in pain but I can manage it,’ ‘This is a sign that I
should meditate,’ or ‘I’ve been through this before,
I can get through it again,’” she said.
CBT isn’t “happy talk” or “positive thinking.”
People are taught relaxation and breathing exercises;
visualization and “mindfulness” meditation (living
in the present moment); they explore new
approaches to activity; and learn to use more
focused self-evaluations of pain and its impact.
Acknowledging the pain actually helps people
manage it. Even better, CBT may alter the
perception of pain by altering how pain is
processed in the brain.
The therapy helps people concentrate on how to
get on with life in a way that’s meaningful to them
and, through this process, to feel less pain.
“We used to think that depression came before
pain, but we’ve found it’s more likely the other
way around,” Dr. Ehde said. “Pain can lead to
depression because it gets in the way of a happy,
productive life. Pain is also socially isolating
because it’s such a private experience.”
Paradoxically, research also suggests that although
social support is vital, overly solicitous or protective
behavior from partners and family members may
actually heighten a person’s experience of pain. Dr.
Ehde counsels loved ones to “validate the pain, but
don’t make it central.”
Exercise clearly helps break the cycle of pain and
inactivity. With MS, any exercise program must
take into account heat intolerance, individual
preferences and physical issues. People with more
severe disability will need an exercise helper. But
otherwise the science is in. Movement actually
releases pain-relieving endorphins, reduces stress,
relieves muscle tension and helps people sleep better.
Exercise also helps to shore up strength, posture and
balance and improves mood and overall health.
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“Pace yourself and don’t overdo,” said Dr. Cohen.
Heat intolerance can be addressed by exercising in
the cooler parts of the day (or in the basement!),
by wearing light clothing, by precooling with a
soak in a cool tub and by drinking cold water
before a session.
“Swimming helps me, along with kicking my legs
or walking in the pool,” said Suzanne Cramer
of Orangeburg, S.C. Swimming in a cool pool
is a true heat beater. In the winter, Cramer uses
a video-based exercise game, rides a stationary
bicycle, and walks her trusty dog, Sparky.
And many more complementary options
Complementary therapies include biofeedback,
various breathing techniques, music therapy, aro-matherapy, self-hypnosis and meditation.
Massage may comfort stiff muscles but it can also
be over-stimulating. Acupuncture may be helpful,
although the evidence for its effectiveness in MS
remains anecdotal. Even so, the list keeps growing. Today’s pain management teams focus on
improving quality of life by combining medication
with complementary therapies that work for the
“Maybe as soon as five years from now,” Dr. Ehde
believes, “we’ll look back and see a variety of improved
medical and psychosocial treatments for pain.” n
Rachel Adelson writes about health science, especially
neurology and neuroscience, through her company Live