Not Alone in Their Pain

Woman in painMADISON - Olga Arrafut, a clinical social worker at the University of Wisconsin Psychiatric Institute and Clinics, has been suffering from migraines for 15 years. She treated the pulsating pain with Imitrex®, a common pain medication.
That helped her with the physical symptoms but didn't do anything to mitigate a debilitating and often overlooked factor for chronic pain sufferers - the seclusion their pain breeds.
"Pain can be very isolating," says psychologist Janice Singles, PsyD, who along with Shilagh Mirgain, PhD, has led a pain management and coping group at UW Health's Research Park Clinic for the last four years. "When somebody has pain - even though they're loved - often their family and friends don't get it. It's hard to understand unless you have it."
Arrafut turned to the group in the spring of 2004. In addition to the more tangible coping mechanisms suggested by Drs. Singles and Mirgain, like paying more attention to the ergonomics of her desk and chair at work and using relaxation and breathing exercise to control stress, Arrafut points to the community the group provided as a significant ally in her battle against migraines.
"One of the things I really like about the group was that it was supportive," she says. "I felt like I was not alone. In the group you feel that people are sharing your experience. They know when you are in pain."
Drs. Singles' and Mirgain's approach reflects a broader way of evaluating and treating chronic pain, one that views the affliction as more than strictly medical. Certainly pain has physical ramifications that need to be addressed. Just as important, though, are less obvious factors like mood and personal interaction.
"We look at mind, body and spirit," Dr. Singles says. "There's the biology of pain, but it's also how it impacts the individual and others and how the person is impacted by others' reaction."
"We want people to tell their stories," adds Dr. Mirgain. "Group can be a wonderful format to provide social support. We find that for some people change occurs faster in a group setting because the group provides them with the needed support, and close friendships often occur."
Chronic pain presents specific challenges, because the source of the pain is unknown and the pain unseen by other people. It's not hard to empathize with somebody who has broken his leg in a skiing mishap. That pain is easily understood and, because of the bulky cast the person is likely dragging around, obvious to the naked eye. Not so with chronic pain.
"It's an invisible disability at times," Dr. Singles says, "and people can get into negative thinking and focusing too much on pain."
The invisible nature of chronic pain often leads to secondary symptoms such as anxiety, guilt and depression that exacerbate the initial problem. In the words of Dr. Singles, there's the pain itself and the suffering around the pain.
To counteract these negative thought processes, Drs. Singles and Mirgain use strategies that promote a more positive frame-of-mind. For instance, chronic pain sufferers often fall into the mental trap of believing their pain reduces their effectiveness in a role they fulfill in their family or community.
Mothers, for example, may think they are failing in their maternal duties and thus are not worthy of the love their children or spouses give them. It's this snowball effect - the way chronic pain becomes something bigger and more fearsome than the pain itself - that Dr. Singles and Mirgain address in the group.

The fall session of the pain management and coping group is just finishing up. Drs. Singles and Mirgain will be moderating a winter/spring session that begins on Monday, January 23 and will meet on eight consecutive Mondays at the Research Park Clinic. They also have organized an advanced group for people who have attended introductory group sessions or have completed individual pain management training.
Drs. Singles and Mirgain conduct interviews by phone prior to group participation, to discuss objectives and goals and to see if the group is a good fit for the prospective participant. To arrange an interview, please contact Dr. Mirgain at 608-890-9476.

Date Published: 06/15/2007

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