Pain and Personal Responsibility

The Mind Is Key

When it comes to persistent/chronic pain, taking responsibility for your thoughts, emotions and actions is paramount to achieving any semblance of a normal life.

If you’ve ever experienced any intense or lasting pain, there’s a big chance you’ve said to yourself at least once “I don’t deserve this”.

Unfortunately, the world is not a fair place, and bad things happen to good people, but, viewing yourself as a victim of pain helps no one, least of all yourself.

This post isn’t about blaming your (or anyone for your pain), but rather to encourage you to take responsibility for the things you can control, in order to give yourself the best possible chance of living a fulfilling and meaningful life.

Is It Your Fault You Are In Pain?

The most commonly accepted model of pain is Melzack’s “neuromatrix model” (1). This model says that pain is an output of the brain, based on multiple sensory inputs, including:

  • Cognitive: memories, attention, meaning and anxiety
  • Sensory: inputs from skin, musculoskeletal tissues and the viscera (organs)
  • Emotive: inputs from the limb system

With this in mind, it is fair to say that any time you experience pain, you probably aren’t at fault based on anything you were consciously aware you were doing, because so much of the pain experience is generated unconsciously.

It is also fair to say that you can influence your pain based on what you think and do when you experience it.

So, to answer the question, in general, the answer is no, it’s not your fault you’re in pain.

However, as always, there are a few exceptions:

  • Acute pain is your fault if it stems from an injury that occurred because you did something stupid – think alcohol related injuries or playing a game of pick-up football knowing you haven’t been active in years.
  • Gradual onset pain stemming from overuse type injury (work, exercise etc) is very preventable with appropriate workload management.
  • Acute, non-specific pain is often the result of psycho-emotional components, more so than any tissue trauma, thus if you constantly put yourself in stressful situations and don’t know how to manage your thoughts and emotions, then you are probably playing a big role in your pain.

No One Can “Fix” You

One of the biggest examples of not taking personal responsibility for your pain, is the misguided notion that someone, or something, will fix you.

There is a growing body of research demonstrating that people with the highest expectations about making a recovery from pain do so. (2)

Combined with the large (and growing) body of research that suggests passive approaches to managing chronic pain aren’t very effective, it is obvious to see that there is a big role for you to play in your own recovery.

This doesn’t mean more passive therapies are useless. It just means the appropriate context has to be set.

What we can boil this down to is as follows: if you can find a knowledgeable practitioner that your like and connect with on some level, who inspires confidence in your ability to recover and gets you involved in the process, then you probably will.

Now, before you think that you have found and done all of that and you’re still in pain, it’s important to define “recovery”.

Defining Recovery

Most of the data on chronic pain comes from specialist chronic pain clinics. These are often public funded and run in, or in association with hospitals. They are typically “end of the line” treatments for people who have not responded to any other form of pain management.

The results these clinics achieve are “fair” when taken objectively, often decreasing a persons self-rated pain by a couple of points on a 10 point scale.

But, when we take into account that nothing has worked before, this improvement is quite impressive.

Additionally, when people are asked to rate their quality of life, measuring things like anxiety, depression and fear of the future, things are generally even more positive.

This gives us good insight into what is realistic for chronic pain sufferers.

If “end of the line” sufferers can improve this much, then good management earlier in the timeline can theoretically achieve even better results.

One of the biggest differences between those who succeed in managing their pain and those who don’t, is that they take action despite their pain.

Don’t Wait For Your Pain to Get Better to Start Living Well

In personal finance circles, there is a lot of talk about developing the habit of saving money, no matter your income.

That is, if you are on the minimum wage, and can only afford to save a few dollars each week, it is still important to do so, even though the amount across a year might not be very much, the habit developed carries on with you throughout life, as you (hopefully) increase your income.

A similar approach can be taken when you are in pain.

Instead of thinking “when I feel better, I can finally do x”, try shifting your mindset to “how can I find a way to do x, despite my pain”.

Now this is often easier said than done, but a good practitioner will be able to guide you through the process. Many times the limitations are self imposed, and a graded exposure approach can work wonders.

What Can You Do About Your Pain?

  • Accept your circumstances, rather than looking for someone or something to blame.
  • Seek out an excellent health practitioner to work alongside you and help build a team around you.
    • Don’t be afraid of medications. Used appropriately, they can be life changing. It goes without saying that you should talk to your doctor before starting or stopping any medications for your pain.
    • Consider working with a psychologist who specialises in chronic pain, in Australia there is an excellent Medicare rebate for psychology – discuss it with your doctor.
  • Outline functional based goals, rather than pain based goals. For example, saying “I’d like to walk my dog for 45 minutes” as opposed to saying “I’d like to walk completely pain free”.
  • Focus on processes, rather than outcomes. Processes are the things you do, outcomes happen based on what you do, but they are always variable (because of factors beyond your control).
  • Start small and build up slowly. 
  • Don’t “let pain be your guide”. Chronic pain is an unreliable guide of what to do or not do. Some days or weeks are worse than others. The challenge is to persist through the bad weeks as much as you can, and enjoy the good weeks without being fearful.
  • Stay positive. I know this can sound like throaway type advice, but there is evidence to suggest that if you can get through your pain, your brain returns to normal – the changes associated with pain are not permanent! (3)

Conclusions

It can seem like an impossible journey at times, and a completely isolating one, but you are definitely not alone.

People have gone before you and conquered pain. Others going on to live full lives despite their pain. Both, in no small part, due to their determination to make their lives better.

This doesn’t mean that you can will yourself better, but it does mean that there is hope.

There are dedicate professionals out there who study hard and work even harder to help people in pain live better lives.

Sometimes you have to work to find them. Sometimes you have to travel to reach them.

But you must, you owe it to yourself, because, the right advice, the right words at the right time, the right actions in the right amount, can change your life.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



References

(1) Melzack and Katz, Pain

(2) Expectation and low back pain recovery

(3) Brain structure during and after pain

 

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