How To Deal With Long-Term Pain
Winter road on the Swedish countryside. Picture taken in Hyltebruk.
Have you ever experienced pain? Yes, of course, you have. We all have. If you have ever injured yourself, you know that the pain you initially felt eventually disappeared as the wound healed. This is the normal procedure. We feel pain, we heal, and the pain disappears. Pain has evolutionarily been vital for our survival. The ability to have a functioning pain system has helped us survive danger. It’s an alarm system from the brain that helps us to see danger and avoid it. For example, it helps us to not put our hand on the hot stove since we know it will burn. If we didn’t know it the first time we tried, we will for sure know it the second time!
But what happens when the “alarm system” is always “swished on”, and never disappears – even if the initial injury is healed? In other words, we have a system that is constantly feeling pain, sometimes so much that we feel pain even if there is no real threat for the system to alarm, we have no hot stove close by? When we experience chronic, long-term pain, the sensory pain system is changed. Despite the fact that the initial injury is healed, the brain is still receiving pain signals.
The medical community has been researching long-term pain for a long time and concluded that pain is a very complex experience. It is a subjective combination of our thoughts, our feelings, and our physical sensations. In addition to this, we also know that the longer we have had the pain, the stronger we feel it. The knowledge of this makes it very difficult to treat long-term pain, since it means that we need to change, or at least challenge, thoughts and feelings that we have had for a very long time. Since our past experiences, thoughts, and feelings affect how we perceive pain, we need to re-think the way we think about ourselves and our capabilities in order to be able to challenge or change it.
Since the experience of pain is so individual, it means that the pain arising from for example a disc prolapse can be a 2 out of 10 on a subjective pain scale for one person, while another person might experience it as a 10 out of 10 — even if there is no “evidence” of an injury visible in an MR scan. This gives us evidence of how complex the science of pain is.
Pain can also, in some situations, arise without the initial injury, for example when experiencing long-term stress, or a mental or physical overload of any kind. It is not uncommon to experience more pain when being mentally exhausted. For me, in my 4 years long burnout and 100 % sick leave from work followed by another 2 years of slowly getting back on track with an increased workload, this has been very evident. Below I will share parts of my story along with strategies on how to deal with long-term pain for you to use in case you are experiencing it right now. So keep on reading. Luckily, there is help to get!
When I played semi-profession handball, I did, in the most intense periods, work out 12 times per week. We got one week vacation from workouts per year, and even that week I worked out, in order to be fit for the next season! I didn’t understand the importance of rest.
I played handball, a very physical sport with several hundreds of jumps on hardwood floors each practice. Although I wasn’t smart about resting, I was very smart about my training and did lots of exercises to prevent injuries. Unfortunately, it didn’t help completely. I had felt a bit of pain in my lower back for some time but ignored it. I was clearly overtrained, but I continued working out as normal since I didn’t want to lose my spot in my club team in the highest division in Sweden, or in the Junior National Team. Until one day, when I could no longer ignore it. When I could no longer move my body.
I was going to play a game with the elite team and during the warmup, I jumped up in the air as always before shooting the ball against the goal to score. But this time it was different. It felt like I was left hanging in the air. One second felt like ten and when I landed on the floor I could no longer move my body. I was in severe pain. A disc prolapse. My teammates had to help me to the emergency room at the hospital and when I got there, the doctor asked me if I could sit, stand or lay down without pain. None of the above, I answered, before they gave me strong sedatives. The pain I experienced was undoubtedly a 10 out of 10 on my subjective pain scale! I have never before (or after!) experienced anything like it! In the following weeks, I spent every minute in bed, got morphine, and could not move my body at all. I did see lots of stars though as a side effect of the strong medicine!
This injury was about ten years ago. At that time I was completely incapable of listening and being in tune inwards, to understand the warnings that my overtrained body had been screaming to me for a long time. I was determined to come back. After months of back rehab with a physiotherapist, I could come slowly back on the field again. After all, I did love to play handball, it was a huge part of my identity to be a handball player, and I was good at it! I did come back, I even played handball abroad, in the U.S.A., where I toured around the country with the Boston and NYC handball teams and even played the U.S. National Championship. My last handball game on a high level was a tournament in Canada, where I played one of my best games ever. I’m very pleased with this ending of my semi-professional handball career! Amazing memory! After 18 years of playing handball, I got a contract to sign with a full-time professional handball club in Denmark — the best league in the world. At this time my severe back pain had unfortunately returned and my law school studies were taking almost all of my time, so turning down the contract was the only wise thing to do since increasing the number of workouts and pushing my body (my back!) even harder would most likely have made me immobile later on in life. I trusted my gut feeling, and remained happy with and smiling at what I had accomplished instead of crying at what I would miss.
A couple of years later, working as a high-performing and “always-on” kind of lawyer, I hit the wall, burned out completely as long-term stress without any rest had taken over my life. The same pattern of “always pushing and never resting” as I had when playing handball had now moved over to how I pushed myself career-wise. To always perform on top and never stop was deeply rooted inside of me. It was my “default” state of being. I didn’t think of it as being “wrong” or unhealthy in any way since it was everything I ever knew. In addition to this, this behavior had led me to amazing achievements and exactly to where I wanted to be in sports and in my law career. I had no reason to change it, or at least that’s what I thought before I crashed completely and had to rethink my whole existence and understand that my deeply rooted behavioral patterns had to change. I also understood the correlation between my back pain and my burnout.
In the long sick leave that followed, I spent up to 17 hours in bed per day, which lead to inactivity in my muscles, and eventually derogation. I became weaker and should be going to the gym, but the combination of burnout, anxiety and depression made it almost impossible for me to get out of bed. I started to experience that back pain from my handball injury several years before came back. And the more I stayed in bed, the more severe my back pain got. But even if I eventually went to a number of MR scans, and doctor visits, and met with personal trainers and physiotherapists, I knew that I had to heal my burnout and get my energy back before I could be able to heal my back issues. One thing at a time.
Now that I, through numerous doctor visits over five years along with therapy sessions, meditation sessions, stress courses, and lots of deep looking inwards, I dare to state that I have worked a lot on my mental health and found strategies to cope with stress and fatigue, and it was now time to deal with my back pain. So I made sure to get admitted to a pain rehab center in Sweden.
I recently finished my attendance at an amazing pain rehab program at a large hospital in Sweden. With the help of psychologists, doctors, physiotherapists, curators, and occupational therapists (all specialized in pain management) in this multimodal program together with other participants in this small group, I got help to tear down, step by step, the incorrectly built fundamentals of how we live our lives — and instead learn to build new thought patterns and behaviors that help us to focus on other things in life than our long-term pain. As it was before joining the program, lots of our abilities (or more correctly, inabilities) in our everyday lives have been determined by our pain. The pain has set the agenda for everything we can’t do, instead of thinking about what we actually can do. What truly matters to us, in the long run.
In this pain rehab program, we are therefore focusing a lot on two main things (among many):
Setting goals in the direction of doing more things that are truly valuable for us, and
Looking at our daily actions in many aspects of life to understand if it’s an action that leads in this desired direction, or if it leads to the persistence of old habit patterns that no longer lead to the desired goal. I’ll explain below.
Think about your life as a road that you are walking on. Like the picture I chose above for this blog post, the “road of life” might be icy, snowy, curvy, and have other obstacles. This is life. But somewhere, at the end of the road, there might be sunshine and beauty. The goal is to strive to get there. Not to be there now or tomorrow, but to work towards it. What is there, at the end of the road, differs from person to person.
1.) The first thing you need to do is to identify what is truly important to you. What is the sunshine and beauty for you, at the end of your road? Is it to be an active parent? To have a purpose-filled career? To have honest and loving relationships, where you can truly be your authentic self? Or, perhaps, to be more mindful, focused, and present at work or when playing with your kids? You can have one or many goals.
2.) When you have identified what is truly important to you, the next step is to find strategies for reaching these goals. What do you need and what can you do today in order to take one small step closer to living a life according to your desired goal, the sunshine at the end of the road? If you, for example, want to be more calm, focused, and present in your relationships, perhaps a good strategy would be to start meditating.
3.) To make this happen it’s good to decide when and where you want to do it. If want to do it ten minutes in the morning because you want to try how it can affect your day to stay more focused and calm, then perhaps a strategy could be to set the alarm to ring ten minutes before your normal wake-up time. If you don’t know how to get into the right mood, perhaps a useful strategy is to get an app to guide you, or perhaps to light a candle to get a relaxed vibe. Only you know what works for you, and what can help you to actually do it.
4.) When you have identified your goals and strategies on how to get there long-term, you have to practice identifying if and when you are doing things in your daily life that lead you in your desired direction, or if you are doing things that prevent you from getting there. Let’s name them a and b.
An a-behavior stands for automatic behavior, while a b-behavior stands for better behavior. An automatic behavior is something we do without thinking about that we do it. It’s the “autopilot” in us, and such behavior doesn’t lead to the desired outcome. A better behavior is a behavior that leads you towards getting away from your automatic behavior and towards a better, conscious, behavior. It is a new behavior that leads you towards what is truly important to you. It is something you want to do more of. In our meditation example above, an automatic (a) behavior would be to continue to do what you have always done, to not meditate, to react immediately to things, and, as a consequence, you will continue to be agitated, stressed, not mindful, and not focused.
“If you always do what you have always done, you will always get what you have always got”
A better (b) behavior would in the same example be to set your alarm for ten minutes earlier in the morning, to download a meditation app, and to just do it, even if it’s just for one minute. As a result, you will be able to observe as opposed to react to a situation, you will feel more centered, present, and focused. If you want a change in your life, something has to change. The more you practice identifying automatic, non-helpful, behaviors in your daily life, the faster you will reach your long-term purposefilled goal.
I’m now practicing daily to identify my automatic behaviors and change them to better behaviors that lead me towards what I truly value — my long-term goals, my own sunshine at the end of the snowy road. My goals are to strive for balance in my everyday life, to be as active as I can, to nurture my healthy relationships, to be authentic in my writing, etc. Small steps and strategies on that road would for me be to meditate at least 10 minutes every day, to text or call my parents and friends, to go for daily walks, and to write from the heart and not from the head in my blog. This will give me the balance I need to strive for things in life that matter for real. To make these things happen, I have implemented different useful strategies, such as the use of apps, scheduling time for them in my calendar, reminders of the positive and rewarding feelings afterward, communicating my goals with and including my family in my goals as a strategy to get them done, etc.
The result will be a change of thoughts and behaviors — two things that we have learned at the pain rehab center are determining how we perceive pain. As you could read, removing my long-term chronic pain or becoming “pain-free” was not one of my goals. The reason for this is that setting “becoming pain-free” as the main goal might have a counter-effect. It would then be too much focus on the pain, which could risk making it worse. Focusing on my pain is what I have spent years doing already without a positive result, so I needed a new strategy. There will be less focus on the pain if I focus on rewiring my brain to instead spend time focusing on what matters to me in my life in the long run. And the pain is definitely not one of these things! Less pain will, hopefully, become a positive side effect of this gradual mind shift, but it won’t be the focus. I’m excited about this journey and mind-shift, and I’m certain that this interdisciplinary approach at the pain rehab center I recently attended will have long-lasting effects since we change things from the inside out.
Change is hard work. It really is. However, it is very brave to dare to start digging deep inside yourself and to start understanding that the way you currently live your life is not the most optimal in order to strive towards the things that you value deeply, the sunshine of your road. Life is too short to not live it the way you truly want to, and it is never too late to change. Perhaps the time is not right for you now. Or maybe it is. Only you know. One small step today is better than no step at all, and a good thing is that you have just taken your very first step towards change by reading this blog article!
