What is Recovery From Suffering With Pain to Living Well
I am referring to recovery from suffering with pain to living well in this blog as being able to live a values aligned life that’s full of meaning, with pain being in the background. Let’s get the clouds cleared and say now that pain can and does change, it even fully goes for some people though this is a low percentage of people.
Very little in life is linear, recovery from suffering with pain to living well with pain certainly isn’t linear, it can look pretty messy. If you tried to draw pain recovery it would most likely look like a child’s scribble. Just as children learn through scribbling how to draw we can also learn through suffering with pain how to live well again. There can be small ups and downs, big dips, sometimes steep rises and lots of back and forth moves. Life in general is messy, it’s often not plain sailing and it can be helpful to recognize the resilience we have built in the tricky waters. We have things that help as we sail including our crew, a lighthouse, a map of our favourite destinations, a compass, understanding the weather and the current changes, and of course an anchor (or a few different anchors). Want to know what a compass, lighthouse and a crew have to do with recovery from persistent pain? Keep reading…
What Has a Crew, a Map, a Compass, an Anchor & a Lighthouse Got to Do With Recovery From Suffering With Pain & Living Well?
All of these things work together, so for example when a rest is helpful if the water is not still enough to rest safely we can drop anchor to add some safety. An example in life could be when things are busy, we have a lot to do and are feeling stressed, it’s is likely that if we simply sit to rest our minds will carry on and our fight-flight system doesn’t get chance to down regulate. One thing we can do is sit and focus on our breathing and do a breath practice like soothing rhythm breathing (used in compassionate mind training), or we can practice a meditation or another grounding practice. Anchoring our mind in our bodies, staying fully connected to the present moment and restoring some balance in the autonomic nervous system are all important and help us live well with pain and can help change it too.
Our crew are important, one really important crew member is our compassionate self, I see the compassionate self as the chief officer. The chief officer shares compassion with the captain and all the crew and also extends this further afield to passing boats, helping everyone to navigate the tricky water. We all have a critical voice, it’s part of being human, and when we are suffering with pain this voice commonly gets quite loud. When we have a flare-up guess what the self-critical voice often gets even louder alongside more threat based feelings & emotions like guilt, frustration, anxiety and shame. These all ramp up the pain volume, it’s one of the common vicious circles in pain. Self-compassion has been shown to help decrease self-criticism and modulate threat based feelings & emotions. Self-compassion is also a more sustainable place to motivate ourselves from than self-criticism, it doesn’t have the drawbacks that self-critical motivation has. Compassion is also important because it’s been shown to help decrease stress, increase resilience and generally be helpful for our wellbeing. Gilbert et al (2017) showed that self-compassion and self-reassurance overlap and that self-compassion mediates the link between self-reassurance and wellbeing.
Other crew members could be family and friends, maybe a pain specialist clinician, and things like exercise/movement and sleep. Sometimes some of the people in our crew need teaching about pain as there are lots of myths and misconceptions around pain. Everyone having an up to date evidenced based understanding of pain and how this relates to you is important. Understanding pain could be seen as a crew member too. All the crew members work together to nurture our health and wellbeing, all are important, some of the most important could be said to be: regular exercise/movement, sleep, good nutrition, connection and compassion. Here’s a link to the exercise and pain blog I wrote about exercising with persistent pain https://www.unityphysio.co.uk/exercising-with-persistent-pain/
Apart from nutrition different aspects that nurture our wellbeing (our crew) are all also discussed in detail in my book, Dancing Through Life: A Guide to Living Well. The PACE’s & SIM’s, the key concepts in my book, could be a useful summary of the crew so I have included the PACE’s & SIM’s summary diagram from the book here.
A little note on exercise, some people prefer to relate to this as movement as they have unhelpful associations with exercise & it’s linked to threat for them (I cover this in my book). Exercise is important for many reasons including that it helps enable us to do what’s most important (along with other crew members like sleep, nutrition and self-compassion). Engaging in meaningful activities can in themselves be the exercise/movement, like in my second example in the meaningful activities & flare-up sections below.
The places we like to visit (things that bring things like joy), our compass and lighthouse help us navigate all the different changes in weathers and currents. The places we like to visit are what’s meaningful to us in life and our compass is our values, our direction of travel (values as a compass metaphor – Hayes et al., 1999). The lighthouse helps us connect to our purpose, what feels like home and is also meaningful, even when we are feeling lost at sea it glimmers in the distance. Some people find it tricky to relate to purpose, if that’s you that’s ok, think of it like the deep why’s behind what you do and see if that helps. Meaningful activities are commonly stopped when people are suffering with pain for fear of making things worse. The flip side of this is that by stripping life of meaningful activities this in itself turns up the pain volume as does the fact that we lose fitness and tolerance for different activities. Meaningful activities also release feel good chemicals that nurture our wellbeing and may modulate pain in some instances, so there’s added benefit.
Meaningful Activities and Flare-Ups
Sometimes the word set-back is used instead of flare-ups, sometimes increased pain volume, or other terms, you can use which ever term you most relate to. Some things when living with pain are worth a flare-up and some just aren’t! Usually things that are meaningful and connected to our values are worth the pain volume being a little louder and we can plan to focus more on things like rest and relaxation for a few days after. I usually ask people if the benefits of doing something outweigh the consequences as a way of helping their understanding, and mine, around their meaningful activities and being able to engage in them. Sometimes the answer is no, this is usually when the value associated with the activity isn’t one of the core ones, or when pain is a strong leader, or flare-up management strategies are lacking. Sometimes we need to consider specifically how a meaningful activity is done to make it possible too.
As well as having specialised in pain I live well with it too. Here are two real life examples of meaning and values in action as part of living well with pain. Recently I went to see my youngest niece on her birthday, within the new covid rules of meeting outside, she had received a trampoline for her birthday. I noticed I wanted to have a go and I also noticed a memory of the significant flare-up from a very brief play on a bouncy castle at her party three years before. So, there were some contextual similarities (my nieces birthday party, something bouncy (even though a trampoline’s different to a bouncy castle). I knew that I was ok to do it, that I was safe (hurt doesn’t necessarily equal harm), my body and mind were calm, and so I connected to having fun and choosing to play. What else helped, I also knew that I could rest and pace things differently over the next few days if it was needed. What happened? I didn’t bounce that long and had great fun (ok technically I had another go later!) and as it happened things didn’t flare up either so my systems are either less sensitive than they once were or it was because a trampoline is different to a bouncy castle, I suspect it’s both! This was meaningful to me as I value time outdoors, play, and time with family. Would I have been fine with choosing not to have a go? Yes as two other values were still present and it was a meaningful event, yet I wouldn’t have known if it was possible and I would not have and the joy and energy from bouncing on the trampoline.
Following on from bouncing on the trampoline three days later I went for a walk with my sister, niece & nephew. The children were on bikes so there was lots of running alongside the bikes! I hadn’t planned this and noticed a couple of thoughts relating to pain & fatigue unhooked from these thoughts and went with it, knowing I could have two days where I could adjust how I paced activities and incorporate more rest if needed. Ordinarily I would have paced running, however when young children are on bikes this wasn’t an option and I chose not to stay attached to this meaning doing more running than I have tolerance for! It was great fun & brought much joy. This again was a very meaningful activity that I made a mindful choice about engaging with. This isn’t something I do regularly, the exercise I do regularly & other practices helped me to be able to do this. I wasn’t bothered if things did flare as the activity was absolutely worth it and I knew I could find a way through any flare-up. I have many more examples from myself and patients where some activities have increased pain volume for a little while and some that haven’t, as this blog is already pretty long let’s go to the summary.
- What’s on your compass (there’s an example below which is mine) – know your core values and how you can live aligned with them
- What does your map of your favourite destinations look like – what activities are most meaningful to you now and why (I will take a guess – they are linked to your core values)
- What’s your lighthouse- what gives you purpose or what is your purpose? What are the deep whys behind what you do?
- What are your anchors (what helps you be present and anchors you in your body, e.g. mindfulness practices, compassion practices, meditation or breath practices)
- What helps when things flare-up – e.g. do you pace things differently or focus on rest and relaxation for a few days, maybe you use your anchors more
- Who are your crew (compassionate self, family & friends, understanding pain, exercise/movement, sleep, nutrition, compassionate self).
Gilbert, P,. et al. (2017). ‘The development of compassionate engagement and action scales the self and others.’ Journal of Compassionate Healthcare, vol. 4(1), pp 1-24.
Hayes, S.C., Strosahl, K,D., & Wilson, K.G. (1999). Acceptance & Commitment Therapy: An Experiential Approach to Behaviour Change. New York: Guilford Press (to the best of my knowledge this is where the values as a compass metaphor was first used).
Parkinson, A. (2020). Dancing Through Life: A Guide to Living Well. UK: KDP (all images except values compass)
Parkinson, A (2021) Values Compass Image. First used in this blog and associated e-book.
Gilbert, P. (2009). The Compassionate Mind. London: Little Brown Book Group.