Managing Chronic Pain

What is Chronic Pain?

Chronic, or persistent pain, is defined as pain lasting more than three months. In some cases, it has a clear starting point: A workplace injury, car accident, broken bone, surgery, or other physical trauma that can be easily identified as the time when the pain began. In other cases, it is harder to identify where pain comes from. Where autoimmune diseases or conditions like fibromyalgia are concerned, the root cause and pattern of the pain can be much more challenging to place. Regardless of whether the source is clearly defined, the pain experienced is real and has significant impacts on the quality of life of the individual. 

How chronic pain impacts quality of life:

• Invisible Injury: Pain is highly individual, difficult to quantify, and largely invisible to the casual observer. That, coupled with the ability those who are living with chronic pain have to mask their symptoms and function “normally” despite their pain, and it gets overlooked and ignored by those around them. This can result in a lack of understanding from friends, family, and co-workers as to why the individual with chronic pain takes longer to complete a task, needs more down time or sick days to recover, or doesn’t participate fully in social situations. This can be isolating and impact mental as well as physical health.

• Fatigue: Managing pain is exhausting. If you think about how tired and irritable you feel when you have a headache or your tooth hurts, imagine living with that level of pain all day, every day. Basic household tasks like folding laundry, preparing food, or taking a shower become daunting instead of routine. We often use the “spoon theory” metaphor to explain how chronic pain impacts an individual’s capacity each day: Essentially, each day starts with a set number of spoons available. Every task you need to complete requires a number of spoons, one to manage each meal, two to take a shower, three to go grocery shopping, four to get through a social call or work meeting, etc. Spoons are used whether you are excited about a given task or it is something you just have to do. Once you’ve used all your spoons for that day, you don’t have any more until you’ve rested. If you use more spoons that you have for a given day, you take away from the number of spoons you have available the next day. Like an energy overdraft account, when you go into the red, you have to pay back with interest what you used. Often, just getting through the basic daily requirements uses all you have, leaving no extra spoons for social or recreational activity.

• Mental Health: Chronic conditions are disproportionally associated with poor mental health. The daily frustration of being overtired, sore, and managing your emotions take a huge toll, and many individuals living with chronic pain do not want to burden those around them with their daily experiences. This further contributes to their sense of isolation because it limits their ability to reach out for support. Coupled with that, physical activity and positive recreation, important non-pharmaceutical interventions for mental health conditions, are often outside of the capacity of those dealing with chronic pain. This can create a downward spiral of isolation and reduced activity capacity. 

What can you do? If you are living with chronic pain, there are some things you can try to improve your capacity. If you can determine your baseline daily spoon needs and capacity, you can very gradually work to build capacity. This is done by trying to not exceed your spoons most days, so that you are not constantly working at a deficit. Once you’ve achieved that, you very gradually add small amounts (1-2 spoons/week) of a chosen activity. For example, you could add one short walk each week, or a coffee date with a good friend. Once that no longer pushes you to your full capacity, you can add a second small thing. Over time, you can build your overall daily spoon capacity to allow for more activity on a daily basis. It is also important to build some flexibility into your plan: Some events are just too important to miss, even if you know you’re going to go past your daily spoon allotment. To counter this, you can plan to have a day or two of down time after a significant event. Building this recovery time into your planning can help limit how long it takes you to recover, and can also reduce frustration.