What Would You Do If You Had Less Pain?

 

  1. Everything
  2. More of What I am Doing Already
  3. Clean My House
  4. Go Back to Work
  5. Exercise

1. If you chose Everything, you are among a noble, but misguided group of people who are thoroughly frustrated by being slowed down by pain. You have been dedicated to finding a fix for your condition and impatiently waiting to resume moving at the rapid pace you used to run through each day. You lament how much you used to do, continually comparing yourself to your pre-pain self.

Solution: Break down your Everything into tangible bite size pieces. What specifically would you choose to spend your time doing if you felt better? Pain can push us to prioritize what is truly important. Everything cannot be important anymore, so as much as you are tempted to fight it, begin to narrow your focus to what you really care about and allow this value to be at the forefront of each day. This will be a challenge if you are used to doing it all or thinking that you should be able to. Letting go of this old belief will make room for creatively reaching toward what you most value.

2. If you chose More of What I am Already Doing, this is an indication that you are already plugged into those activities that you value, but unsatisfied with the level you are currently participating in them. Your identity may be tightly entwined with your accomplishments.

Solution: Ask yourself, when will it be enough? When will I be satisfied with busy-880800_1920what I accomplish? Do I hold myself to a realistic and flexible standard? Pain does slow us down, but this is not always a negative thing. It can open us up to the beauty of seemingly small everyday things that often go unrecognized until we are brought to the moment. Discomfort can bring us to the moment, but it is up to us to find the beauty contained in that moment.

3. If you chose Clean My House, you may be among the many obsessively clean people or among the multitudes who are overwhelmed with too much stuff.

Solution: Your home may be messier than you prefer because you cannot scrub, stand, reach, or bend as easily as you used to. However, it may improve your daily quality of life to let go of some cleaning ideals and at the same time, simplify your environment. Having too much stuff to maintain makes it harder to navigate your home when you are hurting. Redirect your attention to those items that bring you the most joy – books, favorite heirlooms, artwork – and discard as much clutter as you can. This will free up space and energy for the relationships and activities that matter to you more than a clean house while at the same time tidying things up.

4. If you answered Get Back to Work, this is a good sign that you seek meaningful activities and find purpose in what you do. Many people have found that letting go of what they used to do is like losing part of their identity. On the other hand, dissatisfaction on the job is associated with more pain — so finding ways to enjoy work to some degree is important.

Solution: If you used to do work that would be harmful for you to return to, the harsh reality may be that you will have to reinvent yourself. List your current skills and other skills you may wish to acquire. The fear of failure can be strong, but do not underestimate yourself even with physical limitations. Many activities within a job can be modified, as there are hundreds of thousands of people living and working with chronic pain. At first, many people cannot imagine doing anything other than their previous vocation; however, those open to reinvention sometimes find even more fulfilling work than before.

5. If you said Exercise, you may be among the many people who have given up your favorite sport or exercise routine due to a painful condition. This is frustrating as a sedentary lifestyle can tumble into a myriad of other health problems. Dr. James Levine has said to the Los Angeles Times, “Sitting is more dangerous than smoking, kills more people than HIV and is more treacherous than parachuting. We are sitting ourselves to death.” Americans sit upwards of 13 hours per day between desk work and screen time at home. This does not include the 7-8 hours we spend in bed! But how do we exercise with chronic pain?

Solution: How much are you moving currently? Starting at your actual current aerobic exercisebaseline is the key to beginning a movement routine and gradually, gradually, increase in very small steps. This is the best way to reach your newly revamped realistic movement goals while avoiding major setbacks. You may not be able to do the gym workout you used to, but gentle movements are still movements and movement is essential for chronic pain and the prevention of many illnesses. Americans watch an average of 4 hours of television each day. What would it be like to add 4 minutes of easy movements to each of those 4 hours? That would be 16 minutes of movement in bite size chunks.

Exercise may not look how it used to. Many people with chronic pain find that pool therapy or stationary bikes work best for them. Others find the movements of qi gong or tai chi are easier than yoga or Pilates, and you still get the benefits of increased circulation, improved balance, better mood and deeper sleep. Build your tolerance slowly and then gradually increase the “dose.”

Date of last modification: 9-27-2016

Author: Jessica Del Pozo, Ph.D.

Dr. Del Pozo is the founder of PACE, a four-week chronic pain management program (www.paceforpain.org). PACE provides cognitive-behavioral therapies and mindfulness training for those with chronic pain as well as consulting and training services for healthcare providers. She is also the co-author of The Gut Solution (www.thegutsolution.com), a book for families with IBS utilizing SEEDS (Stress, Education, Exercise, Diet and Sleep), a biopsychosocial approach to IBS and RAP. Dr. Del Pozo is also on staff of a multi-disciplinary pain management program at Kaiser Permanente, where she helps many patients refocus their strengths to manage pain without opioid medications.

Coping with Pain: How People Who Cope Really Well Do It

If you wanted to learn how to knit well, you might take a class at your community craft store. You might also get a how-to book out of the library or watch a few YouTube videos. But as you did all these things, you would also pay attention to those who already knit well and watch how they do it. You would then try to do what they do. The same thing would be true if you wanted to learn how to play a musical instrument well or play a sport well or fish well. Say, for example, you wanted to learn how to become a better guitar player. You would probably take lessons from a teacher. You might read how-to books and watch videos on the internet. But you would also listen to how really good guitar players play. And you would try to play like them.

Why shouldn’t the same thing be true with coping with pain?

If you wanted to learn to cope with pain better than you do at present, then you likely would do a few different things. You might find teachers to teach you how (usually, when it comes to chronic pain, such teachers are called chronic pain rehabilitation providers and are found in chronic pain rehabilitation programs). You might read about how to do it (such as in blogs and self-help books). You might also watch videos on the internet (such as this one here).

Also, though, you might try to learn from those who cope with chronic pain really well. Just like learning any other skill, it is helpful to learn from those who do it well. You learn what they do and then try to do it yourself. Of course, like any skill, it takes practice and sometimes it takes a lot of practice.

Looking at coping from this perspective takes the mystery out of it. Coping with pain involves skills like any other skills. In this way, it is just like knitting, playing tennis, fishing, or playing the guitar. These activities are all a set of skills and similarly coping with pain is a set of skills. Like any other set of skills, the more you learn about how to cope and the more you practice, the better you get at it.

Skills, like coping with pain, might be thought of as occurring along a spectrum in which there is no endpoint. There is no point at which you are as good as you possibly ever will get. No matter how good you are at a particular skill, you can always get better with learning and practice. Whether you are a novice tennis player, a pretty good tennis player, or a professional, you can still get better at playing tennis. You can always hone your skills and get better with practice. The same is true with playing a musical instrument. Whether a beginner or a virtuoso, the musician can always get better with learning and practice. The same is true with coping with chronic pain. No matter where you are on the spectrum of coping with pain, you can always get better at it.

Looking at coping in this way takes the judgment out of it. You don’t have to feel bad if there is more for you to learn about how to cope with chronic pain. Everyone, no matter who you are, can learn how to cope with pain better. In reality, it’s true of coping with whatever problem you face. There is simply no endpoint at which someone knows all there is to know about how to cope with the problems they have.

Let’s, then, look at what people do when they cope really well with chronic pain. Research psychologists spend a lot of time studying how people cope with adversity of any kind. Clinical and health psychologists spend a lot of time teaching patients how to overcome adversity. Based on this research and clinical experience, we might review a number of skills and attributes of people who cope well. The point here is that it is a learning process. Just like the guitar player who studies superstar guitar players by listening to them and trying to do what they do, let’s review the skills and attributes of people who cope really well with chronic pain. By doing so, you learn from them and can practice doing what they do.

As we do, try not to feel bad about yourself if you don’t do exactly what they do. Remember the point about the spectrum of coping with pain: coping is a set of skills and no matter how well (or not-so-well) you cope with chronic pain, you can always get better at it. It’s true for everyone. So, don’t feel bad if you can learn a thing or two. Everyone is in the same boat as you are. (In fact, rather than feeling bad about it, celebrate it! Isn’t it great that you can learn to cope better with pain!)

There are almost countless ways to get better at coping with chronic pain. In this post, we will review five of them. We will then review five more in the following post. The intention is for these posts to be a series that reoccurs on a periodic basis.

Skills and attributes of those who cope with chronic pain really well

1. They are open to change and learning from others.

People who cope with pain really well are open to change. They recognize that things will have to be different now that they have chronic pain. In this way, they are flexible and adaptable. They do not insist on returning to exactly how they were the day before they were injured or became ill. They recognize and accept that doing so would be impossible. Rather, they are open to new ways of living. They adapt their work positions or even seek out new employment positions that work well with their chronic pain condition. They find new social and recreational activities. If it hurts too much to stay in the bowling league, they join a cribbage league instead. They also find new ways to stay involved in their religious or civic organizations. Because they are open to change, they might still work or still have fun with their friends and family and are still engaged in their community, despite the chronic pain.

People who cope well with chronic pain are also open to learning from others. They don’t get offended or defensive or nervous when talking about how they might come to learn better ways to cope. Rather, they acknowledge that they don’t know everything there is to know about coping with pain. They also recognize that there is no shame in learning new ways. Like we did with the discussion above on the spectrum of coping, they understand that they can learn a thing or two and don’t feel bad about it.

2. People who cope really well with chronic pain accept that their pain is chronic.

Initially, it might seem counter-intuitive to accept that your pain is chronic. Understandably, many patients want to maintain hope by trying to find the right specialist who can cure them of their chronic pain. At some point, though, it’s helpful for most patients to recognize that medical management has its limits. Why? Because when your pain is truly chronic, it means that it is not curable. Chronic health conditions are conditions for which we have no cures and for which the patient will have to live with. Insistence on finding a cure long after it is reasonable to recognize that your pain as chronic becomes itself a problem. It can reduce your ability to cope because it leads to a vicious cycle of false hope in a cure that never comes followed by failed treatment and then disappointment. Hope and disappointment is a common theme as patients talk about what they have tried when attempting to cure their pain – the various medications, injections, and surgeries they have tried. If this cycle continues for too long, patients come to feel hopeless and depressed.

So, at some point, it is helpful to accept the chronicity of chronic pain. People who cope really well with chronic pain do it. They don’t spend time trying to fix what is ultimately an unfixable problem. They recognize it would be a losing battle and that it would lead to becoming hopeless and depressed.

3. Instead, people who cope really well with chronic pain focus on what they can do to manage their pain.

They seek out things that they can do to manage pain rather than looking to other people or other things to manage their pain for them. They don’t see ‘pain management’ as something that their healthcare providers do or that their medications do. Rather, they see that the lion share of it is their ability and responsibility.

They have a routine of ways to self-manage their daily level of pain. When they have a typical pain flare, they ask themselves what’s going on in their lives that might be contributing to it and then set about to resolve it. In short, they consider themselves to be primarily responsible for their health in general, not their healthcare providers.

This point is true of all people who cope well with any chronic health condition. The person who copes well with heart disease is typically one who doesn’t primarily rely on healthcare providers to manage the disease for them. Rather, one who manages heart disease well is one who quits smoking, engages in regular exercise, changes their diet, loses weight, and manages stress. Of course, they might see healthcare providers too. However, it is a matter of emphasis.

People who manage chronic health conditions well are those who primarily see their health as their responsibility and so rely on their healthcare providers less, rather more.

This emphasis on what the patient can do is called empowerment. People who cope with pain really well feel empowered and confident in self-managing their chronic pain. They know what their pain is. They are not alarmed by it. They know what to do about it. And they do it.

4. People who cope with pain really well exercise on a regular basis.

Typically, they engage in a low-impact, mild aerobic exercise at least three to four times per week. Examples are walking in a pool, walking outside or on a treadmill, riding a stationary exercise bicycle, or using a stationary arm bike. All these exercises involve a low degree of impact to the body. However, they all are aerobic, or cardiovascular, exercises. That is, they get your heart rate up.

The importance of a mild aerobic exercise is its effect on the nervous system. Following an aerobic exercise in which you get your heart rate up for a period of time, the nervous system relaxes. You feel grounded. You have a sense of well-being. It’s why people exercise to manage stress. Runners call it ‘a runner’s high.’ However, you don’t have to run in order get it. The exercises listed above will do just fine.

Why is this important and why is it helpful? It’s because chronic pain is a nervous system condition. Whatever the initial cause of your pain, if you have chronic pain, then you have a nervous system that is stuck in a persistent state of reactivity, making the nerves super-sensitive. Any little movement sets the nerves off firing pain signals to the brain. People who successfully self-manage chronic pain maintain their nervous system reactivity in the lowest possible state. One of the many ways to do this is to engage in a regular, low-impact aerobic exercise.

Following each time you engage in an aerobic exercise, your nervous system relaxes for a period of time. Of course, since you have chronic pain, it returns to a higher level of reactivity after awhile. However, if you do it again and again, on a regular basis over time, your nervous system returns to lower and lower levels of heightened reactivity. In effect, you are down-regulating the reactivity of your nervous system. As such, you have less pain and more ability to cope.

Also, regular aerobic exercise improves your mood. Again, many people exercise solely for its stress-relieving properties. When we engage in an aerobic exercise, we feel good, not only physically, but emotionally too. When you exercise on a repetitive basis, your mood gets better and better. Consequently, when your mood improves, you cope better with the chronic pain that remains.

For both of these reasons, people who cope with pain really well almost always engage in a low-impact, mild aerobic exercise on a regular basis.

(Let me make two quick notes before moving on. First, you should always check with your healthcare provider before starting an exercise routine for the first time. Chances are, they will be quite supportive of the idea. However, some people might have medical conditions that can complicate matters and for which you need specific instructions for your specific condition(s). Second, many healthcare providers continue to treat chronic pain as if it is the result of a long-lasting acute injury. They subsequently recommend stretching and core strengthening exercises. These might be helpful, especially if you are out of shape and would find walking, for instance, too difficult. However, their effectiveness for chronic pain is limited. They are best seen as a way to get you into enough shape that you could then transition to a low-impact, mild aerobic exercise. They are like a bridging exercise to get you to your goal exercise.  In and of themselves, you probably don’t want to expect a lot of improvement in pain or coping from them. Improvement comes when you are able to engage in a mild aerobic exercise over time. )

5. People who cope really well with chronic pain understand the relationship between pain and stress.

They understand that they have to keep their nervous system in check. They understand that whatever affects the nervous system also affects pain levels. Moreover, they understand that stress affects the nervous system. They subsequently use this knowledge to help them cope with pain: one of the chief ways to manage chronic pain well is to manage stress well.

People who cope with pain really well see life’s problems in terms of their stressful impact and how these stressful problems make their pain worse. They see such problems and automatically assume that the stress of them affects their pain levels. Any of life’s problem can be stressful, of course, but some examples are you and your spouse not getting along, your kid getting into trouble, a period of insomnia, getting behind on bills, or the loss of a loved one. People who are coping with pain really well take it for granted that these kinds of problems make their pain worse.

This knowledge allows them to cope with pain well in two different ways. First, they understand that their pain levels are in some ways a barometer of what else is going on in their life. They always have, of course, some baseline level of pain from the pain condition they have. However, what makes their pain wax and wane beyond the normal level of pain is how much stress they are experiencing. If their pain is through the roof one day, they ask themselves what else is going on. They subsequently identify the stressful problem and set about working on it. By resolving the problem, they reduce their pain back down to their normal level of chronic pain. In this way, managing stress is a way of managing pain. Second, by knowing the relationship between pain and stress, they don’t become alarmed when experiencing a pain flare. They don’t, for instance, think that their underlying health problem is worsening or they don’t think it is necessarily cause for seeking repeat diagnostic testing. They know what it is and can identify where it is coming from. They know that it is a stress-induced pain flare. Then, they set about trying to resolve the stressful problem and reducing the reactivity of their nervous system.

In these ways, they remain grounded, empowered, and in control. These are attributes of those who are coping with pain really well.

For more information, please see the next post in the coping with pain series here.

Author: Murray J. McAllister, Psy.D.

Date of last modification: April 21, 2014