Working with chronic sufferers helped Betsan Corkhill to understand how paying attention to enjoyment can help us to manage pain.
Living with long-term pain can be an emotionally and physically draining experience. It’s widely recognised that there’s no quick fix but there are ways you can change pain and your relationship with it to live a more fulfilled, purposeful, productive and active life.
I first became interested in pain when I began running a therapeutic knitting group in an NHS pain clinic in 2005. Those attending had a range of painful conditions from back, hip and knee pain to more widespread pain such as in fibromyalgia. Listening to the life stories in this group made me want to discover as much as I could about pain.
A different perspective
Most people believe there is a linear relationship between injury or a medical condition, such as arthritis in your knee or back, and the pain you feel there. It’s a perfectly logical conclusion to come to but this isn’t actually the case. Pain is more complex. Many factors affect whether you feel pain or not. I like to think of it as a complex conversation that involves everything going on within you and around you. Everything you think and do, and every person and experience you encounter influences this conversation. If, having weighed everything up, your brain concludes that you are in danger, you will experience pain.
Any injury or medical condition will feed into this process, but it isn’t the sole input. Your beliefs, mental and emotional state, past experience, level of social contact, fear, sleep, movement, general fitness, nutrition, and everything you see, hear, smell or even listen to on the radio or TV all feed into whether you experience pain or not. As you may have discovered yourself, but not known why, if you are stressed, depressed or feeling lonely, you will experience more pain.
For example, listening to a worrying news story might tip the balance of the conversation into believing the world is a more threatening place. This can explain why many people feel pain without prior injury or why pain fluctuates depending on context. The pain you feel in your back may not be a reliable measure of what is actually going on physiologically.
Traumatic experiences or adverse life events of any sort can make your systems more sensitive and vigilant to perceived threat, therefore more likely to make pain. In long-term pain, the body’s protective mechanisms become over sensitive to the extent they become unable to differentiate between what’s actually dangerous and what’s not. When this happens, they may respond inappropriately to protect you even when there is no actual danger.
Understanding this complexity offers us ways to change pain. As a wellbeing coach, I specialise in working with people who have long-term pain. Helping them to understand its complexity is a big part of my work as is offering ongoing encouragement, guidance and support in addressing the contributing issues to their pain. It’s not a quick fix. It takes patience, perseverance and courage to nudge forwards little by little but it is possible to make changes that will enable you to live a more fulfilled life.
The good news is that we can make this complexity work for us and the general approach is the same whether your pain is in your back, hip, knee or more widespread. Because so many factors contribute to this conversation, it gives us lots of potential avenues in which to change it. Stories from those who have recovered from long-term pain are remarkably similar. Gaining knowledge about pain helps them to overcome fear of pain.
Happier, more fulfilled lives
Fear of what pain means plays a big part in prolonging the experience. Discovering their pain is the result of over-sensitive systems rather than a sign of something dangerous happening changes the meaning of pain with significant benefits. They still have pain, but it no longer dominates their life, moving into the background to enable them to live happier, more fulfilled lives. Understanding you are safe to move and improve is a powerful realisation.
One of my clients said, “You’ve taken the fear away. I’ve started swimming again and little by little moving more because I now know it’s not harming my back. On the contrary, it’s doing it good to move. What a difference it’s made. I’ve found ‘me’ again!”
It’s a fact that our nervous systems and biology are constantly changing and adapting in response to our environment and experience. Changing your experiences and environment allows you to change your biology. Pain is a biological event, so it can change too. Knowing this can significantly change the way you think about pain and move forward. The ‘real’ you can get lost in the experience of pain.
Focusing on improving wellbeing, on growing and nurturing you as a person and your perception of safety, can change your relationship with pain. Make a start on reducing the issues that are detrimental to your wellbeing and increasing those that improve it. Focusing on the things you enjoy and repeating this not only takes the focus of attention off your symptoms but it strengthens neural pathways linked to these beneficial activities. Do something today, however small, keep at it, then do something more.
It’s a good way to live life.
Make a start today
Making small changes over a range of issues can result in a big overall effect.
- Establish routines: The brain likes routines because they are predictable and therefore increase perception of safety.
- Start keeping a gratitude diary: This will re-focus your brain on the good things in your life.
- Have a flare-up plan in place: Know that it will come to an end. Allow time to rest but no longer than two days. Have flare-up freezer meals prepped, a good film or relaxing music sorted and anything else that makes you feel good to hand.
- Change the sensory input: If pain is getting you down, heat, cold or even gently rubbing the body part will change the sensory input and that conversation with your body.
- Manage stress: Stress and pain are closely entwined. The higher your stress, the more pain you will feel. Calm your mind and systems through relaxation and breathing techniques. Reducing stress tunes up the body’s healing system too.
- Move more: Find your baseline of activity, gently nudging into the level that meets pain. When you’re ready, nudge this up slowly, keeping under your flare-up line. Keep at it. Consider wearing a pedometer. Research shows it naturally increases activity in people with pain.
- Address your sleep: Contrary to popular belief, you don’t have to wait for pain to improve for sleep to improve. Those living with pain respond well to treatment for insomnia.
- Eat well: Food provides the building blocks for your body and healing. Eating rubbish means your body only has rubbish as fuel. Sugar increases inflammation, so cut out sugary drinks. Drink enough water – your urine should be light in colour.
- Get creative: Creative activities focus attention onto more positive issues and teach new skills.
- Be social: Finding our tribe helps to increase our perception of safety. People who are lonely experience more pain. Joining a social activity group such as a choir works well.
- Learn to play again: Enjoy activities purely for the fun of it. Activities involving rhythm work particularly well to make the brain feel safe because rhythm is predictable. Tai Chi, knitting and drumming can all benefit.
- Laugh: Laughter has enormous capacity for improving wellbeing. Join a laughter yoga group or watch a contagious comic video on YouTube.
- Treat yourself kindly: Speak to yourself as you would to a friend.