Thoughts are a constant part of our daily lives. It is, therefore, important to consider their role in pain management.
Often people with chronic pain find their thoughts have changed. The thoughts are often more negative and unhelpful and include more statement about things you can’t do or must/should do. These can lead to negative feelings about yourself and your situation and reduce your motivation.
Thoughts often play a role in the vicious cycles that build up when someone has pain for a long time.
Example of the effects negative thoughts might have:
If you were to have the thought: “I can’t go out with my family because of my pain” you are likely to stay at home alone a lot while others go out enjoying themselves. The feelings of being unable to join in and of isolation would likely make you feel low and depressed. The lack of activity would increase your stiffness and weakness, which in the long-term would lead to more pain. These consequences in turn would confirm the negative thoughts about yourself and your abilities.
Equally if you were to have the thought: “I must go out with the family and keep up despite my pain”, you are likely to go out; push yourself too hard and return with a lot more pain. You might find you need some considerable time to recover. This is likely to lead to feelings of depression, and negative thoughts about yourself. The peaks and troughs of pain will mean you are unable to establish a daily level of exercise to build up strength and suppleness and will also be maintaining the sensitivity in the chronic pain nerve pathways. (Pain Gate & Pathways)
A more helpful thought would lead to a different cycle:
If you were to have the thought: “I could go out with my family if I plan properly, pace myself, take breaks and discuss this with my family in advance” you are likely to go out and have fun without increasing your pain. This would lead to feeling more positive and having a sense of achievement. Beginning to do gentle exercise within your limits will also be increasing your fitness and stamina, enabling you to do more in the long-term. You are likely to also feel motivated to try again – maintaining the positive cycle.
There are 2 ways to manage negative and unhelpful thoughts. Different people find one or the other more helpful for them.
a) Challenging negative thoughts. For example, ask yourself: Am I looking at this in ‘all or nothing’ terms? What might I say to someone else who shared this thought with me? Is there another way of looking at this? Is there a more helpful thought, one that takes account of my limitations but also my abilities and skills, which will help me move towards my valued goals?
b) Accepting the negative thought without allowing it to influence your commitment and action towards your valued goals. Some people find challenging very entrenched thoughts unhelpful. This option allows you to accept that you have these thoughts, but acknowledge them as only that – thoughts. You can choose to remain focussed on your valued goals and work towards these using the plan you have set out, despite the negative thoughts. The sense of achievement and having more positive aspects in your life can in turn make your thoughts and feelings more positive.
Skill and Practice
Both approaches to managing negative thoughts require skill and practice.
Challenging thoughts can be difficult when you first start. Initially you might find it difficult to find alternatives to the negative thought or to believe the new thought. You might find it helpful to write down the negative thoughts when you notice them and come back to challenging them at a later time. With time and practice challenging thoughts can become much easier and indeed second nature.
The skill in accepting thoughts while remaining committed to taking goal-directed action lies in recognising which thoughts are helpful and which are unhelpful. For example, it might be important to listen to a thought saying ‘you have done too much and are in more pain’, if this leads to a refinement of your pacing baselines.
Dr. Claire Winchurst, Consultant Clinical Psychologist
Ms. Caroline Waterstone, Specialist Physiotherapist