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Ask a Therapist is a new series of columns offering insights and advice about common psychological concerns. It is not a substitute for seeking professional psychological or medical care.
As a clinical psychologist living with cerebral palsy, a group of disorders that affect movement and muscle tone, I understand firsthand what it is like to go through daily life with chronic pain. In addition to my personal experience, my career is focused on health psychology, helping individuals with acute and chronic health conditions enhance their functioning and quality of life.
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According to Health Canada, approximately eight million Canadians experience chronic pain, which is defined as pain that lasts longer than three months. Chronic pain is uncomfortable, can be debilitating and causes disruption to daily routines. You may be unable to walk the dog, get together with friends or participate in a beloved sport. Chronic pain can be unrelenting, and you may start to feel consumed by it and by your desire for it to go away.
Peer-reviewed research has confirmed that psychological interventions, such as Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Stress Reduction (MBSR), are highly effective for chronic pain management. The five strategies below will not eliminate your pain. However, by cultivating acceptance, mindfulness and values-based behaviours, they can help you feel less preoccupied by it, allowing you more space to live your life, whether pain is present or not.
1. Stop fighting your pain and radically accept it
It is natural to fight against pain. However, the more you do so, the stronger it gets, and the more depleted you feel. Radical acceptance is defined as being willing to fully accept the present moment as it is. Radically accepting chronic pain does not mean you like it or are resigned to it. It simply means you completely acknowledge the pain in the moment without struggling against it. This frees up energy you can use in more beneficial ways. By dropping the rope and not playing an endless game of tug-of-war with your pain, you create more room for living your life in a meaningful way.
Practice radical acceptance with these strategies:
Pause and breathe. Pause for a few moments and take some slow, deep breaths, focusing on lengthening the exhale. Breathing this way eases muscle tension and creates space between the pain sensation and your response, allowing you to respond to your pain more helpfully and intentionally.
Acknowledge how you feel without judgment. Instead of trying to ignore your pain or negatively evaluating it, you might say to yourself: “My lower back is aching right now, and I feel tired” without adding phrases such as, “This is horrible!”
Use a coping statement. Repetition of helpful statements strengthens their effectiveness. Say to yourself, “This moment is what it is, even if I don’t like it,” or “Although this moment is unpleasant, I can cope with it as it is.”
Shift your focus to what you can control or what is meaningful to you. Ask yourself, “What is something I can focus on right now that is under my control, that I am grateful for, or that is meaningful to me?” and let the answers guide your behaviour.
2. Cultivate a balanced perspective
Focusing only on discomfort increases distress. Multiple things can exist at once. If you practise acknowledging all aspects of your pain experience, you can make a more intentional choice about how you want to act. Broaden your focus by using the word “and” instead of “but.” “And” allows for complexity and dichotomy in your experience. For example, you might say, “I would like to spend time with friends, and I am in pain,” and then consider what type of action is most helpful right now.
3. Come back to the present moment
Spending a lot of time thinking about the past or worrying about how your pain may worsen in the future exacerbates anxiety and distress. Practise refocusing on the present by directing your attention to your experience in the moment. Grounding techniques such as taking a slow breath and noticing the sensation of the air moving in and out of your body, or looking around and naming five things you can see, can help you do this.
4. Engage in values-based behaviours
Life can feel smaller when living with chronic pain. You may be isolated and less able to undertake activities you enjoy. Pause and consider what is meaningful to you and align your behaviour with your values. Ask yourself, “What is important to me that I can do today?” and take a small, realistic action that moves you in that direction.
5. Remind yourself your pain is not dangerous
Chronic pain is often not solely the result of structural damage in the body, but a complex condition that may also involve a misfiring pain alarm. When you experience a pain sensation, the brain sends a false alarm, telling you, “Danger!” when you are actually safe. Perceiving chronic pain as dangerous puts your brain on high alert, and physical sensations that were once neutral are now interpreted as dangerous. The more danger your brain perceives, the more pain signals it sends, creating a vicious fear-pain cycle that keeps pain going.
Remind yourself that a sensation can be unpleasant, yet that does not mean it is dangerous. You can have unpleasant sensations and not be harmed by them. Allow your pain to be present, because it already is, and say to yourself, “I am safe right now. There is no danger here.”
Dr. Jennifer Caspari, PhD, is a registered psychologist in British Columbia. She works at Tall Tree Integrated Health in Vancouver and is the author of You Are More Than Your Body.
