Deborah Barrett, Ph.D.

Deborah Barrett Ph.D., LCSW


Mack Truck Mornings

Chronic pain, even at its worst, doesn't necessarily mean staying in bed.

Posted Aug 04, 2012

What does it feel like to be run over by a Mack truck? Thankfully, actual occurrences are few. When I first developed pain, and long before I heard of fibromyalgia, I used Mack Truck metaphors for my own experience. Having grown up near the company’s headquarters, I may have been quicker than average to make this this association.  Yet, when I was finally diagnosed and began reading about people’s experiences with fibromyalgia and related pain syndromes, I found such references were rampant.  

Most people with chronic pain would probably agree that a personal collision with a truck would exceed even their highest pain moments – after all, those machines weigh tons, and any survivors would unlikely be spared bones or flesh. Fibromyalgia is usually described with benign words such as achiness, stiffness, or tenderness, or as muscles that feel over-exercised --all of which can refer to what everyone experiences from time to time (if not chronically).  These words may fit people with milder symptoms, but they are wholly inadequate for those whose lives have been upended by FM’s unrelenting arrival.

It’s a problem of magnitude. How in fact does one convey feeling wracked with pain, in one’s skin, joints, or nerve endings throughout the body, from  head, neck, shoulders, on down?

It’s also a problem of visibility. “If someone were experiencing that level of pain, it would show!”  Yet it does not.

What would a reasonable response look like to awakening with searing pain? You might cry out, whimper, rush (with help) to the emergency room, or fear moving at all. But getting up and going on with your day as if nothing were wrong would feel inappropriate, even absurd. No?

Yet for many people with chronic pain, “normal” mornings deliver a shocking level of pain. Even after nearly two decades, I can be surprised by the force of the pain that routinely follows a mundane evening and solid night’s sleep.  And like many who live with painful disorders, I have learned that I benefit most from acknowledging the pain (maybe observing its perseverance or tenacity) and then forcing myself out of bed and into the day.

Living well with fibromyalgia can involve observing and then ignoring the feeling that you’ve been hit by a Mack truck.

Going about your day despite intense pain requires the paradoxical skill of acting opposite to your intuition. When your whole body hurts, it takes a powerful narrative to convince you that getting up or moving will help. But often it does. The more self-knowledge you have about the probable outcome of a chosen response, the less difficult it becomes to act in ways that may feel counterintuitive. By learning the consequences of your morning choices, you can benefit from heeding your data rather than listening to your body. Over time, you can develop a new intuition based on what works.

But even when you know that you will benefit from getting up and going, it can still be difficult. For members of the morning Mack Truck club, consider the following:

  1. Appreciate your strength. Remind yourself that no matter how hard a morning may be, you have experienced worse. Be awed by the pain. Admire its ferocity and persistence. Then be awed by yourself and your ability to get through each moment.
  2. Treat each day as an experiment. By treating each new day as an opportunity to learn, you can find value in any response you choose. For example, you could see how you feel when you chose to lie low for a few hours; push past the pain; stay in bed all day; engage in particular activities; use deliberate self-talk; or return to bed later in the day. Recording the effects of your response equips you with data you can use for the next time. You can then make informed decisions based on what has helped most, rather than what you may “feel like" or "feel like doing." This can help you engage in behaviors that you know will be helpful (especially when you feel like avoiding or hiding out), and to continue to adapt others to make situations more doable, comfortable, and otherwise effective. 
  3.  Encourage yourself. As you discover what helps, develop narratives that help you pursue what works most, such as replying to morning pain with a rhythmic mantra of “hot shower, hot shower, hot shower” or "staying in bed won't help..." or whatever will enable you to improve your experience.
  4. Schedule something motivating for each morning. This might be an exercise class, breakfast plan, home task, checking facebook, or other activity. Without a reason to get up and going it is much more difficult. Consider the difference between how you experience mornings when you have to move versus those with little or nothing on the agenda.  Wide-open days can be a huge relief -- however, without any distraction, pain has a way of filling the space. By planning something compelling for yourself every day, you are more likely to get going before negative self-talk (such as “why bother?” or "this sucks") sets in and keeps from pursuing something fulfilling or soothing.
  5. Be mindful, at the same time, of the risk of over-scheduling. Distraction can provide a temporary refuge from pain, but moderation and balance are key. Too much activity activates a vicious cycle of painful flareups.
  6. Don’t “should” yourself. Your usual may be usual for you – but that does not mean it is not hard. Be gentle with yourself. And even when you know how to feel better (or at least less bad), this does not mean it is easy. Even people who have come to accept their situation experience moments when they wish things were otherwise or mourn their losses.

Like someone suffering from depression (and pain and depression can coexist and reinforce each other), facing the day can be difficult. Yet, not doing so most often worsens both physical and emotional symptoms. As a psychotherapist, I have yet to hear from a client, “I stayed in bed for two days and boy did I feel better!” And as someone who have lived for years with Mack Truck mornings, I have learned that regardless of how desperately I hunker down in bed, I fare better by focusing on something constructive and moving ahead step-by-step with my day.

 For more information on finding ways to experiment and improve life with chronic pain, see my book and companion website, with its free, customizable tracking tool. Or stay connected on Facebook.