Avoid Minimizing and Catastrophizing Chronic Pain for a Healthier Life
No tough guys or drama queens here
Every morning, my cat paws at my face to wake me up and my brain starts off my day by assessing my pain levels. As I roll over, my head might already be pounding and my muscles aching as my to-do list that I planned the night before is shredding before my eyes. Or, I sit up and pet Rhapsody, realizing that my pain levels are low, and start deciding which activities are going to get done first that day. My chronic migraine and fibromyalgia pain levels determine my activities, but my attitude toward pain is an even bigger predictor of my daily success.
Toughing it Out
One tendency for people in pain is to minimize our pain, to make less of it than there is, to be a “tough guy”. I was particularly bad about this when I was younger. In our family, we worked through the pain, whether it was doing yard work despite a case of poison ivy or going to school the day after a concussion, as I did in 6th grade. Indeed, our society rewards pain minimization. We like it when people “work through the pain” or “play hurt”. Just listen to an NFL broadcast sometime.
In medical school, we talked a good talk about healthy habits, but we “played hurt” all the time. As a third-year medical student at Tulane in New Orleans, I had my appendix out on the Sunday of Mardi Gras week. We had vacation on Lundi Gras (Monday) and Mardi Gras (Tuesday), but I was back on the wards on Wednesday. And I don’t have a low pain threshold.
Chronic pain is a different animal. Those of us with chronic pain like chronic migraine and fibromyalgia are getting pain signals that don’t indicate an injury. Our pain signals are pathologically hyperalert. Over the years, we learn not to trust our bodies and it becomes easy to minimize our pain, to tough it out. You might think that since our pain indicators aren’t trustworthy that we should just ignore them, but that’s not a good idea.
Chronic pain is an illness and has its own complications, like fatigue and brain fog. I am famous for going hard on my low pain days. If I’m having a good day, I want to clean the house from top to bottom, cook a week’s worth of food, and reorganize the entire basement! Unfortunately, I’m also famous for the resulting “hangover” of widespread pain and severe fatigue for several days afterward.
After 15 years of this illness, I’m finally getting the hang of pacing myself and not racing through my low-pain days like a bat out of hell. I’ve learned, for example, to reorganize a bookshelf or two and then rest with some reading or knitting. If I still feel well after that, I might take on another task or two. Not only do I not exhaust myself, but I enjoy my low pain days much more!
Being a Drama Queen
What is more common in chronic pain, though, is catastrophization. That is, we see our current pain as the worst thing in the world and dominating everything in life. For example, someone might find that pain levels above a certain point make them feel incapacitated. They take to their bed, declare that life cannot go on, and retreat from the world. OK, that’s me. I just described myself early in the course of my chronic migraine illness. In other words, I could be a bit of a drama queen!
I’ve learned, though, that having chronic pain does not require that I remove myself from the world by catastrophizing my pain. I can still function, even if it is at a lower level. The first skill that I had to acquire was that of stepping back from my pain and assessing it dispassionately. I may have to say, “OK. I have a migraine that is at a level of 7/10. I also have nausea and muscle pain. I need to take my medications and sit still, perhaps doing some knitting.” I evaluated my situation and made a plan without allowing significant emotion to take over. I agree that it’s not easy to be logical when pain levels are high, but learning this skill makes life so much better.
That doesn’t mean that I don’t allow myself to get emotional. Migraines and other kinds of chronic pain hurt and we should allow ourselves to feel our feelings. I take time to write about those feelings in a journal and allow my subconscious, conscious, and whatever other conscious to get them on paper and deal with them. This way, I can structure my day based on my physical capabilities while working through my emotional issues separately. And, yes, I do have to take that time to journal and meditate and not let those emotions sit and stew.
Not being a drama queen about my pain doesn’t mean that I have to be overly positive and all “sunshine and roses”, either. The goal is to see the world realistically. I have pain. I recognize and treat pain. And I move on with life, even if it is constrained by the pain and illness.
My counselor taught me to center my days around something other than chronic pain. Yes, I have a lot of habits that are related to my chronic pain diagnosis — stretching, journaling, taking medications. Our goal, though, was to find a focus for my days besides pain. On days that my pain is high enough that I can’t do much very physical, I knit and occasionally read. We decided that those days are now called “knitting days”. By taking the emphasis off the chronic pain, I am able to avoid making the pain a cataclysmic event in my mind.
The medical community is unanimous in their recommendation that those of us with chronic pain conditions need to stay as active as possible. Being physically active helps to keep a steady perspective on a painful condition as well as releasing endorphins and oxytocin. I was never an athlete so I’m rarely tempted to overdo it on the exercise front. If anything, I’d prefer to be a couch potato. So, while I’m not going to go for a run while I have a raging migraine, I am learning that I can take a walk even when I have my daily chronic headache without increasing my pain. And I don’t need to complain to any and everyone in a five-mile radius about the unfairness of life. In other words, it’s OK for me to just take a walk. The “drama queen” business can stay behind.
There are times that the pain is so high that I can’t do anything to distract myself. It’s still important to avoid catastrophizing. I used to spend my worst migraines (levels 9–10/10) with nausea lying on the sofa thinking about how my head was going to explode and I was going to die. My counselor and I came up with ways to change that script. Even during these awful migraines, I no longer let my brain go to those dark places. I tell myself that I’ve had these bad migraines before and they haven’t killed me yet and that the medications eventually work. It’s a much healthier set of messages and gets happier neurotransmitters flowing through my brain.
Avoiding the “tough guy” or “drama queen” approach to chronic pain hasn’t cured my chronic migraine or chronic headache, but it has helped me to cultivate a more stable attitude. From a practical point of view, being able to manage my illness relatively dispassionately allows me to be a better wife, mom, and member of society. Chronic migraine is no fun, but I’m always learning ways to make life better.