Now the last part of the module on the social realm is to talk about social support and positive relationships that can prevent pain. Now we all know, and have discussed already in the previous parts, that low social support is a risk factor for severe disabling chronic pain. Those with lower so, social support levels have more inflammation, they have more disability and pain with arthritis, they have less effective immune systems that are more prone to illness. And they have more complications during pregnancy and other procedures and they have more cardiovascular disease. And people who have significant social support, do have a ability to be resilient and improve considerably with regard to their conditions. And people enjoy helping other people. There are many theories on pro-social behavior. For instance, genetic predisposition due to inherent kindness and survival instinct. Or relief of negative states such as guilt in order to feel good. We feel empathy and can identify with other people's feelings. And there's a tendency for egoism and reciprocal self reward. When we give others, we get it back. And social reward of improving one's image and reputation through praise, as well as responsibility to help others. And believing in the ability to help others are all reasons that we help other people. And there is a biological rationale for social support. It's called the helpers high and it's facilitated by the hormone oxytocin. So oxytocin is a peptide that acts as a brain neurotransmitter, and it's considered to be the love hormone since it's linked to positive human emotions, pleasure and well, sexual activity. And there are studies that have looked at the genetic differences in responsive, responsiveness to oxyto, oxytocin and these were linked to the ability to read faces and determine emotions of others. Those people that have higher responsivity. Feeling empathy and distress at others' hardship. Identifying and have empathy with characters in a novel. As well as having trust in others in this particular study all were enhanced by increased responsiveness to oxytocin. And oxytocin plays a significant role in chronic pain also. The hormone has many biological functions that involve pleasure and comfort. It induces analgesia, or reduces pain, in low back pain patients as well as fibro, fibromyalgia pain by support the endogenous opiate peptide system. It also, the receptor is associated with autism, poor parenting skills, eye-reading task, and stress-prone tests. That plays a role in compassion and helping, and the opposite reaction in these situations. And low oxytocin levels are also a precursor to pain symptoms after emotional or physical trauma. So each of these studies suggest oxytocin does play a role in chronic plain, pain, as well as creating and facilitating the helper's high. So how do we enhance oxytocin, and, what are the different types of social support? Well there's four different types in the literature suggesting. One is emotional, instrumental, informational and companionship, which is similar to emotional. Let's discuss each one. Emotional support is about listening, showing empathy, concern, nurturing, and caring for others. Examples of an individual can listen, hold hands, hug them, show affection, smiling. Tell them you love them, build their trust, accept them for who they are, creating intimacy, encouraging them to be positive with positive reinforcement and let them know he or she is valuable are all characteristics of creating positive emotional support. And social support and pain is very highly correlated. Pain is less when you are loved. So there's a study that was interesting, of 25 women, all with acute pain from heat, an experimental stimuli of heat and the pain was reduced with several tasks. One, looking at a photo of a loved one, holding the hand of a loved one, and even just thinking of a loved one all reduced the pain between these women before and afterwards. And then there's instrumental social support which provides direct concrete benefits to help a person or the family. And this is the most obvious example of that, is financial assistance. Which includes both general assistance, unemployment, disability payments providing material goods, food stamps for instance, services, bringing meals are all examples of instrumental social support. And then there's informational support which is providing useful information to someone to help them problem solve. Examples of this include of course health care providers, and educators providing advice, guidance and instruction. Suggestions such as handouts, providing on-line support and on-line information that's accurate. Scientifically valid. As well as classes and group sessions. And then, lastly, there's companionship. And this is when you encourage social belonging by engaging in shared social activities with the person. Such as a, groups, families, So examples include families and friends spending time with the person. Going to social or sporting events. Going on walks, traveling, together. Big brother programs, sisters programs are also examples of, of companionship as a social support. And those four different types of social support are important with regard to whether it plays a role in chronic pain and recovery. So this is an interesting study of 173 patients with chronic pain. And they studied three types of support to see how it impacted the recovery of those pain patients. Either informational, emotional, which is included in companionship, and instrumental. And the results show that those with low control of pain needed more support. So you have more aggravations of the pain, they needed more social support and wanted more social support. But the informational and emotional support that was provided with was preferred over instrumental support which is interesting. So financial assistance, food stamps, disability, et cetera. Was not as important as receiving informational and emotional support on recovery. And the discrepancy in the emotional support in others. Those people who got less than what they needed in terms of support predicted increased pain and depressed mood. Whereas, a discrepancy in informational or instrumental support did not predict either increased pain, or depression. So the conclusion to that is really that informational and emotional support probably is the most important factor that we need to provide. Patients with chronic pain, but all of the types of social support are important. And, who provides the social support, during trauma, pain, illness, et cetera? Well, Coyle in 2012, kind of identified these 5 different levels of social support. Of course, the most important are the confidants. These are the close and trusted family and friends that you can tell anything to and are not going to judge you, excessively at least. Two is people who help you during difficult times. Now, these may be a close neighbor, a health care provider, a close colleague to help you get through those difficult times of pain or depression or, or trauma. And then there are fr, friends who you visit, you know. I mean they could be close friends, but they're not close by. They're out of town family, friends, and colleagues. And you can also call them. You can talk to them via email, texting, and they do provide good support. And then there's people who share an activity such as a support group, a class, work. You may not know them before the activity, but then afterwards you get to know them better, and they may move up into being a higher level of social support. And then there are acquaintances, in other words people in the community that you know and see frequently but you don't know them very well, participants in programs, school parents, shopkeepers, et cetera. But the most important one really are family members. Family and siblings can and should be level 1 confidants. This is a picture of my daughter and son on a trip to Africa together, they bonded very closely during that time. The martial relationships are also very important. And family, there's, but they're complex. There's family system, social support, operant conditioning and cognitive behavioral, all play a chronic role in families of patients with chronic pain. So an interesting study done by Turk. We'll have 148 married patients with chronic pain and their spouses showed that positive marital relationships was a critical mediator between spouses' responses to pain and the patient's pain. And also it's reported that poor marital relationships will perpetuate pain, disability, and suffering. And the positive social support does enable a person to recover by encouraging healthy behaviors. So what we need to do is really work on developing positive relationships, particularly with patients who have, or people who have chronic pain. It can be prevented by developing positive relationships. And these are some of the characteristics that can help develop positive relationships. Now, there are many more of these. They're just examples to provide you. Accept and celebrate differences between people. Do active listening. It's probably the single most useful listening skill, is be active. Look at the person. Listen carefully. Respond appropriately, and give people the gift of time by being present in the time that you give people. Don't be doing too many things while you're talking to someone. Give them the gift of time and develop bidirectional communication skills. That it's a two-way street. It's not just listening and not just talking, and be positive and brief in using mobile technology to communicate with people, and learn to give and take positive and negative feedback. Learn to respect and trust. To trust is more important than love. And have empathy. People will forget what you said, but people won't not forget what you did. Or they'll forget what you said and people will forget what you did, but people never forget how you, you made them feel. So showing that empathy is very important. And provide random acts of kindness. Do not always expect something back, for the kindness that you provide. Kindness is reciprocal, it can go both ways, and has far reaching effects, partially mediated by oxytocin. Kindness can ease pain from headaches and back pain, increase sense of exhilaration and euphoria. Now these are providing kindness to others. Random acts of kindness. They can heighten your sense of well-being, a sense of connectedness to others, increase satisfaction through giving. Creating greater sense of calmness and relaxation, and reducing stomach pain from excess of stomach acid secretion, reduces blood pressure and increases energy level. There's many benefits to providing kindness, and will help alleviate chronic pain. Another aspect of improving kindness and compassion is to meditate using, specific meditation called loving-kindness meditation. Now this has been used for centuries in the Buddhist tradition to help develop love for self, yourself as well as others. And transform anger into compassion. So, one eight week study of using loving-kindness program for chronic back pain patients showed significant improvements in pain and psychological distress in the loving-kindness group compared to the control group. And it consistently lowered pain on the same day as well as lowering anger, on the next day. It reduced pain, anger, and psychological distress over the eight weeks. So it can be a very useful tool to teach patients. And then there's also online social support. This can take the form of individual coaching. Monitoring discussion sessions, and open chat rooms. And online support can generally be positive, however there are some negative characteristics too. Positive characteristics include that it can be networked to include patient, providers and families. It can be interactive multi-media self management training. It can support reminders and reinforcement and alerts. And it conduct outcomes over time and communicate to all. And it can evaluate and check knowledge level, compliance, and assimilation knowledge. So lots of positive characteristics of using online strategies for self management and support. But the negative aspects may include, misinformation sometimes is found online. May become a complaint haven of negative attitudes, opinions, particularly if it's a chat room that's not monitored, and sometimes confidentiality may be compromised. So the take home with regard to social support is that there are many reasons why people help others, and it's facilitated by oxytocin. And low social support can be a risk factor for chronic pain. Studies have shown that oxytocin is a powerful hormone supporting love, compassion to help others and reduce chronic pain. It contributes to the helper's high. And there are many different of social support and and emotional support is the most powerful. That's what we need to provide the most to the people around us. And there are different levels of social support also. And the need, there's a need for confidant emotional support is really critical. Develop those close relationships that you can tell, people anything. And social support comes with positive relationships that's based on loving-kindness and honest communication. And this loving-kindness meditation can be very helpful to learn, and on-line social support may prove to be a convenient strategy to gain social support from a distance, but be aware of the po, possible negative aspects also. So I appreciate and thank you very much for your attention with regard to this module and happy to be part of the discussion forum. Thank you very much. [SOUND] [BLANK_AUDIO]
