Setting Personal Boundaries

Many people who suffer from chronic pain have a life-long inability to say "no" to others. Because of this, they tend to put more demand on their physical and emotional resources than they can handle. As a consequence, their pain is perpetuated.

Humans are a social animal so our relationships have a significant effect on our well-being. We all walk around with an invisible bubble surrounding us. People in small bubbles with weak walls can easily be squished, making their lives very uncomfortable. Others in large bubbles with strong walls are not easily pushed around but they can  become lonely since nobody can get close to them. Therefore, it is important to establish reasonable but firm personal boundaries in order to maintain healthy relationships. This involves determining the limits of what you are physically and emotionally comfortable with and then asserting those limits.

To illustrate the importance of this, let us say that a person-in-pain reluctantly agrees to help a friend with something. If the task is physical, such as taking care of an infant, it could increase the strain on the person’s body. If it involves emotional support, such as regularly talking with the friend about a messy legal battle they are going through, it would increase the strain on the person’s own emotional state. Both scenarios result in increased pain. Furthermore, doing something that they did not want to do in the first place can cause the person-in- pain to resent the friend.

In these situations, there are ways of asserting personal boundaries without being unkind or having to resort to excuses.

The first thing to do is to ask questions about the task (if possible) before agreeing to anything. Is it urgent? What is involved (in terms of time and effort needed)? Can someone else help them?

Once you understand the nature of the favour, you can then define the parameters of what you can do for them. In the example of looking after an infant, you could specify a day/time that works best for you or tell them to bring materials (playpen, toys, food, etc.) that will minimize the physical strain on you. In the example of the friend going through a legal battle, you can tell them that you will set aside a specific time during the week to talk to them; otherwise, they may call you every day, several times a day. Once you have established the boundaries of what you are comfortable doing for them, it is up to them to accept and make the proper arrangements to receive your help. Remember that you are helping them out of the goodness of your own heart even though there is a cost to you (i.e. it may increase your pain), so setting conditions is not being selfish - you are simply being fair to yourself as well as to the other person. People may react negatively to this assertiveness at first. This is because they expect you to say “yes” so they will need some time to adjust.

Sometimes leading a friend to the right resource is better than helping them yourself. If you do not have the time, energy or ability  to help someone but you know a person/agency who does, referring the friend would be the best course of action. One of my patients with chronic neck pain had a long-distance friend who lived by herself and was very depressed. The patient promised to call the friend every night in order to lift the friend's mood. Over time, these conversations were decreasing the patient's own mood, increasing her frustration with her friend and increasing her neck pain. The patient was advised to refer her friend to see a community counsellor (this was offered for free at a community centre) and to volunteer. This helped to improve the friend's mood so the patient only needed to call her once in a while to check in on her.

Aside from saying "no", many people with chronic pain have a difficult time speaking up for themselves. For example, someone will say something hurtful to them, but they will not say anything to that person. Instead, they let the negative emotions build up inside and then once in a while, they will their partner or children. This damages their personal relationships while perpetuating the dysfunctional interactions with the person who is actually doing the harm.

Speaking out does not mean that you have to attack the other person though. Sometimes, they may not even be aware that they are doing anything wrong! If you tell them that they (as a person) are mean or inappropriate, they will be offended and likely attack you back. This type of exchange generally does more harm than good. A simple and effective way to speak out is to state how you feel in response to an action. For example, you can say “I feel hurt (or angry or uneasy) by what you said (or did)”. This will open up lines of communication with the other person to give you an opportunity to improve your

By speaking up, you are giving the other person the message that it is not ok to speak to you that way. Remember that adults can be bullied too and bullies are conditioned to pick on those that allow them to.

Speaking up does not automatically change the way that others treat you. You cannot control other people or even the outcome of your actions. But you do have control over what you do. If you deny yourself this ability to take action, you will feed into the sense of helplessness that can perpetuate the negative emotions associated with pain.

Dr. Trung Ngo founded Novah Healthcare in 2017, an interdisciplinary clinic that specializes in the conservative management of acute and chronic pain. His Novah clinic will continue the work he did from 2011 to 2016 at Mount Sinai Hospital, where he led an interdisciplinary team in assessing and treating complex, chronic, non-cancer pain. His Mount Sinai team helped patients decrease their pain, improve their daily and vocational functioning and reduce or eliminate their intake of pain medications (including opioids). Dr. Ngo graduated from the Canadian Memorial Chiropractic College and subsequently pursued a residency program at Hamilton General Hospital in which he furthered his training in orthopaedics and pain management.

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