate for lunch yesterday. But it is important to keep a note of what you're feeling and when you're feeling it so that when you describe this to your physician, perhaps they can pick out patterns and ways to address and interrupt those cycles of pain.

Host: No, that's great. Well, this was really helpful information. I really appreciate your time today. So, thank you for all of this great information. We learned a lot about the relationship between chronic pain and mental health. And here are some key takeaways.

One, the relationship between chronic pain and mental health struggles, like depression and anxiety, is very complex. So if you are experiencing chronic pain, it's important to talk to your doctor for individualized guidance. Two, there are many ways to treat the symptoms of chronic pain, including medications, therapies, and importantly, lifestyle changes. When exploring treatment options, look for methods that serve both your body and your lifestyle. Three, while there's no silver bullet to cure chronic pain, exercise, a nutritious diet, stress management, and sleep can greatly improve your overall quality of life, which can help improve symptoms. Four, Iif you're suffering from chronic pain, consider writing what you're feeling in a pain journal. The journal entries will prove useful in a conversation with your physician. And five, never be afraid to advocate for yourself. If you don't understand something your doctor is telling you, or you feel your doctor doesn't understand something you're saying, tell them.

For more information about chronic pain from our experts and other health advice, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast. If you enjoyed this episode, be sure to share it with others who may find it helpful. From all of us at Kaiser Permanente, be well.