Adapting to Chronic Pain.
How to get the best from a Chronic Pain Mindset.

First, what is a chronic pain mindset ? I like to think of it as this….a person is involved in a motor accident. They wake up in hospital next day, and discover that an arm has been amputated. It’s a watershed moment. Huge disappointment coupled with a depressing expectation of an unpredictable future, nevermind the pain etc. It may well take that person several months, even years, to come to terms with such a life changing event. However, with a little luck, the pain should ease off, and , from that point onwards, discounting any phantom pain events, options for adapting back to a purposeful life can be explored.

That’s an acute injury, with lasting effects, and adaptability options. Chronic Pain conditions, with little or no remedial prospects, are similar to that scenario, except the injury and the watershed moment are, in theory, recurring on a daily basis, but to a lesser degree, and there is usually little prospect of being able to subjectively envisage an eventual pain-free self management outcome. If the calculated risks and potential outcomes can be predicted fairly accurately, as they would be with the amputated arm scenario, then the planning for the future becomes less unpredictable, and more positive. Chronic pain patients usually can’t predict even tomorrow’s pain intensity, and so they must adjust their expectations to accommodate the unpredictable….that’s like allowing a little (or large) vacuum into any planning, or expectations, so that, if the worst happens, there’s always room to maneuver or change yesterday’s expectations/plans. Not easy, when you consider the expectations of how social/work pressures demand a co-ordination between people so that time is not wasted……it’s okay to lapse occasionally with an excuse, but not on a regular basis. So, it’s a double whammy for the chronic pain patient. They must face the daily disappointment of negative pain improvement, coupled with a struggle to meet social/work expectations. That’s something which can only go wrong, without good management.

There’s also the small matter of ‘healing expectations’ which we all rely on to reinforce our belief that we can cope with whatever life presents us with. The ‘healing expectation’, although we may not be aware of how it dominates all our thinking, is a major foundation of all our decision making. Without it, we would be living in fear of unpredicted health issues, and would probably find it difficult to leave the house without a dominating fear of being injured, or catching an infection, which might result in death. It is only our ‘trust’ in healing expectations which keeps such a mindset from dominating our every action. This, however, is what chronic pain patients, to a lesser extent, must deal with on a daily basis. Although they understand that their ‘healing expectations’ are still valid for everyday threats, they are also more than aware that there are no ‘healing expectations’ for their chronic condition….and so the negative protective mindset appears, and it must somehow mesh with the ‘healing expectations’ mindset, and still make sense. Again, not an easy psychological balancing act to achieve. Chronic patients juggle these conflicting conscious understandings continually, something which is probably not too obvious to those who assess patients for treatments. Where there are conflicting internal understandings of foundational platforms which we build our lives upon, it is likely that either one understanding, or the other, will dominate at any given time. But it doesn’t mean that either understanding is dispensed with. It’s an awkward duality of understandings, which can undermine the platform with continual contradictions…but, it can be managed.

Added to these, within the chronic mindset, there is also the direct effects of the painful sensations. These effects are no different to acute pain events, except they occur continuously, whether fluctuating, intermittent, constant, or variable in intensity. Makes no difference, they are just like acute events recurring daily, with little prospect of alleviation, and no prospect of matching normal ‘healing expectations’. The cause of the pain may be neurological or physiological, but it is unlikely to be psychological. We wouldn’t insist to a patient who’s just had their arm amputated that their perceived pain is merely psychological….and so we shouldn’t to a chronic pain patient where the cause is less evident. The problem there is ignorance, not the patient’s psychological state. Medication is obviously a big issue where pain is concerned, but I prefer to look at and assess the probables/possibles without that complication. The first goal has to be treatment without possible side-effects. Chronic patients learn, over time, to be resilient to pain, perhaps more so than non-chronic patients….it’s difficult to accurately assess toleration levels in both groups. So, I’m inclined towards thinking that the other mindset issues mentioned above have a more profound effect on the chronic mindset than just the recurring pain sensations. To put it another way, if the pain sensations are eased with medications, the other issues will still dominate the mindset….a chronic patient will not escape the default thinking which evolves from dealing with a recurring issue.

So, that’s the mindset. Next question is how to get the best from it ? The chronic mindset and the ‘healing expectation’ mindset do not mesh together well. Any comparisons, or comparative expectations, are somewhat pointless. The chronic patient must find some satisfaction or contentment within the ‘no expected healing’ mindset, in order to manage their lives. They can’t be expected to strive for a ‘healing expectation’ result, when all the evidence suggests it can never be achieved. That’s just adding to their already ample frustrations. So, what achievable goals can be introduced into their management systems, which can be better satisfied. This is where ‘comfort zones’ become important. Comfort zones create a good environment for good decision making, and good decision making is exactly what’s required for deciding good management strategies. Comfort zones can really only be determined subjectively, but the means to discovering them can be advised. Sometimes the distress of the patient interferes with their decision making, the advice to exercise etc. can be counter-productive and confusing, especially when the exercises don’t work, and a little coaxing (neuro nudging) towards first establishing a ‘comfort zone’ before any decisions, can be really helpful. Once settled, the patient can then start working on their own ideas for expanding the comfort zone, and perhaps be able to make more rational decisions about any suggested treatments. Empowering the chronic patient into a sense of control over their own comfort zones will open the door to more exploratory self management.

I think that it’s probably important to realise that a chronic pain patient will be unable to alter their default mindset to accommodate an approach which doesn’t include an understanding of the complex conflictual ‘healing expectation’ mindset which already exists. The reality of that internal conflict can’t be denied, and yet they are encouraged to attempt such an alteration in most attempted treatments. That’s merely imposing the expectations of the operator onto an already confused patient. The operator should be prepared, and trained, to accept the chronic mindset first, before assuming whether the patient is willing to participate in treatments, or not. That’s what empowering the patient really means.

In conclusion, the best mindset available to a chronic pain patient is probably one where there is no demanded, or suggested, imposition of expectations which may not be achievable. Such impositions, although possibly well intended, are more likely to increase ‘no healing expectations’, and mindset conflict dilemmas , rather than help settle those persistent perceptions which the chronic patient has no choice but to accept as their default mindset. The way to settle that daily continuous internal conflict is to offer advise which helps the patient to focus on ‘comfort zones’ , which in turn offers up better options for the patient to explore expanding those zones. As a first step, that’s an achievable goal which won’t conflict with already embedded mindset dilemmas. Also, it will help the patient to realise the importance of their own primary role in exploring favourable options, rather than an over-reliance on advised strategies, which might be unintentionally overlooking the complex dilemmas in play. Basically, any attempts to return the patient to a more normal appreciation of ‘healing expectations’, by means of suggestion or imposed regimes which don’t consider the chronic mindset, are doomed to failure. That mindset has evolved from the realities experienced, and it won’t be changed by suggestion or imposed regimes, unless those suggestions and regimes can prove, without doubt, that they can resolve the issues which created the mindset in the first place. The chronic mindset is a valid mindset, and should be respected by all, as such.

Similar Threads: