I want to share my story of pain and depression from both a patient and a practitioners point of view. Pain can put a lot of strain on your finances, mental health, relationships and who you are as a person. Poor mental health and stress can be powerful predictors of the transition from acute to chronic pain. When someone comes into the clinic with persistent pain, they are not just coming in with pain, but with all the complexities that make us human. Here is my story about finding out who I am.
About 10 years ago, I had chronic pain, depression and anxiety. When I reflect on the years before my pain, I was probably sitting on the edge of depression and anxiety for many years, and I didn’t even know I was struggling. I had the full catastrophe going on – kids, mortgage, one income – and my way of making more money was to work harder. My sense of self and self-coherence was slowly being eroded, and I had stopped doing what made me, me. I stopped fishing, exercising, gardening and learning, and I was just surviving. Then I started to get an ache in my right shoulder.
“The vulnerable organism is more prone to pain states when you are low, you hurt more easily” (Louis Gifford 2014).
When the pain didn’t go away, I started catastrophizing about the meaning of the pain and what it meant for my family and my future – how would I do my job? I was using a lot of avoidance behaviours to stop me from hurting myself further. I couldn’t see a clear path forward, and I couldn’t make sense of what was happening to me. Over the next year and a half, I saw Myo’s, Physio’s, Osteo’s, Acupuncturists and my GP. None of this treatment was effective for the pain, I spiralled into depression and anxiety. My danger detection systems were in overdrive, I was perceiving dangers everywhere, and this was a feed-forward mechanism. Looking back the pain was not a 10 out of 10, it was more a 5 out of 10, but if you listened to what I was saying (I mean really listened) the word “pain” was like a code word, and I was saying I was in trouble and needed help. Not one of those therapists asked me about my mental health and what the pain meant to me. They were only focusing on the pain and looking at it as being a tissue-based problem. Most practitioners (including myself) were working within a mainly biomedical framework at this time.
I remember waking up one morning and thinking if I died at that moment, I would not care. Death would have been a relief, and this was the catalyst for me to take control and do something about my depression. For a lot of people, there is a definite turning point, and for me, it was this day when I started changing from “being a patient, to being a person again” (Thompson 2019). I went to my doctor, and I started treatment for my depression.
In the weeks that followed, I started moving again in spite of the pain (realizing pain did not equal damage), and I enrolled in an 8-week mindfulness course (MBSR – Mindfulness-based stress reduction). Mindfulness was probably the hardest and most rewarding skill I have learnt in my life. The course was hugely influential in cultivating a change in my relationship with pain, mental health and my sense of self.
During this phase, I developed coping strategies that moved me towards what I valued and loved, and I looked at ways of decreasing the dangers (real and perceived) in my world (or at least giving them less power). I also started seeing a friend Sally (Myotherapist) who was guiding me with care and empathy to get more active and to allow me to take more time to myself and was also checking in on how I was going. Gradually I got my depression under control, and my pain went away. Could there be a link?
This experience is behind my drive for helping others in chronic pain or in vulnerable state. It was a catalyst for me to fully embrace the biopsychosocial framework and delve deep into pain science. You need to be able to pick up on when a client is struggling or has deteriorating mental health because early intervention is vital for stopping or slowing the progression. We are not Psychologists, but we need to be psychologically aware, so we can make appropriate referrals when needed. I have developed a networking group in the hills of different health professionals to give us a wide referral network to help manage and treat this interplay between chronic pain and mental health more effectively.
Gifford, Aches and Pains, CNS Press, 2014
Thompson, Gage, Kirk, Living well with chronic pain: A classically grounded theory, Disability and rehabilitation, 2019
Koole, Sander L., Schlinkert, Caroline, Maldei, Tobias, & Baumann, Nicola. (2019).
Becoming who you are: An integrative review of self-determination theory and personality systems interactions theory. Journal of Personality, 87(1), 15-36. doi: 10.1111/jopy.12380