We can begin to learn to become more willing with different sensations and emotions by practicing with our breath. As we learn to make room for urges, emotions and sensations, we offer ourselves more choices in life to live by our values. Please read the disclaimer at the beginning of the video. Only participate if it is safe for you to do so. If you are unsure, please speak with your physician.
If you’re just tuning in this week, we’re halfway through a 4-part series on some of my favourite pain coping skills. Why are they my favourites? Well, for one, they all have worked for me so direct experience is useful. Two, they are all evidence-based – there has been scientific research on them (and yes, I’m nerdy enough to spend the time reading the articles published in scientific journals). Third, I see them work with my clients in my counselling practice. And as such, I thought it was about time I shared them all with you. This week we’re talking about self-talk and changing that from the harsh inner critic to something a lot more compassionate.
Recently I wrote a post about being kinder to ourselves, which seems to be quite popular, so we can think of this as an extension of that. Most people have a harsh inner critic, or voice in their heads, telling them that they aren’t good enough, or shouldn’t have done this or that, etc. The voice is there for evolutionary purposes (see the video below on the caveman mind) but it unfortunately isn’t too helpful in our modern world. When we have chronic pain, the voice often shows up as “you’ll never be able to do anything again,” “this is what your life is now,” “no one will ever love you if you’re like this,” etc. Sound familiar? If it does, know that you’re not alone. This is extremely common. But what if we could combat this voice somehow?
The great thing is, we can learn to respond to it with a compassionate voice. No, that inner critic voice probably won’t just go away (remember, we evolved to have it). But we can learn to respond to it differently. We don’t have to just listen to it, give into it, get hooked by it. This takes some practice though.
I recently went through the Mindful Self-Compassion Workbook by Kristin Neff and Christopher Germer. In it there is an exercise on developing your compassionate voice. You are supported to think about a behaviour you’re struggling with. Then notice what your inner critic is saying. So example, with chronic pain this might be getting up to go for a walk or clean the house, etc. Your inner critic might be saying “you’re never going to be able to do these things again.” Then you are to try out a few self-compassionate phrases. Such as “I am here for you, and will take care of you.” or “I know you are suffering. I love you.” And so on. It should be something you really need to hear. Then when that critical voice appears, we can use our new phrases to respond to it.
What does this do for us? Well for one, it greatly improves our mood. The relationship between low mood and chronic pain has well been documented (low mood creates more pain, more pain creates lower mood). So by improving our mood, we may actually have less pain (I find this is very true for me). It is also more motivating to respond this way. Yes, it may be hard to engage in the behaviour, but by being here for yourself, supporting yourself, you may be able to take some steps (however small) toward doing that behaviour.
I hope this helps with your chronic pain coping. As always, keep making the most of it!
It’s common to get overwhelmed by your emotions, and equally common to get overwhelmed by sensations when you have chronic pain or chronic illness. I know, because I’ve been there with you. Today I’m giving some psychoeducation on these storms and one way you can learn to deal with them so you don’t get swept away.
This is part 2 of my 4-part series on my favourite coping skills for chronic pain. These are all things that I use and find helpful. Additionally, they all have scientific evidence supporting them as being helpful. This week we’re going to talk about relaxation: how it can be beneficial and some ideas for incorporating relaxation into our daily lives.
Let’s start with what the research says is helpful about incorporating relaxation into our “treatment” for chronic pain. Relaxation enhances our ability to tolerate pain. But how does it do this? First, it increases our brain’s ability to respond to endorphins, which are our body’s natural pain relievers. Second, it reduces inflammation, which is often a cause of pain. Third, it allows our muscles to relax, and tense muscles tend to cause more painful sensations than relaxed muscles. Fourth, it reduces hypervigilance and desensitizes our central pain pathways, meaning that it helps to decrease our sensitivity to painful sensations. Fifth, it improves our mood and makes us less emotionally reactive to our pain, and since we know the mind-body connection is a thing, this makes sense. I also want to point out that the research states that mindfulness skills are more effective than relaxation skills. However, I think having both is important, and the research seems to support that as well.
So, let’s talk about a few different relaxation skills we can access, learn, and some other ones that I use that aren’t necessarily research based but are helpful for me.
Progressive Muscle Relaxation: in this practice we tense each muscle group, one at a time, and then release the tension allowing for relaxation. I love this one and feel very relaxed afterwards. There’s been a lot of research on it, and it’s one we can do on our own as there are a ton of guided versions. Here’s a guided version I made from my YouTube channel.
Guided imagery is another practice we can do on our own. I personally like “safe place” imagery, which I haven’t made for my YouTube channel yet but any guided imagery that uses peaceful, soothing or symbolically therapeutic mental images has evidence that it enhances relaxation from physical and emotional pain.
Yoga is another practice that I normally associate with mindfulness, though I will admit that I find it relaxing as well. Yoga emphasizes a number of processes including acceptance, attention, mediation and relaxation, which is likely why many people find it effective. Here’s an interview I did with MS Warrior and Yoga Instructor, Clarissa, on the podcast.
Hypnosis in an intervention that I haven’t tried, however there is growing research that it shows promise as being helpful for chronic pain. It alters our perception and cognitive patterns that occur in chronic pain syndromes through the use of relaxation. Here’s an interview I did with physical therapist, Sam, who uses hypnosis with his patients.
Biofeedback is another intervention I haven’t tried but has a lot of research support it’s use and was discussed at the World Pain Summit I attended last fall. It increases our physical awareness and induces relaxation through the use of markers of the stress response. I definitely think it’s worth looking into.
Pick any activity you find relaxing! Okay so this doesn’t have specific scientific evidence but if it induces relaxation then it can’t be bad. For me, that is taking a bubble bath (or epsom salt bath) and reading a book. I find it incredibly relaxing and definitely helpful for me.
As a therapist, I’m always surprised how many of my clients don’t have a lot of relaxation skills, which makes me wonder how many people actually actively use relaxation skills in general. So, I hope this gives you some helpful options, and I encourage you to try to make some time each day to actively do something relaxing. Keep making the most of it!
I’ve been eating a lot more plant-based lately and it seems to be helpful fr my digestions, so I decided to share one of my favourite recipes with you. The recipe was also shared by my guest, Kathy A. Davis on my podcast. Listen to it here.
I decided to do a 4-part series on some of my favourite pain coping skills. They are all either my favourites because I have found them to be particularly useful for me, or that reason plus I have seen them be useful for other people. I will also add that I always double check to see if there is any scholarly literature on the subjects I write about, and there definitely is for all of these coping skills. So, without further ado, lets start off with self-monitoring.
You might be asking, what is self-monitoring? It is a part of our awareness (executive functioning in the brain) that we all have, that tracks our behaviours and the impacts they have on us and our environment so that we can alter our behaviour in the future if we choose to. We all use this pretty often. For example, adjusting to social norms would be using self-monitoring. So would reviewing your work for mistakes (because ideally you won’t want to make the same ones in the future). We can break self-monitoring down into two types. Qualitative – or what I’ll call subjective monitoring – which is how our emotions, sensations and behaviours change throughout the day and during different situations. Then there is quantitative – or what I’ll call objective monitoring – which is the frequency, duration, and difficulty of our behaviours.
What the heck does this have to do with chronic pain? Sometimes people with pain over-self-monitor in that we overthink our pain and our behaviours which is typically not helpful (I’ll get to that in a minute). When done properly, self-monitoring can be used to help us accept our emotions and sensation, create some distance between us and our thoughts about pain, and get us to do behaviours/actions/set goals/whatever you want to call it, that will improve our lives or just in general fulfill us! And this is what I see is often difficult for chronic pain warriors. For example, if I notice that a certain activity causes me more pain than normal, I would mentally note that as well as the frequency, duration and difficulty of the activity so that I can make adjustments in the future (i.e., not to the activity, do the activity for less time, do the activity less – or more, depending on the situation – often, or do a similar activity that is less difficult). A few years ago I did a pole dancing class. Super fun and a great workout. However, I did notice that my hip pain increased, especially after the class was over. I decided that while though it was fun, the friend I went with and I have lots of other activities we can do together and I exercise in other ways, that maybe this wasn’t the workout for me. I adjusted. Another example is hiking. I know how long a hike I can do (about 75-90 minutes max.) before I have expended too much energy and/or crossed my pain threshold. What does that mean? I still hike because I LOVE hiking, but I do it for 90 minutes or less, followed by rest.
Earlier I mentioned that when we over-self-monitor we often do things that aren’t helpful. This also happens when we don’t self-monitor our pain at all. Let’s tie it into that pain cycle I wrote about a few weeks back. In the pain cycle we see that being less active leads to a loss of fitness, weak muscles, and joint stiffness. If you self-monitor and notice that if you lay on the couch all day this happens but if you go for a (short) walk it doesn’t lead to these specific symptoms, that might lead you to do the walking. Pain cycle again says that then we create lists of “no go” things we cannot do, and this leads to sleep problems, tiredness, and fatigue, which also leads to stress, fear, anxiety, anger, and frustration. Okay, so doing less isn’t necessarily helpful even though our brains say it will be. We can also skip ahead in the cycle and go to negative thinking and fear of the future and how that leads to depression and mood swings. Monitoring our thoughts is helpful at this stage. And then there is time off work, which inevitably causes money worries and often ties into relationship concerns. And then everything leads back to more chronic pain. I want to point out with the activity portions of the above paragraph, that pacing is essential and I did a whole post on that a few weeks ago.
What can we do to start self-monitoring in an effective way? First thing is to keep track of your pain. This can be mentally, but if you have brain fog or just tend to forget it can be more effective to write it down in a journal. There’s a few ways you can track it. Just a general 1-10 score for the day and a list of what you did during the day. Or, if you want to be more effective with your activities, you could write a score before and after each activity you did to track changes. That will also tell you when there was no to little change so you know if you can keep doing the activity the same way, for the same amount of time. The other important thing to track in the journal can be other triggers to pain. For this one, I would suggest tracking emotional pain (sadness, anxiety, anger, etc.) as much as physical pain. Why? The body-mind connection. Often the more depressed we are, the more pain we have (and vice versa). Same with anxiety. It’s easier to make adjustments when we know what’s going on.
Okay, longer post than I anticipated but I hope that it’s helpful for all of you warriors! Keep on making the most of it!
Making room for our emotions (like our sensations) can be difficult to do, mostly because we spend most of our time doing the opposite – pushing them away. If you watched my video from January 9 on The Struggle Switch, I explain how doing the opposite – allowing/accepting/making room for difficult thoughts, feelings and sensations – actually makes them less powerful and have less control over us. This meditation is one way we can learn to do it.
Let me know how it goes and keep making the most of it!
I’ve heard from two camps when it comes to pets and pain/illness. One, is people (like me) saying that it has been really helpful for them. The other says that its too hard to take care of a pet (particularly dogs) and they want to (or do) give their pets up. So I thought we could look at some of the research on pets and pain this week so you can decide for yourself if it’s good. While I will state up front that I always found it good for me (I had to put my little guy down in September 2020 and I’ve been without a pet since), I am happy to look at some of the challenges that can come from having a pet as well. I’ll link the main article I’m referencing at the bottom if you want to read it (it’s a scholarly journal article so it’s not for everyone) but I also got a lot of this information from the research summarized at the World Pain Summit I attended last fall. Most of the information between the two overlaps, which makes sense because, again, it’s based on research.
I want to look at the benefits of having a pet, particularly a dog (though a cat or other small mammal usually provides most of the benefits) into two categories: physical benefits, and emotional benefits. Let’s start with the physical.
a lot of pet owners report having lower levels of overall pain. This could be for a variety of reasons, but some stated include distraction from the pain and less pain catastrophizing (if you haven’t read the post I did on that basically it means constant thinking about being in pain).
It helps promote healthy behaviours such as physical activity. This means that you may have to get up and take the dog for a walk (even a short one), and we know from other research that exercise reduces pain. You may also do other physical activity such as cleaning a cage or litter box or cleaning up the yard, and again, movement is good.
Better sleep. A lot of pet owners who let their pet sleep with them find that they get better sleep because it soothes them, they feel a sense of security, and they have better sleep routines/sleep hygiene. Anyone with a dog knows that they get into a habit of a bed time much better than we do, and they also have good wake up time habits.
The second area of benefits comes in the form of emotional ones, so let’s look at them.
They can give us purpose in life. This can also be viewed as “behavioural activation” which means we are motivated to go to the thing (in this case get up and take care of the pet or go outside).
Less psychological distress. This means less depression, and lower levels of anxiety.
More relaxation. Cuddling a dog or cat literally releases oxytocin in our brain which has a calming effect on us. Pets in general promote relaxation, as well as comfort, patience, and protection.
Support. Pets are extremely good nonjudgmental listeners. People who talk to their pets about their problems and pain feel supported and comforted by them, and then often don’t feel as strong a need to talk about it with their friends and families, which can sometimes improve those relationships.
Social connectedness. This especially works for dog owners who will often socialize with other dog owners when out for walks or at the dog park. If you have a dog you may be aware of how many people stop to chat with you and your pup.
So if those are all the benefits, what are the downsides? Because we know there are always going to be some.
Increased worry. This is in regards to your pet. If you can find someone to look after it if you are unable to (i.e., hospital visits, etc.). If you have the money to care for your pet, etc.
Anticipatory grief. I find this one interesting because I didn’t think of it, but yes, our pets don’t live long and I remember the grief I experienced when I put down Spike (and I still get waves of it). So that can be difficult.
Fear of injury or strain. To yourself, because you’re already in pain and those “what if” thoughts can come up when playing with your pet, walking it, carrying it, etc.
Sleep interruptions. Though most people report pets improve their sleep, some notice that it can get interrupted (especially if your pet is sick or has to go out to pee).
Overall, it seems that most of the research so far supports having a pet if you have chronic pain. The benefits seems to outweigh the costs (which not every pet owner experiences). I’m sticking with my thoughts that pets are helpful for pain. Again, I’ve always found that for me. I hope that I’m able to get a new dog in the next 6 months or so, because I’m ready for those positive benefits (even if the challenges creep in).
Comment to let me know your thoughts, and keep making the most of it!