According to the Institute of Medicine, a whopping 100 million Americans—that’s one in three—suffer from some sort of chronic pain. And if you’re one of them, chances are at least one doctor has told you, “It’s all in your head.”
The trick is that chronic pain wears many disguises. Sometimes chronic pain is psychosomatic, which does not mean it’s all in your head or that you’re faking (that’s another term: malingering), but does mean that your very real pain is caused by psychological factors, like stress or depression.
Other times, to everyone’s befuddlement, pain is caused by a mysterious injury that may or may not be visible on x-rays or MRIs. In other cases, there’s an underlying condition, like arthritis, fibromyalgia, or neuropathy. And if those weren’t enough options, sometimes chronic pain stems from damage to the the nerves and spinal cord—the pain system itself.
In the comprehensive book that inspired some of these tips, Managing Pain Before It Manages You, Dr. Margaret A. Caudill likens chronic pain to a fire alarm that keeps clanging long after the fire is out.
But whether your chronic pain stems from any of these four sources, it’s still, well, a pain. For those with migraines, back pain, joint pain, or anyone else who knows tension headaches are for amateurs, here are five tips to manage your chronic pain.
Tip #1: This pain is not your fault, but you are responsible for taking care of it. In other words, own your pain. Hear me out on this one. Too often, we get caught up in existential rumination like why we have this pain or what we did to deserve this. Most often, we expect the health care system to rescue us and, when its fails, we get caught up in blame and anger. The result: tension builds, which leads to—you guessed it—more pain. To stop the cycle, decide that you will be the driver of your pain. Doctors and therapists will be there to help, but you are in charge of your pain.
Tip #2: Be active. Hear me out on this one, too. It’s counterintuitive. You may think you should rest and protect the painful part of your body. You may be scared to move, for fear of more pain.
While rest is essential for acute pain, like a sprained ankle or a pulled muscle, rest reinforces chronic pain. As your muscles get weak and stiff from inactivity, the pain may actually intensify.
So do what activity you can—slowly ride a bike, walk, swim, do chair exercises. Find a gentle yoga class. Lift light weights. And don’t skip physical therapy.
An important trick is to break up exercise into shorter chunks—try for three 10-minute walks rather than one long walk. Also, try not to leave activity until late in the day—you’ll likely be too tired or simply unmotivated.
Being active has one last benefit: it makes you feel less like a prisoner of your pain. You can set goals, get outside, or team up with friends, all of which stave off depression and hopelessness in addition to reducing your pain.
Tip #3: Track your pain. I know, I know, you don’t even want to think about your pain, much less keep track of it. But keeping a pain diary can help you make connections between what you do and how you feel.
So, take a week or two to track your activity during the day and how much pain you feel. You don’t have to track every detail—just broad strokes like “sat at my desk all morning” or “grocery shopping” will do. Then rate your pain—the classic from your doctor’s office is the 0-10 scale, where 0 is no pain and 10 is the worst pain you’ve ever experienced. Don’t be afraid to use the whole scale; you don’t want an unhelpful chart loaded with 5’s and nothing else.
Once you’ve tracked your pain for a week or two, look for patterns. Maybe you feel worse after time on your feet, after sitting at a computer, or on days after you’ve pushed yourself.
Use your newfound data to modify your environment and schedule. If sitting at your desk at work is killing your back, ask to have your chair evaluated or even aim for a standing desk. If your joint pain flares from preparing dinner, break it up into smaller chunks or delegate when you can.
Tip #4: Don’t push through it. It will get worse, I guarantee. So, resist getting indignant and showing the pain who’s boss. You may push through and accomplish everything on your to-do list, but the next morning you won’t be able to get out of bed.
Instead of strong-arming your pain, try a technique called pacing. The rule of pacing is to stop an activity before you’re in pain. Go by time, not task. Time how long you can comfortably do activities that are challenging for you, like typing, driving, or cleaning. Once you know your limits, aim to do those activities for less time than your limit, and then take a break before your pain flares.
For example, instead of powering through the dishes, do them for five minutes, then take a break and pay a bill. Then wash for five more minutes, and take a break to fold some laundry while sitting in a chair. Finally, finish up with five more minutes. It takes some work to change your habits, but it’s much easier to prevent pain than it is to quell it once you’re in the throes.
Tip #5: Question your beliefs about your pain. This is the big one. Your thoughts may be working against you. Remember what we said at the beginning: own your pain. One way to do that is to question your old beliefs about pain. You may find yourself saying, “This will never get any better.” “My pain makes me a bad mom.” “I should be able to muscle through this.” “If I can’t work, I can’t ever let myself do something fun—that would be too indulgent.”
Shine a bright light on your beliefs and ask if they’re really working for you. Chances are, you’ll find some duds. Re-calibrate: “I can have an impact on my pain.” “I face more challenges than the average mom, but I’m not bad, plus I set a good example by trying hard.” “I don’t have to power through; I’ll outsmart my pain by pacing.” “Even if I can’t work, doing fun things gives me the energy to keep fighting my pain.”
To wrap up, know you’re not alone: 42 million Americans’ sleep is disturbed by pain more than once a week, 26 million Americans suffer from frequent back pain, and $600 billion dollars annually are either spent by the health care system on chronic pain or lost due to decreased productivity and disability.
In short, if you’re in pain, you’re in good company. And it’s not all in your head. Well, okay, unless it’s a headache, but you get the picture.