As cold weather and dark skies arise, we may be tempted to hibernate – staying home and keeping cosy as much as possible. This seems like an intuitive way to care for ourselves.
However, living with chronic pain, it becomes easy to gradually and unconsciously reduce our lives so they become smaller and smaller in an effort to experience less pain and suffering. This is a strategy that appears to work in the short-term to help us avoid pain but in the longer term hinders more than it helps.
Our unwanted superpower
All pain is part sensation and part emotion. The emotion that wreaks most havoc in the lives of people with chronic pain is fear. In normal circumstances of acute pain, fear can be helpful because, if we’re injured, we are afraid to move – giving ourselves time to heal.
With chronic pain, fear is not helpful. When we have chronic pain, our brains become very skilled at turning on pain. So much so, our brains become trigger-happy and turn on the pain response all the time. This is our superpower – a lightning-fast response that can jump straight to the highest volume setting for pain.
Even when the brain and central nervous system receives neutral sensory input from the body, the pain response may be triggered anyway. This means the pain response in chronic pain has become severely stuck in the switched-on state.
This means that for people with chronic pain, a sensation of pain does not always indicate harm or injury in the way it might with acute pain. This process of hypervigilance and hypersensitivity, called central sensitization, likely plays some part in your experience of chronic pain.
Fear amplifies this process. This fast and frequent pain response superpower is one we have to learn to dampen down and neutralize as best we can.
The slippery slope to deconditioning
When the pain alarm system is constantly firing, we feel more and more fearful about experiencing pain. The fear means we move less and do less. This creates a vicious cycle that results in our bodies becoming more and more deconditioned resulting in more pain.
The fear avoidance trap
The fear avoidance cycle represents this process. The first step in the cycle begins when we experience pain. The profound unpleasantness of this experience causes us to worry about it happening again. Our thoughts turn to when it might happen again, what the consequences might be, how we can prevent it. The more we fear the pain, the more negative, frequent and insistent these thoughts become.
Fear makes our superpower stronger
All of this fear and worry brings us into the second step in the cycle – pain catastrophizing. The more we catastrophize about our pain, the greater our fear grows bringing us to the third step in the cycle – fear of pain. Fear is a powerful motivator and often leads us to employ a strategy of avoiding anything we believe might cause us pain. This seems like a smart strategy and it may work – for a while. As time goes on, the list of activities and situations that we perceive as causing or worsening our pain becomes longer and longer.
Stop feeding the beast
Over time, the smaller our lives become – the less we move, the less we go out, the less risks we take, the less people we see – the more we feed our fear and the more our pain grows. This becoming smaller and retreating and withdrawing from life actually makes our pain worse in the long-term leading to the fourth step in the cycle – increased distress and disability.
With more emotional pain from the effects of isolation and more physical pain from less movement, we arrive back to where we started – the first step in the cycle – pain – and on it goes worsening and worsening over time.
By doing all that we can to avoid pain and the fear we feel about experiencing pain, we actually create more fear and more pain and get locked into an ever-worsening cycle of fear and pain. All the while, our superpower of a lightning-fast, powerful pain response become more embedded and more powerful.
Make your life bigger
If you find your life has gradually become smaller, what can you do? By understanding the fear avoidance cycle and acknowledging you are trapped in it, you have already made an important leap.
The key to progressing further is to start small. Very small. We can thoughtfully employ pacing and graded exposure to ensure we don’t do too much. Just enough to make a start from where we are today.
In his book Atomic Habits, James Clear describes the value of accumulating tiny changes over time. He notes that getting 1 percent better each day for one year will leave you 37 times better by the end of the year. He emphasizes meaningful change rather than radical change.
One baby step followed by another baby step is all we need to head in the right direction out of the fear avoidance cycle.
Start small and build big
Clear recommends we forgo setting goals and attempting to achieve them. Instead, we divert our energy to thoughtfully building a system to scaffold our new habit. He recommends we create an effective, obvious cue to initiate the habit every day. We also need to ensure our new habit is attractive, easy and satisfying to us.
No-one can prescribe a new habit for us – only we can figure out for ourselves what we enjoy and what motivates us. We set ourselves up for success by intentionally creating a system that is unique to who we are, and what we enjoy, and this supports our new habit.
Befriend yourself
If, one day, we don’t follow through with the habit, we don’t beat ourselves up. We just pick up the habit again the next day.
Beating ourselves up is another superpower for people with chronic pain boosted by its partner-in-crime perfectionism. The voice in your head that gives out to you and starts with ‘you woulda, coulda, shoulda’ is your conscience.
A healthy conscience niggles at you and drives you to reflect and perhaps rectify a situation where you did not make a good choice in words or deeds. A healthy conscience helps us in our relationships with others and in our relationship with ourselves.
Notice your inner critic
However, like a pain response that is trigger-happy, our conscience can become too sensitive, too responsive, too powerful. It can then morph into an inner critic that attacks us harshly. The inner critic can become too big and powerful in our psyche taking up too much room and space in our thoughts.
A harsh inner critic harms us instead of helping us. We do not deserve to be attacked, belittled and ridiculed in this way. Instead, we can view the inner critic as a part of ourselves that worries a lot. This part acts like a coach whose intention is to help but they only know how to harshly criticise in a way that sabotages our inner world. The first step in reclaiming our inner space and making it more peaceful is to begin to notice when this critical voice arises.
Reassure your inner critic
The more we notice it, the more we recognise how inappropriate and unhelpful the criticism is. We can then learn to thank the inner critic for trying to help, acknowledge this part is worried and reassure them that we are going to manage just fine. You can gently escort them to the bench while you continue with the game of life absent of their harassment. Over time, this approach lessens the power of the inner critic to take over and sabotage our progress.
Meet yourself where you are
This allows us to meet ourselves where we are with compassion and start our baby steps towards change with an attitude of support towards ourselves instead of harmful thoughts that habitually attack us. In a world where we often face stigma, invalidation and a lack of understanding, it is even more important that we become an ally to ourselves and turn toward ourselves with kindness, understanding and compassion.
Meet yourself where you are
Baby steps help us move gradually out of hibernation breaking free from the fear avoidance cycle and towards liberation with a gentler kinder inner relationship with ourselves.
Blog Article written by Niamh Walsh, Psychotherapist, CPI Board Member and person with lived experience of chronic pain
Image credit: Adapted from: nscenterforanxiety.com
