Recently one night in the space of 10 minutes I read an email (one of Peg’s emails to my Mum) and an article tweeted by one of my Twitter pals mentioning the word ‘burden‘. They both resonated with me because so many of my patients are significantly ‘burdened‘ with their persistent pelvic pain (PPP).
Firstly let’s look at the dictionary meaning of burden.
*Something that is carried.
*Something that is emotionally difficult to bear.
*A source of great worry or stress; weight.
*A responsibility or duty.
Now Peg’s email is very insightful. It’s a concept that I try to impart to patients when managing their persistent pelvic pain. Unfortunately I don’t know the author, so I apologize for not being able to attribute it.
‘A young lady confidently walked around the room while explaining stress management to an audience; with a raised glass of water, and everyone knew she was going to ask the ultimate question, ‘half empty or half full?’….. she fooled them all… “How heavy is this glass of water?”, she inquired with a smile. Answers called out ranged from 8 oz. to 20 oz.  She replied, “The absolute weight doesn’t matter. It depends on how long I hold it. If I hold it for a minute, that’s not a problem. If I hold it for an hour, I’ll have an ache in my right arm. If I hold it for a day, you’ll have to call an ambulance. In each case it’s the same weight, but the longer I hold it, the heavier it becomes.”
 She continued, “and that’s the way it is with stress. If we carry our burdens all the time, sooner or later, as the burden becomes increasingly heavy, we won’t be able to carry on. As with the glass of water, you have to put it down for a while and rest before holding it again. When we’re refreshed, we can carry on with the burden – holding stress longer and better each time practised.
 So, as early in the evening as you can, put all your burdens down. Don’t carry them through the evening and into the night…. pick them up tomorrow. Whatever burdens you’re carrying now, put them down for a moment. Relax, pick them up later after you’ve rested. Life is short. Enjoy it and the now ‘supposed’ stress that you’ve conquered!” 
Now that might sound somewhat simplistic but many times when I point out that stress is a provoker of PPP to patients and they make conscious efforts to manage their stress better, they are very pleased with the impact on their PPP.
Also some people are naturally more anxious than others and just as we can practice scales and get better at playing the piano, we can actually ‘train and practise’ being stressed. But similarly we can also do the converse – ‘train and practise’ not being stressed. Simple strategies we can employ – we can consciously ‘train’ relaxed breathing and sometimes simply have a big breath in and a big sigh out; also trying not to catastrophise every situation. Some other strategies to manage stress –  watch a comedy show and hopefully laugh out loud; exercise – walk briskly, do a workout in the gym, dance – and another one of Peg’s pearls…….Nobody cares if you can’t dance well. Just get up and dance.
The second reference to ‘burden‘ is an abstract by Kowel et al on ‘Self-perceived burden in chronic pain: relevance, prevalence, and predictors.’ (Journal of Pain. 2012 Aug;153(8):1735-41. Epub 2012 Jun 14.)*
This article examines patients’ perceptions of feeling that they have become a burden to others. Research on self-perceived burden in different medical populations, such as cancer, amyotrophic lateral sclerosis and stroke has shown that it is associated with physical symptoms and with psychological difficulties and concerns. In this study, 238 chronic pain patients were assessed for prevalence and predictors of self-perceived burden in a tertiary chronic pain clinic. Self-perceived burden is a clinically relevant and commonly reported interpersonal experience in patients with longstanding pain.Their significant others (n = 80) also completed a measure of caregiver burden. The conclusion was that self-perceived burden was a commonly reported experience among persistent pain patients.
So if you have a friend or relative with persistent pelvic pain do be mindful of  the significant burden they are carrying and help them to lighten the load.
*Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.PMID 22703692 [PubMed – in process] Full text: Elsevier Science
PS For all those people who sent their best wishes to me regarding my Mum’s surgery – Thank you on her behalf and I can report that she did brilliantly and is back home now raring to go. Thanks to Dr Nano and all the lovely staff at Greenslopes Hospital.

Mum five days post-mastectomy surgery, 2012 (aged 87)