Chronic Pain

If you are in pain chances are you have been struggling for a long time.  The material below is an excerpt from an article I found while working in a pain clinic.  As a therapist, often a very important part of treatment is education around a diagnosis and how it impacts a persons daily life.  This article provides some basic information about pain and I found it helpful not only for individuals in pain but also loved ones.

Why am I in Pain?

Written by Cathy Rogers 2011

Pain is a normal experience

Pain is a normal, but unpleasant, experience you feel in response to what your brain believes to be a threatening situation and can involve actual or potential tissue damage (Butler & Moseley, 2003). The pain experience is what motivates you to take notice of tissue damage and do something about it. When you accidentally step on a sharp object your brain alerts you to the threat (tissue damage) and you will quickly remove your foot from the object to prevent further damage. Think of your pain as an alarm system; it has the capability of sending danger messages to your brain when your brain perceives that it is under threat. Your brain then processes these danger messages and decides what the necessary action your body should take to prevent further tissue damage (like removing your foot from that sharp object).  This system is essential to your survival.  Pain is a poor marker for tissue damage  We already know that pain can be related to a change in your tissues. Postural pains, pains from a sprained ankle, and pain from a bulging disc are all the result of some degree of damage to the surrounding tissues. You would assume that the larger the degree of tissue damage, the greater degree of pain. So, why is a paper cut on a finger so painful? Why are migraines so debilitating?

What we now understand is that the severity of the pain report does not always give an accurate indication of the degree of tissue damage. Paper cuts on a finger typically involve only a minor amount of tissue damage (which heals with little or no care on your part), but the degree of your pain report is usually quite high, while some life-threatening cancers can go undetected for years as there are no associated symptoms. This highlights our understanding that pain is a much more complex phenomenon than we expected.

When pain becomes persistent

Whenever we injure ourselves, the damage to the surrounding tissues activates a cascade of events known as inflammation. Inflammation helps to promote healing of your tissues. Different tissues take different amounts of time to heal, but typically, all tissues do heal. We expect that as the tissue heals, the degree of pain associated will lessen over time. So, why do some people report ongoing or increasing pain symptoms that last months to years, well beyond the expected healing time for the injured tissue?

There is no easy answer to this question. There may be some ongoing inflammatory reactions in the tissues that cause the persisting pain. The tissues may have healed but are not yet healthy; muscles may remain weak and underused, there may be motor control issues with the core muscles. Or, the central nervous system (brain and spinal cord) may have become sensitized over time. Essentially, this system becomes too good at what it does.

If you have chronic pain and would like to know more about coping with the emotional aspects of pain, feel free to contact me.

Check out these videos below:

Low Back Pain By DocMikeEvans

Understanding Pain in less than 5 minutes, and what to do about it!

Mindfulness for Children

This is a list of Mindfulness Exercises for Children I found while I was working with a family health team in Toronto. The exercises are effective both for adults and children that may be experiencing anxiety or everyday stress.  Since many people find mindfulness difficult at first, I recommend starting with a simple exercise to start, and any of these would do. Since mindfulness at the most basic level is about being in the present moment these exercises are about noticing things around us with the five senses.

Provided by © 2015

The Feeling Exercise

Collect a number of interesting objects such as feathers, putty, stones, or anything else that might be interesting to hold. Give each child an object, and ask them to spend a minute just noticing what it feels like in their hand. They can feel the texture, if their object is hard or soft, and the shape. Afterwards, ask the children to describe what they felt.

The Seeing Game

Ask the children to spend one minute silently looking around the room. Their goal is to find things in the room that they’ve never noticed. Maybe there are some big things like a poster or a picture, or just little details like cracks in the ceiling or an interesting pattern on the door. After the minute is up ask the kids to share the most interesting new things they noticed.

Ocean Breathing

Have the children sit or lie down in a comfortable position. Ask everyone to slowly breathe in through their nose, and then out through their pursed lips (as if they are blowing through a straw). Point out that the slow and steady breathing sounds like ocean waves, gently crashing on shore. Let the children continue breathing and making the ocean sound for one to two minutes.

The Power of Listening

Ring a bell, a wind chime, or anything else that creates a long trailing sound. Ask each child to listen, and silently raise their hand when they can no longer hear the sound.  After the ringing ends, ask the children to continue listening to any other sounds they can hear for the next minute. When the minute ends, go around the room asking everyone to tell you what sounds they heard.

The Body Squeezing Exercise

Have the children sit or lie down in a comfortable position, and ask them to squeeze and relax each of the muscles in their body one-by-one. They should hold each squeeze for about five seconds. After releasing the squeeze, ask the kids to pay attention to how it feels when they relax. Children understand this exercise better if you help them visualize how they can squeeze a particular muscle using imagery, such as the following:

1. Curl your toes tight like you are picking up a pencil with your feet.

2. Tense your legs by pretending like you are standing on your tippy-toes, trying to look over a fence.

3. Suck in your stomach as if you are trying to slide through a narrow opening.

4. Make fists with your hands and pretend like you are trying to squeeze all of the juice out of an orange.

5. Pretend like a bug landed on your nose, and you’re trying to get it off without using your hands. Try to scrunch your face and move your jaw to make it fly away!

The Five Senses Exercise

Take the children outside if the weather is nice, and have them lie silently in the grass. Begin to call out each of the five senses in turn (sight, smell, sound, taste, touch), and ask the children to notice everything they can with that particular sense, until you call out the next one. This exercise can also work well on walks, and in a number of other situations.

Panic Attacks

What are Panic Attacks?

As a Social Worker and Psychotherapist I provide both Cognitive Behavioural Therapy and Exposure Therapy for panic attacks and anxiety. Over the years I have met with many individuals who come to see me after they ended up in a hospital emergency department with feelings of panic. Time after time they would report they went to the hospital in fear they were actually having a heart attack, only to find out that they were experiencing anxiety. One of the first steps to treating anxiety is recognizing the symptoms associated with it.

Provided by © 2015

Panic attacks are brief periods of overwhelming fear or anxiety. The intensity of a panic attack goes well beyond normal anxiety, and can include a number of physical symptoms. During panic attacks, people often fear that they are having a heart attack, they cannot breathe, or they are dying.

Symptoms of a Panic Attack

Note: A panic attack does not need to include all of the symptoms listed below.

 Pounding or racing heart

 Sweating

 Trembling or shaking

 Fear of “going crazy”

 Feeling of being detached from reality

 Breathing difficulties

 Sense of terror, or impending doom or death

 Chest pain or discomfort

 Nausea

 Fear of dying

Panic Attack Facts

Panic attacks may feel scary, but they don’t actually cause physical harm. The most common fears associated with panic attacks (having a heart attack or fainting) are not actually a threat.  Panic attacks are usually brief but intense. The symptoms of panic typically peak within 10 minutes, and end within 30 minutes. However, some lingering symptoms can last over an hour.

Panic attacks can seem to occur randomly, or they can be closely linked to a specific source of anxiety such as driving, crowded places, or simply leaving home.  Panic disorder occurs when a person has frequent worry or fear of future panic attacks, or when they change their behavior in to avoid attacks (such as avoiding a feared situation).

How are Panic Attacks Treated?

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a common and well-supported treatment for panic attacks and panic disorder. CBT works by identifying and changing unhealthy thinking patterns that trigger panic attacks. The benefits of CBT can be long-lasting. I also use Acceptance and Commitment Therapy to help treat anxiety which is considered a type of CBT.

Exposure Therapy

During exposure therapy, the patient is intentionally exposed to the symptoms of panic in a safe environment. As exposure continues, the symptoms become more familiar and less terrifying. Exposure therapy may also involve gradual exposure to feared situations.


Medication for panic attacks can act as a short-term treatment for severe cases.  Because medication does not treat the underlying issues that cause panic disorders, it should be accompanied by another form of treatment such as psychotherapy.

Relaxation Techniques

Much like how muscles become stronger with exercise, the body’s relaxation response can be improved with practice. Frequent use of relaxation techniques such as deep breathing, meditation, and progressive muscle relaxation can be helpful to manage anxiety and panic.

You can also click this link to book to book a consultation or appointment.

Crystal Gerlach RSW RP

Psychotherapy and Clinical Social Work
Anxiety, Depression, Stress, PTSD, Life Transitions, Chronic Pain and more
5063 North Service Road, Suite 200
Burlington, ON L7L 5H6
Direct Line) 905-399-0808
“Social Workers. Real Experts for Real Life”