Accepting Chronic Pain: A Lifetime's Journey

For my chronic pain clients and myself, living with chronic pain is a big challenge and a lifetime journey.

From the first moment you experience the pain, to the moment you see your doctor, to the time you start realising this might be with you for a while, it's an emotional rollercoaster ride.

Let me take this ride with you and explain some the "milestones" you can expect on this journey.

First sign of pain

Whether you've injured yourself, had a build up of stress which you're now feeling in your body, or the pain seemingly came from nowhere, this acute pain is uncomfortable and often times distressing.

This experience of pain is your brain's way of letting you know that a threat is present and to engage in a flight/fight response to get you through safely. That translates into doing things to avoid the pain (e.g. staying off that sprained ankle) or "fighting" the pain by tackling it head on (e.g. seeking treatment).

In seeking help, most people's first point of contact will be their GP or Physiotherapist to explore a potential injury and/or seek short-term relief (e.g. medication or manipulation).

Why am I still in pain?

Chronic pain is defined as pain that has lasted longer than expected (e.g. >10-12 weeks with a typical broken limb) or has an unknown origin but lasting >3-6 months.

Chronic pain can develop for a number of reasons:

• physical recovery taking longer;

• nervous system becomes 'sensitised' to the pain;

• our fearful thoughts and avoidance behaviours give the pain more "air time" and power in the brain;

• existing issues with sleep, anxiety, depression etc., may make you more vulnerable to developing chronic pain;

• the more we avoid doing things, the more likely our muscles will deteriorate and secondary issues can develop.

Where can I turn to?

A multidisciplinary approach has been found to be the most effective way to manage chronic pain. This includes various medical and allied health professionals working together as a team to provide holistic care. This approach is helpful because it takes into account the fact that chronic pain can impact every part of your body from head (i.e. our mind) to toe.

These multidisciplinary teams may include:

• Pain Specialist

• Nurse

• Physiotherapist

• Exercise Physiologist

• Podiatrist

• Dietitian

• Occupational Therapist

• Psychologist

This is not to say that only these professions can help with chronic pain, but typically, chronic pain management programs will have some of these professionals as part of their team.

These programs can range from shorter workshop-type sessions, to ongoing treatment appointments to inpatient programs. Everyone's needs are different so please speak to your GP to explore what will work best for you.

How can Psychologists help?

Psychologists can help because there is a mental component to pain. I'm not saying that "it's all in your head", but your head (i.e. mind) certainly has something to do with it.

When we're in pain, our mind will naturally pay attention to the pain because it hurts and is therefore deemed a threat to our wellbeing. In chronic pain, we have become used to paying attention to our pain and over time, our body will become 'sensitised' to the pain. That is, our threshold for noticing the pain will become lower and lower and objectively less painful things, will feel more and more painful.

Psychologists can help by looking at the unhelpful thoughts that we might have developed over time to see how it may be hindering our ability to live life despite the pain (e.g. "I can't get out of bed because my back hurts").

Psychologists can then help us shift our thoughts to be more realistic and helpful so that the pain doesn't have to get in the way of us doing what we want to do (e.g. "Although it hurts, I know if I do my stretches, I'll feel a bit better and get stronger over time").

Psychologists may use approaches like Cognitive-Behavioural Therapy or Acceptance and Commitment Therapy to help change the relationship we have with our thoughts around pain.

On the road of acceptance

Over time, you may come to realise that the pain isn't going anywhere. That is a really hard pill to swallow and will be more challenging to accept when you're in the middle of a flare up. But that doesn't mean the pain has to get in the way of us living a meaningful life.

Yes, it does mean we might have to think a bit more and problem-solve how we do certain things (e.g. housework) so that we can have the physical, mental and emotional energy to do other things (e.g. hang out with friends), but that's not unlike other things we have to consider in life too, such as money.

For example, when we budget, we may be more careful with our spending so we can save for a holiday. We stop spending on smaller, less meaningful things (e.g. buying that random knick knack) so that we can enjoy the bigger rewards (e.g. a holiday). Or, maybe you decide to buy that knick knack but that means having to accept the consequence of delaying the holiday a bit more. At the end of the day, there's no right or wrong answer, it's whether or not it's worth it to you.

This is the idea behind pacing in chronic pain management. We are more strategic with how we spend our energy on low-stakes tasks (e.g. "I have to do the vacuuming in one go") and instead learn to break it down into smaller bite-sized chunks so that we can have the energy to do more meaningful tasks (e.g. take the kids out to the park).

Once we're able to accept this change, the pain is less likely to get in the way of us pursuing things we would like to do (which could include vacuuming!). Chronic pain is something we can work around most of the time, but that doesn't mean flare up moments are not debilitating.

What we aim to do in chronic pain management is to reduce the:

• frequency of flare ups (i.e. how often they happen);

• intensity of flare ups (i.e. pain rating /10);

• duration of flare ups (i.e. how long it lasts for).

If we can change any one of these factors, this could represent a significant change in functioning and lead to more opportunities to lead a fulfilling life despite the pain.

Conclusion

No one wants to be in pain but for some, this is our daily reality and a lifetime's journey.

If the pain's around every day, then it's no longer the deciding factor in the choices we make.

"No matter what option I pick, I'll still be in pain". Therefore, why not pick the option that you want to pick and through chronic pain management strategies, we can figure out how to do this with the least amount of impact on your ongoing functioning.

It's not an easy road to go down, but you don't have to do it alone. There are trained professionals who can help with your journey of living your life to the fullest. Despite the pain.

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If you need urgent assistance, please contact your doctor, or emergency hotline.

If you are in Australia, please contact the following 24/7 services if required:

• Ambulance, Police, Fire 000

• Lifeline 13 11 14

• Suicide Callback Service 1300 659 467

• Beyond Blue 1300 224 636