Chronic pain: Managing your emotions

When chronic pain intrudes on your life, you may feel overwhelmed by intense emotions. Panic, grief and anger are just a sampling. Like the pain that spawns them, these emotions can linger and transform you into a different person. A person you don't like. A person no one likes.

When you see that your own words and actions convey anger and bitterness, your sense of self-worth takes a plunge, and your relationships suffer as well. Your strong, negative emotions also can produce changes in your body that sap your energy and intensify your pain. Your pain and unhappiness also may trigger cycles of difficult emotions and dysfunctional behavior in those around you.

Now the good news. There are healthy ways to deal with your inevitable and understandable negative emotions. If you take advantage of these techniques, you not only will improve your relationships, but also may become more effective at managing your pain.

Admit your loss

For many people, the first step in dealing with negative feelings is to admit that the feelings exist. That's very difficult for some people to do, especially in a culture that often praises the optimist and criticizes the complainer.

If you're grappling with chronic pain, one of the earliest and most wrenching emotions you experience is a deep sense of loss. You may miss:

• The healthy person you once were
• Your independence
• Your privacy
• Job satisfaction
• An enjoyable hobby
• Sexual intimacy
• Untroubled family relationships
• Gatherings with friends
• Feelings of energy and confidence
• A sense of happiness

These are difficult losses. You may feel as if nearly everything precious to you has vanished. Your natural response is to grieve. Grieving can trigger various feelings. Even within a single day you may experience several different emotions.

Many people respond to chronic pain with the same feelings that typically accompany the loss of a loved one:

• Denial. You may deny that pain is an unavoidable part of your life. You continually seek a cure or quick fix, even though you've been told your pain is incurable or requires a long-term program of rehabilitation.

• Anger or frustration. You've tried numerous ways to control your pain and nothing seems to be working. You find yourself more irritable more often. You get upset when others don't seem to understand what you're going through.

• Depression. You become overwhelmed by feelings of sadness, worthlessness and helplessness. You don't feel like doing anything, and you have difficulty concentrating. You withdraw from others.

• Guilt and shame. You sense you're not the person you used to be. You feel that you're somehow failing those who are closest to you.

• Acceptance. You stop focusing on things you can't change and begin to look to the future. You accept that your pain is a part of your life.

You may come to terms with your pain more easily if you:

• Recognize your losses as serious. Don't trivialize them.

• Admit your feelings to yourself and others — to supportive family members and friends, as well as to your doctor. Acknowledging and talking about your feelings is the first step toward emotional health.

• Give yourself time for emotional healing, and ask your doctor, a counselor or a therapist for advice and help.

Manage your anger

Unrelenting pain, interrupted sleep, unsuccessful treatments, job woes and insurance battles — a lot of things can make you angry, especially when you're in pain. But it's unhealthy to stay angry, bottle up your anger or express it with explosive outbursts.

Mismanaged anger can hurt you in many ways. Whether it's short-term and intense or lingering and subdued, anger causes your body to release chemicals that can lead to headaches, backaches, high blood pressure, irritable bowel syndrome and other health problems. Anger can also influence your pain. It typically produces muscle tension, making it difficult to relax.

Here are some ideas to help you manage your anger:

• Identify your anger triggers. If, for example, a visiting friend generally manages to upset you, knowing this ahead of time can help you prepare for the next visit. Think about discussion topics that spark your anger and practice what to say to defuse the situation. For example, if your friend starts to bring up a past dispute, you might respond by saying, "Oh, we've discussed that before. Certainly we've got more interesting things to talk about."

• Identify symptoms of emerging anger. What do you do when you start to get angry? Do you clench your teeth? Do your neck and shoulders begin to tense up? Read these symptoms like a caution light — a warning that you're getting angry.

• Respond appropriately to your symptoms. When you find yourself becoming angry, take a short timeout. Count to 10, take a few deep breaths, look out a window — anything to buy time so that your brain can catch up with your emotions, and you can think before you act.

• Give yourself time to cool down. Before you confront the person who's made you angry, find a way to release some of your emotional energy. Go for a walk, listen to music or clean the house.

• Don't bottle up your anger. If your anger stems from what someone did or said, talk directly to that person. Don't verbally attack the person with accusations and a history of how this person has angered you in the past. Deal only with this episode, and approach it from the perspective of how you feel instead of what the person did. For example, try a statement like this: "I feel hurt by what you said." That way, you're more likely to find a receptive listener than if you launched a blame-offensive statement, such as: "You insulted me for the 20th time today!"

• Find release valves. Look for creative ways to release the energy produced by your anger. These might include listening to music, painting or writing in your journal.

• Seek advice. If anger-provoking situations continue, confide in people who care about you, such as family members or friends. Ask them to help you brainstorm possible solutions. You might even try role-playing scenes that spark your anger so that you can practice a healthy response.

You can't keep yourself from getting angry, but you can manage your anger so that it doesn't become an ongoing problem that aggravates your pain.

Practice positive thinking

To help yourself cope with the upsetting emotions that chronic pain can produce, try positive self-talk. Self-talk is the endless stream of thoughts that run through your head every day. Some people refer to this process as automatic thinking.

Your automatic thoughts may be positive or negative. Some are based on logic and reason. Others may be misconceptions that you formulate from lack of adequate information. The goal of positive self-talk is to weed out the misconceptions and challenge them with rational and positive thoughts.

Here are some common forms of irrational thinking. Try to identify and challenge these types of thoughts:

• Filtering. You magnify the negative aspects of a situation and filter out all of the positive ones. For example, you had a great day at work. You completed your tasks ahead of time and were complimented for doing a speedy and thorough job. But you forgot one minor step. That evening, you focus only on your oversight and forget about the compliments you received.

• Personalizing. When something bad occurs, you automatically think that you're to blame. For example, you hear that a family picnic has been canceled and you start thinking that the change in plans is because no one wanted to be around you.

• Generalizing. You see a troubling event as the beginning of an unending cycle. When your pain fails to go away, your thoughts may proceed as follows: "I'll never be able to do what I used to." "I'm a burden to everyone around me." "I'm worthless."

• Catastrophizing. You automatically anticipate the worst. You refuse to go out with friends for fear your pain will act up and you'll make a fool of yourself. Or one change in your daily routine leads you to think the day will be a disaster.

• Polarizing. You see things only as either good or bad. There's no middle ground. You feel that you have to be perfect or you're a failure.

• Emotionalizing. With this type of distorted thinking, you allow your feelings to control your judgment. If you feel stupid and boring, then you must be stupid and boring.

You can learn positive self-talk. The process is simple, but it takes time and practice. Throughout the day, stop and evaluate what you're thinking. And find a way to put a positive spin on your negative thoughts. Start by following one simple rule: Don't say anything to yourself that you wouldn't say to someone else. Be gentle and encouraging. If a negative thought enters your mind, evaluate it rationally and respond with affirmations of what is good about yourself.

Eventually, your self-talk will automatically contain less self-criticism and more self-acceptance. Your spontaneous thoughts will become more positive and rational.

Challenge your expectations

Some people are perfectionists, constantly striving for excellence. These are the homemakers whose houses could pass a military white-glove inspection, the master welders who pride themselves on their precision work and the grandparents who never miss their grandchild's soccer games.

This compulsive perfectionism isn't the lifestyle for someone with chronic pain. Trying to live up to a perfectionist's expectations can become emotionally and physically damaging.

Before pain invaded your life, perhaps you could work 50 to 60 hours a week with no problem, clean your entire house in two hours and play a set of tennis every Saturday. Now, even part-time work leaves you exhausted, household chores become intimidating daylong projects, and tennis is unimaginable.

As long as you compare yourself with how things used to be, you'll likely feel miserable about your performance. Your work won't be good enough, and your leisure time won't be enjoyable enough.

There is a way to keep an upbeat outlook — become a perfectionist at adjusting your goals. People who don't adapt to new challenges are more likely to become discouraged and depressed. But those who are flexible enough to adjust their expectations generally manage to stay active. "I can't work a full-time job and still keep a perfect house," you might say to yourself, "but I can at least clean up the dirty dishes in the kitchen and make sure the floors aren't littered with newspapers and clothes."

Whatever new projects you take on, or goals you set for yourself, don't focus on only the outcome. Learn to enjoy the process, not just the completion of the task. Look at it as an opportunity to learn and grow.

Learn to assert yourself

Responding to all of the challenges of daily life can be difficult. And sometimes, one of the toughest tasks is learning to say no, even when doing so is in your best interest. To keep from disappointing others, you do things you know you shouldn't. You spend all day on your feet shopping with a friend. You agree to stay late at work to finish a last-minute project. This is passive behavior. You put your thoughts, feelings and health aside for the sake of others. Passive behavior can stem from your upbringing and your beliefs about the importance of helping others and treating them with respect. Or it can result from low self-esteem.

Unfortunately, passive behavior and chronic pain can be a dangerous combination. When you continually give in to the wishes of others — at your expense — your frustration can grow, your self-esteem erode and your pain increase.

It's possible to stand up for yourself without being blunt or hurtful to others. How? By behaving assertively — that is, honestly and openly expressing your feelings, while showing concern for the feelings of others.

Here's an example: "I miss spending time with all of you, and I'd like to go golfing with the group. But instead of playing 18 holes, I'm going to bow out after nine and wait for you to finish. I hope you can understand."

Assertive behavior is based on "I" statements. "I" statements allow you to tell people exactly how you feel and what you think, without placing blame or creating feelings of guilt.

Here are some tips for communicating more assertively:

• Observe your behavior. Honestly evaluate your behavior when speaking with others. Are there times when you're assertive, such as when talking to a certain co-worker or family member, or are you always passive or aggressive? Make a mental note of times when you communicated your needs simply and directly. When a conversation leaves you feeling unsatisfied or resentful, try to identify what went wrong so that you can avoid it in the future.
• Think before you respond. When you want to make a statement or you're asked a question, think briefly about the best way to get your point across assertively, instead of simply blurting out an automatic response.
• Plan for a difficult situation. Think about a situation you're likely to encounter in which you'll need to be assertive. Close your eyes and imagine how you'll respond. What might the person say? What will you say in return?
• Pay attention to your body language. As you practice being more assertive, observe how you stand or sit, along with your gestures, facial expressions and eye contact. For example, when talking to someone, do you look at the person? Or do you stare at the ceiling or floor or out a window?

Boost your self-esteem

Here are some ways to redirect your thoughts when you start getting down on yourself:

• Structure your day with goals you can meet. When the day is done, you'll feel a sense of accomplishment.
• Talk with a friend. Having someone who's willing to take time to listen to you lets you know that you're valued.
• Spend time with others. It will make you feel more connected and less alone.
• Help someone. It reminds you that your life makes a difference.
• Treat yourself to something you enjoy. This might be some new music, a great book or a scoop of gourmet ice cream. Just as you buy gifts for others who are feeling blue, you need to do the same for yourself.
• Spruce up your appearance. Try a different hairstyle. Buy some new clothes. The better you look, the better you feel about yourself.
• List reasons people like you. It reminds you that you have special qualities people enjoy.
• List things you do well. Then do one of them.

Living with chronic pain can take a toll on your mood, outlook, relationships and self-image. It may take a struggle, but if you can manage your anger, practice positive thinking, challenge your expectations and assert yourself, you'll find renewed joy and purpose in life.

By Mayo Clinic staff

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April 07, 2004

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