Chronic Pain: The Coping Process

Coping with chronic pain is not a linear event with a beginning and an end. It is a continuous process. What is the function of pain? It is designed to warn us of any injury so we do not injure ourselves more and so that we are aware of it and take care of it until it can heal properly. Well and good. We need pain. So the demand it makes to us is to end the pain. Wrap a bandage around it, slap on a band aide or take some painkillers.

What people need to understand about chronic pain sufferers, and those of us with invisible disabilities, is that that demand pain has on a healthy person does not go away with chronic pain. They seem to think when we function we must be tolerating it and so we must be able to do so on a continuous basis. Pain tolerance is built in a person by our ability to ignore that demand as best we can in order to function in the ways we need to to survive. It is a skill that comes with a price. With chronic pain, with that constant pain demand, we try anything to ease it, knowing we will never be rid of it. What they need to understand is the emotional price that comes from this pain demand when there is no way to get rid of the pain. No way to take a pill and feel all better, no place to slap on a band aide, no area that can be wrapped up and no way to heal.

Coping with chronic pain has similar aspects to coping with dying, but without the dying part. What makes it difficult, and maybe even makes us envy the dying process, is that when dying of a disease there are only two options A) you're are cured and go on living your life B) you die and have no more suffering. This is not to say having an incurable and fatal disease is easier, but that with chronic pain we have no finality and sometimes we wish for it because the endless struggle gets to us. It follows a similar pattern, the difference is when someone is dying they go through certain stages once, whereas the chronic pain sufferer goes through them over and over, in different orders and staying in one short term or long term. There is no such thing as coping perfectly. What we must do is acknowledge which stage we are in, healthy responses to it, so that we may continue to cope in a positive fashion. This process is a lot like a war, we may win or lose some battles but the aim is to win the war. Let’s just review the stages of the coping process with an understanding that we may bounce from one to another randomly and we may stay in one stage a day and another a year.

Denial- denial is a shorter stage, but sometimes for inexplicable reasons we fall into it later. It is this insistence that we can keep on doing all the things we used to do. When we are coping very well and have that ideal balance in our lives, it is quite easy to slip back into denial, believing we can do more than we can and as a result we bite off more than we can chew. Denial is also one of the first stages because we believe in the beginning that our condition, our pain, will not have an effect on the life we live.

Guilt- Guilt is powerful. We feel so very guilty we can't perform as we once did, that we miss too many days of work, that we are a strain on our families. Guilt is a common occurrence. One that makes us believe we are failing our family, our employer, our coworkers our spouse and even society itself. This can follow quite easily from the inevitable disillusionment we feel when denial comes to an end and we are faced with all the things we cannot be, with all the expectations we have placed on ourselves. What we must think about is what assumptions are we making? Do we believe if we cannot work that we are not worthy? Do we feel we are less and not functioning members of society. We must be realistic with our own expectations and do not demand so very much of ourselves so that we fail to attain ideals we simply cannot do.

Anger- This is that frustration we have that we have to suffer so and wonder why we should have to suffer so. Angry that the ER or doctor could not help us. Angry at the demands others put on us when they do not comprehend what we are going through. Angry that we have to pretend we are not suffering every moment at work. Just plain angry at the whole situation. This is a natural response, since we cannot simply be rid of our chronic pain. Anger, however, can be used to come up with ways to better our situation. Motivate us to find new ways to cope, to change our lifestyle, to be proactive with our doctors.

Depression- This might not be a deep depression. It can be a day of pity. Melancholy. A little sad. Losing hope. Feeling like things will never get better. Or it can be full blown depression. While we know that no matter what our doctor prescribes for us, no matter all the changes we make to help ourselves get through the day, in the end the pain will remain. There is a reason depression is always comorbid with chronic pain conditions. Pain wears us down. To deal with a day of melancholy we can get ourselves some relaxing alone time to recoup. When it comes to full out depression we need to seek medical attention and therapy, since this stage can last a very long time and it will make the pain far harder to cope with.

Compromise- This where we cut out things that are causing stress or additional pains. Where we compromise to make things better. Where we make plans and strategies and try to do things that might help ourselves out. We made adjustments to our work environment or we find a job that we are capable of doing. We avoid known stressors, including negative people. We make all the lifestyle changes, that will not rid of us pain, but make it easier to cope with. This is an optimistic time. A time when we seek to help ourselves in any way we can.

Coping-hope- This is where we feel that we are managing things well. We have hope for improvement. That we have a solid structure we can add to. We found that perfect balance and strive to maintain it.

Acceptance- That acknowledgement that we cannot control everything, our environment or the demands other make on us, but we can control how we react and we choose to just let it roll.

See also Chronic Pain: The Facade of Wellbeing