I completely ruptured my right Achilles tendon playing volleyball the other day and am waiting for surgery. The timing is appropriate given that this blog is about thoughts, emotions and pain.
As I'm hobbling and crawling around my home, I'm reminded that pain and impairment can substantially rob us of our independence and dignity (I experienced a left ruptured Achilles in 2004 and a frozen shoulder in 2008). There is a tornado of things going through my mind: Why did I even go to volleyball-I was already tired!...It’s going to take another year before I can get back to my activities!...I feel bad for my wife – she has to take care of our 2 kids and the house chores for the next few weeks!...How are my finances going to be affected by this?...What if something goes wrong with surgery and I get an infection and lose my leg…or my life?!!!
Having negative thoughts and emotions is absolutely normal when going through a painful experience, especially when it is unexpected and was in no way your fault. Acknowledging these thoughts and emotions and appropriately addressing them is useful in getting you through hard times safely. However, either suppressing them or leaving them unchecked can intensify and prolong your sensation of pain.
How do thoughts and emotions affect pain?
Remember that pain itself is not a disease like a tumour, infection or fracture. Pain is a signal that tells you something is wrong...like a fire alarm. Furthermore, the alarm cannot tell you whether something is life threatening (like a raging fire), minor (like smoke coming out of a toaster), or incidental (like someone pulling the alarm by mistake). So simply masking the alarm (eg. By using pain medications or passive therapies) without investigating its source will not help you to prevent it from being triggered again or persisting.
In the blog "Why Does Pain Persist?", I discussed how various parts of the brain (eg. that deal with thoughts and emotions) interact with pain signals to produce the feeling of pain and an associated meaning. Let's apply that to the analogy of a fire alarm. Recall a time when you were in a public building or a condo and the fire alarm went off. Once this happens, you will immediately be on alert since something is happening. But your response to the alarm will be largely based on different cues. For example, a voice over the Public Announcement system might say: "Please stay calm. An alarm was accidentally tripped.” or "This is not a drill. Please exit the building." These messages are analogous to your thoughts.
In addition to the PA system, the overall atmosphere of the people around you will provide you with cues about the alarm. If the people around you are ignoring the alarm, you will probably just shrug it off too. But if they are running around hysterically, then you will likely be in more of a panic. These people around you are analogous to your emotions.
Together, your thoughts and emotions put a meaning to the alarm (or pain signal) and will trigger a response from you that is in line with that meaning.
When a person shuts off the PA system or ignores the people around them (which is akin to suppressing their thoughts and feelings), they will be faced with a loud alarm (intense pain) without knowing what that alarm means. This can be immensely frustrating and is not advisable.
Let’s take a look at some strategies to deal with thoughts and emotions beginning with the three common emotions linked with pain: Fear; Sadness; and Anger.
Fear is a completely valid feeling when in pain since it protects you from doing things that might aggravate you; however, if you restrict your activities too much, this will result in your body getting weaker and tighter, leading to more pain with activity…leading to anxiety about performing any activity…leading to less activity…resulting in your body getting weaker and tighter…in a perpetual cycle.
In order to ensure that your fear helps to protect you from pain rather than perpetuating your pain, you need to approach activities differently. First, attempt something. If you feel increased pain, stop the activity (if your pain remains the same, then it is alright to continue). Look at how you’re performing the task as well as the surroundings of your task and think about a different way of doing the activity based on the principles I discussed in the blog “Moving Without Pain”. Most activities can be modified so that it is less painful. Once you can do more activities, you will feel more confident in your abilities and break the cycle of fear/inactivity/pain.
When you cannot do what you were once able to do effortlessly, it’s only natural that you would feel sad about losing your sense of self. Unfortunately, over time, this sadness can lead to hopelessness and helplessness and spiral into depression. It makes you want to isolate yourself which is the worst thing you can do.
It’s best to address sadness before it becomes depression. Dealing with sadness requires you to be open to doing things differently. If it is a physical task, think about the biomechanics of that activity. If it is an interpersonal task, think of how you are interacting with the other person (this will be discussed in future blogs).
One of our patients did not want to go out to bars with her friends since she could not pour a drink for herself due to pain and weakness in her wrist. When she changed the way she held a pitcher to pour a drink, she began to feel less disabled and resumed this aspect of her social life. It just takes a small change to begin regaining control over your life.
Anger is such a powerful emotion. My team has witnessed anger consume a person’s life and destroy their relationships. The one good thing about anger is that it actually motivates a person to do something whereas other emotions cause a person to withdraw from life.
The timing of when you express anger is very important. Don’t talk to others when you’re in a rage – this will only damage your relationship and hurt your chances of getting what you want out of the conversation. But don’t lock your anger inside either – this will cause your pain to increase or result in you blowing up at a later time. Instead, let the other person know you’re angry so that it opens up the lines of communication. Then literally go cool off – use an ice pack or cold shower or go to a cooler place. Or take some slow, deep breaths. During the time that you’re cooling down, clarify to yourself why you’re angry (if you can) and then use the motivation that anger gives you to let the other person know why you’re angry and ask for what you want from them.
Anger can be especially difficult to let go of when an injured worker feels that they have been unfairly treated by their employer, compensation system or healthcare system. In these cases, it is important to seek advice on how to appropriately advocate for yourself. The Canadian Injured Workers Alliance and Office of the Worker Advisor are independent agencies that can provide information and support.
Surprisingly, yelling and screaming at your employer, case manager or healthcare provider will not get you very far.
One patient my team saw was a very bright woman who was very motivated and compliant with all of the strategies that the team taught her. Still, her pain seemed to increase instead of decreasing with treatment. We then did a simulation of her daily routine in our clinic and began with how she gets out of bed. We asked her to lie down and pretend that she was just waking up. Within two minutes, her eyes had welled up with tears and she had not even moved! When we asked her what she was thinking of, she told us that she was planning her day and was becoming overwhelmed with all of the education we had given her – How she was going to get out of bed, open the bathroom door, brush her teeth, shower, walk down the stairs, deal with the people on the bus on her way to work, deal with her co-workers, perform her duties...
This example clearly illustrates the power of thoughts over pain. Constant negative thoughts such as "This pain tells me that there's something seriously wrong with me," or "I'm never going to get better" can perpetuate pain. In order to deal with this, the first step is to be aware that these thoughts are present and are not productive. Then, you need to stop those thoughts. You can even say "STOP" to yourself to break the cycle of negative thoughts. Then try to replace these thoughts with other thoughts that are more productive. For example, you can think: "This pain tells me that something is not right...is it my movement?...am I feeling a strong negative emotion?...am I being pushed around by someone?" or "Today is not a good day for my pain but I do have good and bad days...what can I do right now to help it go down?" By changing the thoughts from something that is very negative and out of your control to something that causes you to think about productive actions, your thoughts can be used to empower you to control your pain as opposed to being enslaved by pain.