Blog written by Dr Catharine Powis, Psychologist, ROH Pain Management Service
I recently went for an x-ray guided hip injection to hopefully help with the increasing pain I was having. I’ll be honest, I nearly cancelled. I was aware that my nervous system was definitely sensing danger!
Pain is very much a biopsychosocial experience and serves a protective function. The more danger messages received from my body, and importantly my brain interpreting that I am in danger, the more pain messages that are sent. My body has learnt pain over these years and I’d say those pain pathways are pretty embedded.
Before the appointment, my brain was contending with memories of past medical procedures, having been diagnosed with Juvenile Idiopathic Arthritis from the age of 5. The sights and sounds of the hospital and all the associations that brings up. The language used when discussing my x-ray… “wear and tear”, “abnormal” shape of my hip joint” and how I’ll likely need a hip replacement when I am a bit older. All ringing those alarm bells for my nervous system!
Before I started working in chronic pain I had no idea how important the nervous system was in understanding physical pain. I knew from working with complex mental health and trauma that it was pretty key to a lot of things, but not so much for physical pain. I also supported a lot of patients in secure care who were experiencing chronic pain, often with no clear cause at the time. It all makes complete sense now.
The knowledge of pain science I have gained through many amazing resources like Flippin' Pain and Live Well with Pain, combined with skills I have learnt over my psychology career (as well as from my amazing pain management team colleagues at The Royal Orthopaedic Hospital NHS Foundation Trust), all helped when waiting nervously for that procedure.
I reminded myself that I have been through many joint injections before and have always got through them (shifting thoughts from danger to safety).
I practiced mindful breathing and used EFT (tapping) to tap on my finger points before I went into the procedure room (just to stop that sympathetic nervous system response).
I reminded myself that I needed my nervous system to feel safe otherwise I was likely going to experience greater pain intensity during the procedure.
I distracted myself by not looking at the needle (seeing the size of that would not have helped), instead observing the ceiling and bringing in those often underrated mindfulness skills.
Using muscle relaxation helped as all my muscles kept tensing in anticipation of the procedure starting. Luckily the doctor was lovely and explained everything which helped reassure me (more safety messages).
We are only human (even psychologists) and it’s normal to experience fear when living with persistent pain. There are however little things we can all do (including the medical professionals in the room) to help bring in feelings of safety to the nervous system and improve a person’s experience. Who knows, it might even impact treatment outcomes for the better?
For more resources and support for dealing with chronic pain, visit Royal Orthopaedic Hospital - Pain Management
