Cycles of Chronic Pain
Cycles of chronic painPeople living with chronic pain often compare their lives to a roller coaster ride. There are good days when you feel uplifted and in control, followed by bad days when your mood sinks and you feel helpless. Rarely does pain stay at an even level — it fluctuates. Pain also doesn't have any boundaries. When a part of you is in pain, your whole body reacts.As you try to understand, accept and manage your condition, your behaviour and emotions may go through a series of ups and downs. This is especially true if you have debilitating pain. Often, these behavioural and emotional changes follow a predictable pattern. Behavioural cycleOne of the first noticeable effects of chronic pain is the change it brings in your day-to-day activities. Regular tasks often become more difficult, even impossible.The following scenario is an example of how chronic pain often works and how it easily can alter your routine and behaviour:- Stage 1: Decrease in activity Because of your pain, raking the yard seems like too big a chore. So instead, you let the leaves fall. But every time you pass by a window, you're reminded of what you can't do. You could hire someone to rake the yard, but that would cost money. You could have your family do it, but they might feel resentful that you're not helping them out. Plus, you don't like the idea of watching others take over your responsibilities. So you wait for a day when you feel better. Stage 2: Increase in activity When the day arrives when your pain seems to be improving, you rake the yard. But you also run errands, clean the garage and go out to dinner with friends. You put in a busy day — but as long as you're feeling well, why not catch up on all of those things you've been neglecting? Stage 3: More pain, less activity The next day, you can hardly move. You chastise yourself for trying to do too much at one time and spend the next few days resting and trying to recuperate. Eventually, you begin to feel better. But as you start to become more active, your pain worsens. You think that the only way to control your pain is to limit all physical activity — so you turn over many of your daily chores to family members or friends and spend more time in bed. Meanwhile, the leaves continue to fall, friends keep calling and you don't feel up to doing anything. Stage 4: Loss of strength and physical deconditioning The time you spend lying around is making you tired and weak and less able to finish up those leaves. Because of your long stretch of inactivity, your stamina is leaving you. You get fatigued easily, and even the thought of physical labour is daunting. Stage 5: Withdrawal and isolation You find yourself spending more time alone and less time with those who care about you. Because you've stopped going out with your friends, they've stopped calling. They figure that you'd just turn them down anyway, so why bother? Your family has become accustomed to doing things without you. Not only can they now rake the yard without your help, but also they've started going out to dinner or attending social events without you. They think they're accommodating you by not forcing you to go. You retreat even further from your family, friends and favourite activities. Eventually, a day comes when you begin to feel a little better. It's followed by another good day, and you feel optimistic that your condition may finally be improving. But once again, your pain flares, and the cycle repeats itself. Emotional CycleJust as your behaviour fluctuates when you're in pain, so do your emotions. Often, the two go hand in hand — the more you're able to do, the better your mood, and the less you're able to do, the worse your mood. Like your behaviours, your emotions also tend to follow a cyclic pattern.Stage 1: Fear and concern When you first experience your pain, you're fearful and concerned. You worry that your pain may be a symptom of a disabling or serious disease. Your pain becomes the focus of your attention. The more you worry about it, the worse it seems to get, and in turn, the harder it becomes to ignore. Stage 2: Hope and promise When you finally learn what's triggering your pain, your fear and concern are replaced with hope that your doctor will be able to make the pain disappear and your life soon will return to normal. If your doctor isn't able to find a cause, at least knowing that your pain isn't a symptom of a life-threatening condition makes you feel better. You think that relieving your pain is a reasonable request. In today's society, when something breaks you expect someone to fix it. But repairing your body is far more complicated than fixing your car or a household appliance. When the pain continues to linger despite repeated trips to various doctors, your hope starts to diminish. Stage 3: Anger and frustration You become dejected and depressed over the state of your life. This is the stage when you ask, "Why me?" and "What did I do to deserve this?" On some level, you may know that the pain isn't a punishment. But, still, you feel as if you've done something wrong and now you're paying the consequences. You may also find it easy to vent your frustration on others — your doctors, your insurance representatives, and even your own family and friends. But it's displaced anger. What's upsetting you may be the long wait at the doctor's office, the bill at the end of each visit, the increased dependence on others, a sense of loss of control or, perhaps most of all, no relief from pain. As your life feels less and less your own, you may seek to gain control in other, destructive ways, such as increasing your pain medication or using alcohol. You may become more irritable with the people who are trying their best to help you. Stage 4: Guilt and withdrawal You feel guilty over the things you've said and done. Instead of communicating this guilt, you withdraw from people so that you won't take your anger out on them. You also feel guilty because you aren't able to do your full share anymore. Your spouse or children have taken over some of your household duties, and co-workers are having to lend you a hand at work. Instead of venting your frustrations, you may start to withhold your emotions and keep them bottled up inside. Stage 5: Renewed hope, followed by depression Gradually, or perhaps suddenly, you feel better. You're optimistic that your condition finally is improving or the new treatment you're trying is working. Excitedly, you start getting back into your old routine. But after a time, the pain returns and you become deeply disappointed and lose all hope of recovery. You feel depressed and find that you can hardly make it out of bed in the morning. Things that used to matter to you, such as appearance or attending family or social activities, don't seem as important. You begin to feel as though you're no longer loved or needed, and your self-esteem hits an all-time low. You may even begin to wonder if you're deserving of love and attention. As you draw deeper inside yourself, your pain becomes the focus of all of your attention. Fear, isolation and depression, combined with days with nothing to do, make the pain feel even worse. The severity of your pain finally forces you to look for other forms of treatment, setting you up for a repeat of the cycle. Your family's responsesYour pain, and how you react to it, also affects your family. Their responses to your behaviour and emotions can take on parallel cycles of their own.Family behavioursWhen chronic pain first becomes a problem, family members generally show a great deal of support. They're often increasingly attentive to you, and they do more tasks around the house so that you can relax and get better.Family members also become vigilant in assessing your pain and keeping track of the activities that seem to make it better or worse. They monitor you closely in an attempt to help lessen your pain and help your doctor make a diagnosis. When your pain doesn't improve, your family's patience may start to wear thin. At this stage, they begin to resent the extra burden they've been handed. And though most family members realize that it's not your fault, they may find it becomes difficult to separate the person from the pain. They might begin to withdraw themselves and pay less attention to you. Family emotions Family members often go through the very same emotions you do. Initially, they fear the cause of your pain. Later, when your treatment doesn't seem to be working and they're shouldering more responsibilities, they become angry and begin to ask, "Why us?" Just as you do, family members often feel a loss of control over their daily lives and normal routines. This frustration can lead them to withhold affection because they're angry at the situation facing them. They may unintentionally take this anger out on you. They feel bad about being angry with you and, in turn, start to feel bad about themselves and how they're acting. "I'm not a good person" and "I should be able to handle this" are common thoughts. Their guilt often leads to increased attentiveness and care, beginning the behavioural cycle again. Unfortunately, even though you and your family share common
feelings, you may find these feelings difficult to talk about. Your
family members fear it will sound like they're blaming you for your
pain. They also don't want to come across as being selfish and inconsiderate.
You have many of the same fears. The silence, however, often brings
more resentment and frustration. Communicating your pain Pain Behaviours
People around you generally react in one of two ways to pain behaviours. They become annoyed by them — "Not this again!" — or they become overly attentive to the behaviours — "Here, let me do that." Either response creates an unequal relationship in which
people tend to focus more on your behaviours than on your thoughts or
feelings. Pain behaviours also consume a lot of energy that could be
channelled into other, more productive ventures, such as taking steps
to manage your pain. 
Here is a picture that shows you what is meant here:-
|
