I recently pulled something in my shoulder and suddenly had a bout of acute pain that lasted for many days. Like most of us, I’ve had my share of injuries and pain, but this issue was so sudden and affected so much of my day to day life that it really threw me off my game. I couldn’t do many of my usual activities and experienced jabbing pains with every micro-movement I made. I found myself catastrophizing, focusing all my attention on the pain and how terrible it was, and it really dominated all my attention. I am right handed, so because the injury was on my right arm, the impact of it was always front and centre in everything I did. It took me a few DAYS before I could take even a small step back and observe how I was reacting to this unfortunate situation. Eventually I got around to taking that small step back and asked myself: I must have learned something in all my psychology education and experience that I can apply to myself! What can I do?
Here are a few things I dredged up from my memory banks and research once I could get a little much needed perspective. I tried them out in the midst of my acute pain situation, and all helped improve my experience, leading to more acceptance, and, therefore, to thinking and acting in more helpful ways.
Before I launch into the strategies for responding to pain, I want to acknowledge how hard it is to disrupt our incredibly strong — and natural — reaction to pain. It makes sense that we have extreme (though unhelpful reactions) like the ones I did: we go into survival mode when we have acute pain! It makes sense to feel fear, anger, helplessness, etc. We are literally wounded animals.
However, it is helpful to remember that we experience the pain of the physical pain, and then we experience the pain of our response to the pain. What Rick Hansen calls “the first dart and the second dart”. The first dart is the painful event. The second dart is the emotional suffering we experience — and which are largely created by — with our thoughts. We might not be able to change the first pain at the time, but we can change the impact of the second kind of pain — our mental suffering. (As a bonus, by changing our response to the pain, the intensity of the pain is often somewhat reduced.)
On to the strategies worth experimenting with the next time you find yourself having to bear acute pain:
What we focus on grows:
I know this! Yet, yeesh, did I ever focus on the pain for those first few days. What can you do instead? You can be actively mindful of the present experience:
Sit quietly, eyes closed, and notice the pain.
Notice the differences between the varying kinds of pain. Is it jabbing pain? Is it a dull ache? Is it hot or cold? Etc. Try to tease out the differing ways of describing it, and deliberately name them.
Notice how they may ebb and flow, come in waves and recede, or move around.
Then start to notice other parts of your body. Notice other sensations and name them too. Are there any places without pain? Notice that. Actively appreciate the places without pain. Something like, “I am really thankful that my feet don’t hurt at all!”
Then starts noticing other sensations in general: smells, textures, wind, sounds, music you like, sunbeams, visuals, the scent of baking, the greens of the trees, etc. If you really look, you can find things to appreciate. Name them. Appreciate them actively. Feel your real appreciation for these things.
The idea here is to expand your focus on to other things besides your pain. Other things in your life still exist, but pain tends to bump them out from one’s realm of attention. By deliberately bringing other aspects of life back into our realm of attention we can remind ourselves of these other things, it expands our realm of attention, and can help us take a step back from the painful experience. This may help us feel calmer and like we have more choice in what we pay attention to. This can feel empowering, especially when faced with something painful that we did not choose. Stepping back allows us to observe ourselves — a key to improving our mental health, especially when in distress or crisis.
One of my favourite methods of breathing is box breathing. I think I like it best because it is so easy to remember. (Also, Navy Seals use it to calm down in crisis situations, so it must be effective.) Breathing like this can help our nervous systems calm down. When we are dealing with pain our bodies are typically tense and activated by being in a kind of survival mode. Box breathing can help you relax and tell your body that it is safe, even though it is in pain.
Separate yourself from the pain:
Imagine the part of you that is in pain as just a part of you. Do this by Imagining it as a member of your inner team. Perhaps imagine it as a vulnerable child deserving of care, or as an injured team player who needs encouragement. Whatever idea works for you, think kindly towards this part, encouraging it, being compassionate towards it. “I see your pain and I care for you. I am here for you.” Send love to your injured part. Does this sound cheesy? I get that it might. The goal here is to separate your self from the injured part to help to not be overtaken by the pain. Often the intensity of pain leads us to feel like we ARE the pain and it is us. We have difficulty separating ourselves from the pain, and are unable to take that important step back. Framing the painful part as a part can help take this step back.
Challenging your thoughts:
When pain is acute, extreme negative thinking can really ramp up. “This is so bad! I hate this! It will never get better! This is terrible! This wrecking my life! Why is this happening to me! It’s so unfair! What if it goes on forever?”
The very uncomfortable feeling of pain can easily trigger anger, fear, helplessness, and desolation. Notice all the exclamation points? Everything feels urgent! These urgent feelings often slide right into these kinds of extreme thoughts. However, just because these kinds of thoughts make sense when you are injured — remember, you are a literally a wounded animal — it doesn’t mean these kinds of thoughts will help you feel better in the midst of this acute pain event. They won’t. These kinds of thoughts cause stress and they are not helpful to you because they can serve increase your distress. Remembering that these thoughts are unhelpful to us can allow us to actively choose more helpful thoughts.
More helpful thoughts can include thoughts like this:
Reminding yourself that many people get injured, most injuries heal, pain usually changes over time
The present experience will inevitably change
You have likely been injured before and got through it
It could likely be worse than it is
Pain is your body’s way of telling you to rest and heal
Being injured is sometimes a part of being an active human being.
The idea here is to be able to take a broader perspective and reduce the extreme thoughts to having more reasonable and realistic ones. This works to reduce your stress and slow down the accompanying escalation of emotions.
My final idea for handle acute pain is to create a metaphor for the pain. We will all inevitably face challenging situations we need to bear: from natural events like going through childbirth, to challenging ourselves with a marathon, to unfortunate events like dealing with a painful injury, your home being flooded, or getting through the flu. And so many more. The story we tell ourselves about these events will either help us get through them, or lend to feeling even more distressed by them.
Humans are story telling creatures. When we are deliberate about choosing the story we tell ourselves, we can draw strength from that story. Some examples might be: weathering a storm, surfing tumultuous ocean waves, or climbing a mountain. I like the metaphor of weathering a storm because weather is one of those things that just happens — just like unfortunate events — and we just have to bravely wait for the whether to eventually change — which it always does. Ideally we can get through the storm by using constructive coping strategies like some of the ones I suggest here.
Essentially all these strategies can help us accept what is happening in the present moment. It is the railing against what is actually happening that increases our distress.
Experiment to see what works for you. We are all different and some of these strategies may be more effective than others. Even if you get hooked into the destructive thinking for a while like I did, you can eventually take a step back and use strategies like these to decrease your own distress.