Updated: Jul 30, 2020
Do you struggle with chronic pain? Read on if you want some information on how to better manage pain.
I was an elite competitive gymnast for 12 years before college. I thought that my college scholarship was the beginning of my career, but shortly after I experienced a career-ending injury - an Achilles tear requiring two surgeries that put me on crutches for 8 months and out of commission for almost two years. Growing up in the gymnastics world, I was no stranger to injuries. I completely subscribed to the get-tough/push-through mentality, believing not only that injuries were part of the job, but that pushing through injuries was strength, that it was "cool" to compare scars, that my worth was hinged on my ability to keep going even when my body wanted to give up. This mentality was definitely helpful - it got me through gymnastics in the short-term. What I didn't know is that these injuries and pushing my body to its literal breaking point would have consequences for years to come. I now suffer from chronic pain, through a combination of old injuries and some other chronic health conditions that are just part of my genetics (but may have some roots in gymnastics, surely).
If you're an athlete like me, or a performer, or a member of the military, or have ever had a physically demanding job, you're at so much more risk for injuries and chronic pain. What you might not know is that 50 million people in the United States struggle with chronic pain. That's 20% of the U.S. population. Most people think chronic pain is simply about the physical sensations of pain we experience, but it's actually more complicated than that.
Pain is comprised of: 1) physical sensations, 2) emotional reactions, and 3) how pain impacts activities of daily living (or ADL's; things like sitting, standing, putting clothes on - the things that help us live our lives). Most people trying to manage pain over-focus on #1 and miss #2 and #3. Probably because the physical sensations of pain are the most distressing - and some of us might not even be aware of the impact of pain on our emotions or daily functioning. It's kind of like treating the surface instead of treating the root of the problem, or thinking of the short-term instead of the long-term.
Even worse, most people try to manage chronic pain with medicine (including opioids), alcohol, or distraction. Our efforts to manage chronic pain include numbing the pain or avoiding it. Chronic pain is a long game. You're in it for the long haul. All those short term strategies seem really shiny and alluring, and they work to a certain point, but they're not going to keep you going in the long-term. So what is?
Here are some tips for managing the emotional side of chronic pain in the long-term.
You can remember them by using the acronym, don't FUSS with pain.
F - stop FIGHTING pain
When we experience pain, we not only experience the pain that we feel, but we also experience emotional distress from pain. We call this suffering. Suffering occurs when we fight reality. Suffering with chronic pain might look or sound like, "I wish this didn't hurt anymore," "why can't this be different," or "this sucks." And honestly, experiencing chronic pain does suck. But wishing it were different and fighting reality makes it suck worse. So in order to reduce our suffering, we can stop fighting pain and accept our reality.
Accepting reality is accepting our situation as it is right now, without worrying about what will happen in the future or what happened in the past. We know that we are in pain right now, but we can't buy into the stories we tell ourselves that the pain will last forever or things will only get worse - we don't actually know that. Accepting reality might look or sound like, "I'm noticing I feel this pain right now"; "The pain I feel right now isn't going to last forever"; or "I'm going to do my best to make myself more comfortable." Just because we accept something doesn't mean we like it or approve of our situation, but accepting it helps reduce the emotional suffering that we feel, so that we can then focus our energy on other things that are important to us. By accepting reality as it is right now, we still feel the pain, but we don't add the suffering on top of it, which helps us manage in the long-term.
Here is a great video explaining the concept of Radical Acceptance, which is a skill that helps us not fight reality. Check it out here: https://youtu.be/iVwIVwGOnpo
Accepting reality is easier with mindfulness.
U - Use mindfulness
Mindfulness is focus on the present moment. It is noticing and observing physical sensations, thoughts, and emotions, without judging ourselves for experiencing them. It is just noticing what is, rather than assigning extra meaning and judgments to what is.
Click here for more information on the basics of mindfulness. Mindfulness has numerous benefits - it helps us manage emotions, focus attention, reduce anxiety/stress, and promote relaxation in the body. It even helps us feel less fear by changing our brain chemistry. But mindfulness is also crucial for managing chronic pain.
Mindfulness, or specifically Mindfulness-based Stress Reduction (MBSR), is one of the most effective strategies for chronic pain. MBSR has shown to reduce pain intensity, improve quality of life, and reduce distress from pain. Practicing mindfulness deliberately and intentionally for 5-20 minutes a day can help with the experience of pain.
Here are some mindfulness strategies to try:
1) Belly breathing: Belly breathing is breathing using your diaphragm (a dome-shaped muscle that sits below the lungs). Often when we breathe, we use our chest muscles, which just increases muscle tension, creates shallow breathing, and gives us more anxiety. The key is to breathe using your belly (think like you're filling up a balloon), and emphasize a long exhale through your mouth. The exhale is what releases muscle tension and reduces anxiety. Here is an instructional video on how to breathe using your diaphragm.
2) "Just noticing" skill: Noticing sensations, emotions, and experiences without judging them. You might say to yourself "I'm noticing I'm feeling frustrated with my pain" or "I'm noticing feeling anxiety in my belly right now." Just noticing means not getting caught up in the meaning of the pain, not worrying about how long it will last, not jumping to conclusions that the pain means something catastrophic ("something must be really wrong"). We are just noticing what is.
3) Body Scan. The body scan skill is a way to notice what your body is feeling. It is the opposite of numbing out, and involves actually leaning in. It's asking yourself, "What do I feel right now?" You might start with your face and notice the sensations, and then move down to the neck, back, etc. and flow through the body. Check out a simple body scan mindfulness here, and a body scan specifically for chronic pain here.
Remember, there isn't a right way to practice mindfulness. Mindfulness is all about effortful attention on the present moment.
Check out these links for mindfulness exercises you practice do for chronic pain.
If you're interested in reading more about chronic pain, check out a new book on mindfulness meditation for pain relief by the expert in this area, Dr. Kabat-Zinn. You can find it on amazon here.
S - Set realistic expectations
It's important to set expectations that are realistic - not too high or too low. This includes physical and emotional expectations. It's unhelpful to think that your pain will continue forever, but also not helpful to think it'll be gone tomorrow. Chances are, if you're struggling with chronic pain there are going to be good and bad days, and the intensity and struggle of your pain will vary. Take it day by day.
Set baby steps that feel manageable for physical tasks. Start with the smallest step you can think of. Do the same for the emotional aspects of pain. If you're unable to reach a goal or expectation one day, remember that you can try again tomorrow. Listen to your body; chronic pain is a long-game and so it's not helpful to push yourself past your limits to reach some self-imposed goal. Baby steps add up to big steps.
In managing my own pain, one of the most helpful things for me was rejecting the
push-through mentality I learned from gymnastics and actually listening to my body. I prolonged my pain for so long because I continued to exercise and push through the pain, even though it hurt. Then for years I stopped exercising completely because I was so afraid of making the pain worse. It was only when I started to set manageable expectations that I landed in the middle - I tried things out, realized realistic ways for me to move my body that was both good for me and didn't make my pain worse.
S - Seek support
Chronic pain is really hard to manage on your own. Emotional pain can be easier to bear when we have others to share it with. Pick people who have some understanding of chronic pain or can empathize with it. Avoid people who say unhelpful things like suck it up, just think positive, or yeah I broke a bone once and now it's healed but it was really hard.
Do you have a friend who can make space for you to voice your frustrations? If not, what about a supportive caregiver? A therapist can also be a source of support to not only learn skills to manage pain, but be a sounding board for how hard it is to live with pain everyday.
Support groups can also give people a listening ear, peers to relate to, and skills to manage pain. Here are a few online support groups:
Pain Connection https://painconnection.org/ offers monthly online conference calls. All support groups are free of cost.
Ben's Friends http://www.bensfriends.org/ offers online support forums for people living with various types of chronic pain.
You can also find support groups through the American Chronic Pain Association https://www.theacpa.org/about-us/support-groups/
In summary, don't FUSS with pain. Stop fighting pain/reality, use mindfulness, set realistic expectations, and seek support. Living with chronic pain is a difficult reality, but you're not alone. We feel better when we share our experiences with others. Feel free to share and comment on this article to connect with others who also experience chronic pain.
What are other ways that you manage chronic pain? Comment below!
Disclaimer: The information and practices in this article are not meant to diagnose or treat chronic health conditions. If you're experiencing chronic pain, make sure to follow-up with your physician.