Beth Dinoff, PhD, is a clinical associate professor of anesthesia and a pain psychologist with University of Iowa Hospitals & Clinics' Pain Management Clinic.

By Beth Dinoff, PhD

Between the COVID-19 pandemic and recent social unrest over racial justice and equality, 2020 has been extremely challenging in previously unimaginable ways. Even as people express gratitude for essential workers, they also are admitting to feeling overstressed, depressed, worried, and traumatized. These are clearly stressful times even for those who are in good physical health.

For the more than 100 million American adults living with debilitating chronic pain, the unique stresses of 2020 may actually make their physical pain worse by causing “pain flares” – temporary increases in pain levels that are expected to resolve within a relatively short time.

Pain flares increase suffering, fearfulness, and disability. In normal times, they can be caused by daily life stresses, medication or dietary changes, overdoing activities, or even resting too much. Add in the uncertainties of a new virus and the abrupt and drastic changes to many aspects of everyday life, and it isn’t surprising that your chronic pain may feel worse than ever.

Fortunately, the techniques that pain psychologists prescribe for “normal” pain flares may be even more useful in these not-normal times. (They may even help those who don’t suffer from chronic pain, but who are feeling the same kinds of stress related to current events.) These techniques involve making adjustments in four main areas: social support, work, exercise, and mindfulness.

Social support
People who have chronic pain are at risk for becoming socially isolated while feeling depressed, fatigued, and overwhelmed. In turn, social isolation makes people with chronic pain feel more sad, tired, and disorganized. It can become a seemingly endless cycle of fear and defeat. The best way to combat this cycle is to spend time with those who are important to you.

Of course, socializing with others outside your household is more challenging in the COVID-19 era, so you may have to get creative. Here are some suggestions:
•    Spend time with others outside. Nice weather makes getting together a little easier (and safer!). Meet up with family or friends for a social-distanced picnic or sit (6 feet apart) around a fire pit.
•    Connect with video. If you have a computer, a tablet, or a smartphone, you have numerous options for video chats. Facetime, Google Hangouts, WhatsApp and Zoom all offer free video call options.
•    Offer your support, too. Providing comfort and support to someone else often helps you feel better as well. Aside from lowering your blood pressure, helping others also can give you a sense of purpose and satisfaction.

Work
Work can mean going to a job or doing a job from home, but for our purposes it really means routine and structure. For people with chronic pain, having a structure makes it easier to get through the day without giving in to fatigue and sadness.
 
Some tips for creating and maintaining a schedule:
•    Alternate work time and non-work time. Work tasks can be anything – housecleaning, yard work, home schooling, etc. Rest breaks can include short walks, a few stretches, applying heat or ice, practicing deep breathing, or reading an inspirational passage in a favorite book. The key is to pair work time and rest breaks frequently throughout the day.
•    Start small. Start with small chunks of work and non-work time. Do your work task for the first 5 minutes, followed by 10 minutes of an enjoyable activity or rest break. Every few days, try increasing both your work and non-work chunks by 5 minutes each.

Exercise
Many people with chronic pain give up on doing regular physical activity out of fear of getting injured or having increased pain. But exercise can boost your mood and even help control your pain. Consult your healthcare provider to find out what kinds of physical activity are appropriate for you. When physical activity has been medically approved:
•    Try to do your recommended exercise level daily.  During a pain flare, you may think you’re hurting too much to be physically active, and this could lead you to become sedentary for several days. Then, you will likely find that you are hurting more than ever.
•    Don’t overdo it when your pain level is down. When you have decreased pain, you may feel a surge of energy to do all the things you didn’t do while you were resting. But overdoing it can cause problems, too. Pacing yourself on low pain days is just as important as pacing yourself during pain flares.

Meditate
Many types of meditation are highly effective in helping people to live a fully valued life in the context of their chronic pain, including breathing techniques, progressive muscle relaxation, and guided imagery. YouTube and free apps like Insight Timer also can help you get started. If you’re new to meditative techniques:
•    Experiment to find the meditations that you enjoy the most.
•    Start out with 15-minute sessions a couple times a week.
•    Once you find a meditation that works for you, increase your weekly sessions until you’re doing one every day.

About the Pain Management Clinic
The Pain Management Clinic at University of Iowa Hospitals & Clinics is an evidence-based, multidisciplinary clinic that addresses the physical, mental, and emotional aspects of chronic pain. In addition to board-certified pain physicians, the Pain Clinic has two licensed clinical psychologists who work exclusively with chronic pain patients. If you’d like to learn techniques that don’t rely on medications for managing chronic pain, please ask your medical provider for a referral for pain psychology. New patient appointments are available most days of the week.