This video is meant for psychoeducation only. Please consult appropriate healthcare/mental healthcare professionals as required. When we have difficult and painful thoughts, feelings and sensations, we can easily get swept away from them, as they pull us from what’s important to us and how we’d like to be. We can also learn to effectively manage ourselves when these thoughts, feelings and sensations arise.
The chronic pain cycle is essentially what happens to us when we are in pain and let it consume us. First off, this is normal! I totally remembering being there myself. Usually we try to address only part of the cycle, without managing the whole thing (i.e., we like those prescribed medications from our doctors but still get frustrated when they don’t fix everything). I thought today we could talk about a few different versions of the cycle, and address a few ways to address them so that pain is less consuming and we can get back to a life that is closer to what we want.
First off, some of the examples of the pain cycle are pretty basic. Pain leads to sleep problems leads to mood problems leads to decreased activity leads to low energy leads to decreased pain. Or pain leads to muscle tension leads to reduced circulation leads to muscle inflammation to reduced movement leads to pain. And any case, you can start pretty much anywhere in the cycle, but you always end up with more pain. A more comprehensive version of this cycle is shown in the diagram below.
Here’s the problem: our brains tell us that we shouldn’t move, we shouldn’t be active, that things will never be good for us, that we will never have normal lives, etc., etc. because they are trying to keep us safe. Unfortunately, all the research shows that our brains are incorrect and that these thoughts really don’t do us any service. They keep us trapped in the cycle. I remember when I first decided to start making changes for myself. I took myself to physiotherapy (physical therapy for you Americans), the chiropractor, the naturopath, massage therapy, and psychotherapy, because I wanted some relief. What I was encouraged to do was break the pain cycle. How?
Psychoeducation/Health education about chronic pain. I know most of you won’t read scholarly journal articles (as I do) about all of this and that’s fine, but there is a wealth of information on the internet (think clinic websites: Mayo Clinic, John Hopkins, etc.). Also, if you talk to health care provides (your specialist, or any of the above that I’ve mentioned) they will be happy to provide you with the knowledge you need to start making different choices. You just have to be open and willing to listen.
Increase fitness and exercise. This might be as simple as stretches and easy exercises given to you by the physiotherapist, chiropractor or massage therapist. It might also include actual cardio and/or strength training. This should of course be paced, and you should come up with a plan with your healthcare specialists. I went to the gym and got a personal trainer who had worked with people with autoimmune diseases before.
Take your medication. Inflammation in particular is often best addressed with some sort of medication. Of course, there are alternative ways to address it as well, such as through diet or supplements. I like the approach of doing both. I take my medication as prescribed and then balance that with diet.
Address side effects of medication, such as weight gain or others. This might be with your doctor – adjusting doses or which medication you take – or it could be done holistically through other therapies (as mentioned above), exercise, and diet.
Address the cognitive issues that arise. This means anxiety, depression, sleep issues, stress, fear, frustration, anger, negative thinking, rumination, etc. While these are normal experiences, they can make it harder for us to make changes. These can be addressed through sleep hygiene, meditation, and psychotherapy.
Where am I in the pain cycle? Look, to be honest, some days it’s not perfect and I fall right into the cycle. However, most days I can openly and curiously acknowledge and accept my pain, breaking the cycle before it begins. I use all of these tools and healthcare providers because it helps. I know from experience that chronic pain does not have to be life consuming.
I’ve linked episodes of the podcast and my meditation channel throughout this post if you want more information. Until next week, keep making the most of it!
I know there are those of you who don’t like meditation or really believe that mindfulness can have powerful effects on our minds and bodies (there is loads of scientific research on this). What we have here is a why to be mindful, without meditation, and while engaging in an activity we all do – drinking! This can be water, tea, coffee, juice, pop, alcohol, it doesn’t matter. What matters is bringing nonjudgmental, purposeful awareness and attention to your experience.
There are more informal mindfulness practices on my YouTube channel which you can find here.
Let me know how this practice is for you, and keep making the most of it!
Today I want to take a slice of Pete Moore’s Pain Toolkit and share it with you. Who is Pete Moore? He’s a chronic pain warrior who came up with this incredible Pain Toolkit to help others struggling with chronic pain. Here’s the website: https://www.paintoolkit.org/ . The truth is, we can learn to self-manage our chronic pain. Like Pete, I have also learned to do so to a point where, yes I have pain, but no it does not affect my day-to-day life (that’s not to say I don’t have bad days, heck I had bad pain the other night and had difficulty sleeping). One thing we want to do when we have chronic pain is cultivate resilience. Now, I’ve written about resilience before in the past, so I’m not going to go into detail here. For those who aren’t familiar with what resilience entails, here are a few things: optimism, self-belief, willingness, self-control, being able to adapt, psychological flexibility, problem-solving, emotional awareness, social support, and humour, to name a few. So, here are 5 ways we can learn to do this.
Goal Setting and Action Planning – I often set goals for myself, even on days that I’m not feeling great. In our third atmospheric river (basically several days of torrential downpour) since November in BC, Canada, I’m again feeling it in my body. But I know my body also needs to move. So I set a goal for how far I will walk in the rain (which is less than my goal would normally be but appropriate for the weather, my body at this moment, etc.). So, set your goals, and prepare for barriers to them. Here’s a podcast episode I recently did on that.
Engaging in Activities of Daily Living – Getting out of bed, having a shower, eating breakfast, etc. All the regular stuff we do in our lives. It can be really hard to want to do them when you have an illness or pain, but doing them can also improve our overall well-being. Check out this episode of the podcast for more.
Problem Solving – Problem solving can include a lot of different things. Pacing is important and I’ve done a post on that (December 1), prioritizing and planning your days, and really importantly, having a setback plan. What are you going to do when things don’t go the way you planned (in your goal setting and action planning stage). When I was recovering from hip surgery last year, I had to problem solve how to do all of my daily activities because I couldn’t put any weight on my left foot (for 6 weeks!) and I live alone. I still had to figure out how to cook, shower, dress, and even get to some appointments.
Be Active – this will mean a lot of different things to a lot of different people, but it really means to move your body. It could be walking, exercise/going to the gym, stretching, yoga. Exercise itself is an evidence-based treatment for chronic pain (here’s the podcast episode). It can be light movement, as long as it’s movement. I can’t go a day without moving my body. Even when I notice I’m having the thought that I don’t want to move or I’m in too much pain, I inevitably actually feel better if I go for a walk or do some restorative yoga.
Be patient with yourself – offer yourself some compassion. Change is slow. Like it’s an average of 10 weeks for someone to start noticing differences (in their minds or bodies) when they start to make any changes. If you find you’re having difficulty being patient with yourself, try this mindfulness exercise. I’m definitely guilty of wanting change to occur quickly for myself. But interestingly, when I offer myself patience and compassion instead of criticism, change seems to actually occur more quickly than when I’m only hard on myself.
I hope this helps you with some pain management. I know it’s things that have helped me and many others. So, just keep making the most of it!
This meal, with meat instead of a meat substitute, was a staple in my house growing up. I’ve modified it to fit my current dietary/nutritional restrictions and it’s just as good. It also shows that you can cook really delicious vegetarian/vegan meals. Make sure to speak with your healthcare team before making any drastic dietary changes. Check out this interview with Emily Marquis on how to make the changes once you’ve decided on them. Keep making the most of it!
For those of you who are against yoga, because some random person said to you once, “But have you tried yoga?” when you were telling them about your pain or illness, just stay with me for a second. No one likes unsolicited advice, but I’m guessing that if you’re here, reading this blog post or looking at this blog at all, it’s not really considered unsolicited. There is actually a lot of evidence that yoga can be helpful for pain, and I have personally found a huge difference after beginning to practice restorative yoga at the beginning of the pandemic (circa April 2020 is when I began).
Let’s start off by reviewing some of the research as to what yoga can help with and if it actually is beneficial. Guess what? The research is overwhelming a yes, yoga is helpful for chronic pain. There are tons of studies on it but I just picked three for the purpose of this post. Tal, Unrah & Dick (2011) found that pain patients in their study were able to “reframe what it is to live with chronic pain.” What does that mean? Well, not all of there patients actually decreased in the pain itself, but most found that the pain bothered them less. In other words, it was less interfering in their daily lives. Skip ahead to 2019 where Uebelacker et al. found in their study that pain patients who did yoga saw their moods improve, decrease in their anxiety levels and decrease in their pain levels. That same year, Schmid et al. (2019), found that pain patients who engaged in yoga had better occupational performance (they could return to work, do well at work), were more engaged in their regular daily activities, and had less depressive episodes.
This research is all well and dandy but the original intent of my post was to look at the meaning of the word “yoga” and how that in itself shows how it can be helpful to us chronic pain warriors. Yoga is derived from the Sanskrit word “yuj” which means to unite (or unity). This describes unity between the individual with the universe, person with nature, and importantly, mind with body. This is likely why we see things like mood improvements and decreases in anxiety in people who practice yoga, which is mindful movement. A yogi is someone who is self-realized and self-realization leads to freedom. Linking back to the research, freedom to work, freedom to engage in activities, and freedom from pain being “bothersome.” Finally it’s important to note that health (both physical and mental) is a natural result of practicing yoga, for all of the above reasons. Do you have to practice yoga? No. But I also don’t see the harm in trying (assuming you have consulted with your healthcare team).
I hope this brings some insight. Keep making the most of it!
How much time do you spend thinking about your pain or illness? Does it consume most of your day? Just a little bit? I remember the time when I was spending a lot of time thinking about being in pain, and wondering “why me” or what my life would be like going forward etc. These are often referred to as chronicity thoughts. Happily, this was the past for me and is not my experience anymore. I know that many of you may be having this as your current experience though, so I wanted to take sometime to talk about it.
First of all, I want to say that this is a totally normal experience for anyone with chronic pain or a chronic illness. Our minds are literally trying to help us (or they think they are trying to help us, which is what they evolved to do). The problem is, this kind of constant thinking about pain makes our lives worse, not better. There are three types of common chronicity thoughts: (1) ruminating about being in pain/sick – I keep thinking about it, it’s all I can think about because it hurts; (2) magnifying our pain/illness – it will get worse, something terrible is going to happen; and (3) thoughts of helplessness – nothing I do makes it better, nothing I can do will ever make it better.
If you went to a doctor (Western or functional) or a therapist, they’d likely assess this with a tool called The Pain Catastrophizing Scale (PCS). My commentary is that I don’t like the name because “catastrophizing” sometimes has the connotation that it’s all in your head, but that’s not what it means in this case – it’s really referring to chronicity thoughts. The questions on the scale include:
I worry all the time about whether the pain will end
I feel I can’t go on
It’s terrible and I never think it’s going to get any better.
I wonder whether something serious will happen.
and so (there are 13 questions total, and you self-report on a scale of 0-4 for each question, with 0 meaning not at all and 4 meaning all the time.)
So what can we do about all these chronicity thoughts? First, I will always suggest that working with a therapist is the way to go. Remember this blog is educational and not mental health/medical advice. We all have unique situations and unique thoughts, so having someone you can work with one-on-one (or in a small group) is always the way to go. I will let you know about a few different approaches. First, let’s talk about classic Cognitive Behavioural Therapy approach, where we challenge thoughts.
Notice and name the thought: I’m having the thought that “It’s terrible and I never think it’s going to get any better.”
Review evidence for and against the thought: For might include things like, it occurs frequently, has high intensity, a doctor’s prognosis, etc. Against might be things like, there are times of day when I don’t notice it or it’s less intense or my doctor said with this medication or these lifestyle changes it will improve
Replace the thought with a more accurate one: This doesn’t mean being optimistic or denying anything that’s true. Instead it’s incorporating the evidence against the thought (not just for the thought which is what we tend to do). So a different thought might be: “It’s really unpleasant right now, but it might not always be this bad/constant.” (You choose a thought that works for you, this is just what might work for me.)
As a therapist, I am well-trained in CBT but I prefer to use Acceptance and Commitment Therapy (ACT) on myself and with clients, especially those with chronic pain/illness. There is no step-by-step way to challenge thoughts in ACT because we don’t challenge them, but here’s now I might work with them.
Contact the present moment: ground myself my noticing and acknowledging my thoughts and feelings, while noticing what I can touch, taste, smell, hear, and see. (Here’s a guided version of this).
Creating distance between myself and my thoughts: This might be noticing and naming the thought. It might be reminding myself that my brain is just trying to help me and saying “thank you mind.” This might be just watching my thoughts come and stay and go in their own time (guided version of this one is here).
Accepting my experiences: particularly physical and emotional pain that I might be going through. This could be actual sensations or emotions such as sadness or anxiety. For this I often just observe what the sensation/emotion looks like, where it is in my body, and so on. Then I send my breathe into the part of my body I feel it most intensely. Then I make some room for it, noticing that my body is bigger than it. Finally, I just allow it to be there without consuming me. (Guided version here).
I connect with my values: what qualities of being are important to me? I know that compassion (for myself and others) is a big one that is often helpful in moments of pain, sadness, anxiety, etc. (Here’s an exercise on connecting with your values.)
Taking an action to live by my values: So if we’re going with my above example/value than it might be doing some self-compassion work. (Here’s a guided practice). It could also be setting goals to make some of those lifestyle changes that might help. It doesn’t matter what the action is as long as it is rooted in your values. (podcast episode on how to do this available here).
So that’s it. A bunch of different ways to work with your chronicity thoughts so that hopefully you can improve your life and keep making the most of it!
Mindfulness is a skill we want to develop because it can help so much with chronic pain and a lot of mental health issues. Meditation is the best exercise for that muscle. Looking back, I wish I had started practicing meditation when I was much, much younger. However, I’m glad I did start because there have been so many improvements for my overall wellbeing.