Andrew L. Martin, PsyD
Chronic pain profoundly affects a basic human task – movement – changing it from something we take for granted into a source of anxiety and frustration. We have to move, but we naturally don’t want to hurt. Here are a few concepts for deciding when and how to move in order to reduce pain, frustration, and anxiety, and to get more accomplished.
Hurt versus Harm. “Hurt” means I am experiencing pain. “Harm” means my body is being damaged. On a deep level, our brains don’t know the difference between the two. As we think about moving, the brain often tells us, “no – you will harm yourself.” Such thoughts happen quickly and outside our conscious awareness. Over time, they can cause us to move less and less, which can make chronic pain worse through weight gain and de-conditioning.
So – will moving really “harm” me? If my arm is broken, then yes – I shouldn’t move it! But with chronic pain, all the harm or damage is already done, and any healing that’s to occur has already happened. The pain we feel when we move is just that – old chronic pain. Next time you dread moving due to chronic pain, practice thinking: “this might hurt, but it is not going to harm me.” This may help you to move more.
Pacing. How long should I do a task that involves pain? Until the pain gets bad? Until the task is ‘complete?’ If I work until the pain gets bad, I am often done for the day, and must rest the next day. If I work until the task is complete – despite intense pain – I may be out of commission for several days. But what if I pace my activity based on my knowledge of my body, versus based on pain, or based on a wish that I could move like I used to, or a belief that I should complete a task all at once – no matter the cost?
Pacing for chronic pain is based on the idea that each task involves a little bit of pain, but then there’s always a time when the pain really gets bad. For example – I know I can mow the lawn for about 25 minutes before I have to stop due to severe pain. So now I never mow for 25 minutes. I mow for 20 minutes, rest for 10 minutes, let mye body recuperate, and then I can mow another 20 minutes, relatively pain-free. And – my body’s not broken and I’m not having to rest the next two days. I can still do things with my family, or do other projects or activities.
So pacing for chronic pain involves figuring out when intense pain usually happens with each kind of activity, then never doing that activity for that long – always stopping 5-10 minutes before you know the pain usually gets bad. My patients have found a couple of thoughts helpful for pacing: “It’s smart to quit and rest while I still feel good – because I will get more done in the long run, with less pain.” “I wish I could move like I used to, but I can’t, and that is out of my control. But I can certainly maximize how much I can do by moving smarter.”
Summary. Thinking consciously about “hurt” and “harm” can allow us to move more, helping us build stamina, lose weight, and condition our body – all of which can reduce pain. Pacing our movement based on knowledge versus pain can reduce pain over time as well. We can slowly move more and more with less pain because we’re no longer in a cycle of over-activity and extended rest.
NOTE: As you experiment with thinking differently about movement, consult your physician about what movements/activities are safe for you.
REF: Murphy, J.L., McKellar, J.D., Raffa, S.D., Clark, M.E., Kerns, R.D., & Karlin, B.E. Cognitive behavioral therapy for chronic pain among veterans: Therapist manual. Washington, DC: U.S. Department of Veterans.