“I hurt terribly all the time and nothing helps!” If you relate to this, or hear this from someone in your personal life or professional practice, it can feel depressing, discouraging, and trigger feelings of hopelessness. Yet even when pain is severe and unrelenting, everybody experiences some variation. It may be that:

  • Hot soaks or other types of soothing rest breaks may cause aches and pains to recede.
  • Creative endeavors or other distracting activity may cause pain to take a back seat.
  • An amusing movie or an enjoyable interchange may cause burning or shooting pain to become less evident.

Such reprieves may seem inconsequential because they are time-limited and the degree of relief is minimal. They will not help people feel “pain-free" or able to behave or feel “as before.” But any variation can be mined for answers that lead to positive adaptations. Learning the reasons for ups and downs can enable increased control and comfort.

Of course, severe pain can make variation difficult to spot. Pain and accompanying depression both tax cognitive abilities. Thus, people who live with chronic pain are more vulnerable to negative thinking, such as “it’s always this bad!” and to compromised memory, which make fluctuations more challenging to recall or view in context. 

So what can you do if you can’t locate variation in your experience? What if it feels like your pain is a constant 10 out of 10?

Notice your worst times.

One strategy is to consider times that felt even worse. This has been a helpful first step for clients of mine who felt that their pain was “always the same.” No matter how bad it may be; it can always get worse. (I know this, too, from personal experience!) If you are struggling to recall any moments of relief, start by looking for the opposite. Exploring the reasons for worst moments reveals clues about ways to reduce their frequency and duration. You might notice that your pain was particularly difficult when:

  • Barometric pressure rose with a coming storm,
  • You stood in a long line, embarked on a jam-packed day, or stayed in bed for days, and/or
  • You received unpleasant news or had been mulling over an unpleasant thought. 

Factors associated with intensified symptoms can provide clues to antidotes or alternatives.

Process of understanding:

Once you identify when your symptoms were at their worst, dig into the detail. If your pain spikes during times of high stress, you might practice relaxation techniques, such as diaphragmatic breathing and meditation. If sleep interruption is to blame, you might focus on sleep-enhancing tricks. Even identifying factors that are beyond your control can be useful. Take the weather, for example. Many people find heavy atmospheric pressure intensifies symptoms. While we cannot change the weather, we can adapt our response to it. Don’t underestimate the power of being able to say to yourself, “it makes sense that my pain is higher today” instead of feeling blindsided by an unexpected painful flare.  Awareness of exacerbating factors can let you plan your schedule accordingly and reduce overgeneralizations that intensify suffering. At times not making things worse is the best anyone can do.  Moreover, you can treat relevant information—such as the coming of a high-pressure weather front—as a cue to be ready with your most soothing, compassionate responses.

Silver lining:

Identifying times when your pain was worse also means there are times that were “less bad.” This reveals positive variation that might have otherwise been missed when thinking is overwhelmed by exhaustion. Recognizing variation, even subtle movement, introduces the possibility that you can understand and affect your experience.

Among the struggles of chronic pain is unpredictability. Flare-ups that seem out of the blue not only make it impossible to make plans but can make people feel powerless and demoralized. As you observe your ups and downs and the factors associated them, you gain control. This may come little by little. Figuring out how to reduce pain from a 10 to a 9 may not seem significant; but, as you learn what helps, you can incorporate this into your life, leading to greater and lasting improvement.

Be mindful of variation

Mindful attention to variation itself can reduce suffering. Mindfulness involves deliberate awareness to the present moment, without judgment. Mindfulness reveals difficult moments for the moments they are, without assigning them undue significance, and emphasizes the choice we have in each and every moment. It can be helpful to remember that all we ever have to survive is this current moment. Approaching any feelings, thoughts, or sensations that arise as transitory can help you through them.  When phrases like “I can’t take it” arise in your day, practice viewing them as fleeting thoughts rather than facts. Such thoughts may come and go but do not define your whole reality. Awareness of variation can not only reduce the sting of low points, but open us to see the positive exceptions.

 Adopt a curious mindset.

Variation represents possibility. Research shows that perception of chronic pain and fatigue depends on a long list of factors including how we breathe; medication; engagement in positive distractions;  emotional and physical intimacy; pacing of activity and rest; application of heat and cold; laughter; gradual and graduated exercise; our facial expression, self-talk, and attitude. As you note what brings relief, build these into your day and see the effects add up.  By learning what helps (and hurts), you can make informed choices to increase joy, capabilities, and comfort.

What gets in the way?

The strategy may feel inadequate when you are wracked with pain and nothing brings sufficient relief. But what is the alternative?

Sometimes judgments about what “should be” interfere with steps to adapt, adjust, and embrace life as it is, in the best way you can. This is understandable; however, fighting against one’s current reality worsens the experience. Consider the example of standing in a long line or another activity that likely increases pain. While in line, you can intensify your suffering by fighting against reality with statements like, “this shouldn’t be so hard!” Or, you can bring a folding chair, stretch, meditate, engage in conversation, slow your breathing, or any number of strategies to reduce discomfort, while planning a restorative break to follow. 

Acceptance does not mean liking things as they are. Chronic illness is dreadful, incredibly challenging, and involves multiple losses. You may have times when you need to wallow in the misery. Be gentle with yourself. Grief is an important part of this process. Make sure to acknowledge the validity of this.

Hope is vital!

Sometimes people with chronic pain retreat out of hopelessness. Looking for the variation in one’s experience—no matter how trivial it may seem—can be a vital first step in enhancing the life that you have.

© 2013 Deborah Barrett

Author, Paintracking: Your Personal Guide to Living Well with Chronic Pain  

For more on this approach, including a free online tracking tool, please visit: www.paintracking.com

You can also join me on Facebook  

About the Author

Deborah Barrett, Ph.D.

Deborah Barrett, Ph.D., MSW, LCSW is a clinical associate professor in the School of Social Work at the University of North Carolina at Chapel Hill.

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