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Pain as Portal 

Pain can be a prison or a portal to compassion. 

It can widen our world or shrink it, open doors or slam them shut. 

Prison 

Pain often feels personal.  

Under attack from an omnipresent, amorphous enemy, our natural response is to hunker down and fight like hell. 

But personalising pain imprisons us and disconnects us from the truth: pain is universal. 

Yes, pain is unevenly distributed, and some bear greater burdens than others, but pain affects every living being in some way.  

Portal 

When we realise its universality, pain can become a portal to compassion, a window to shared experience.  

The fruits of kindness grow in the garden of pain. By helping one another, we nourish our common roots. Empathy enriches the soil. 

When we can’t physically be present, practicing loving-kindness meditation connects us with the pain of others, keeping the portal open.  

Liberation 

"We are all unified and share the same substance. We breathe the same air. We share the same hopes and dreams." - Ryan Holiday, What is Sympatheia

We live in intricate webs of interconnection. Right now, others are feeling the way you do. You are not alone. You never were. 

Pain can be a prison or a portal. Choose liberation. The world needs more gardeners.

Pain & Joy 

Living with chronic pain can be emotionally exhausting. On any given day, we may experience a complex mix of frustration, sadness, envy, and anger. It’s easy to get lost in the fog of negativity. 

However, pain does not preclude joy. Living with chronic pain can paradoxically make us more attuned to pleasure, finding beauty in the mundane, ordinary parts of life we take for granted. 

The mindfulness we rely upon to manage our energy and moods may reveal vistas of joy. These pockets of pleasure can provide moments of consolation and calm that can change a day. 

On Simple Pleasures 

One of my favourite poems exalting the importance of simple pleasures is by Patrick Kavanagh. He wrote it sitting by the Grand Canal in Dublin, lulled by the waters streaming through the lock. 

Lines Written on a Seat on the Grand Canal, Dublin – Patrick Kavanagh 

O commemorate me where there is water, 
Canal water, preferably, so stilly 
Greeny at the heart of summer. Brother 
Commemorate me thus beautifully 
Where by a lock niagarously roars 
The falls for those who sit in the tremendous silence 
Of mid-July.  No one will speak in prose 
Who finds his way to these Parnassian islands. 
A swan goes by head low with many apologies, 
Fantastic light looks through the eyes of bridges – 
And look! a barge comes bringing from Athy 
And other far-flung towns mythologies. 
O commemorate me with no hero-courageous 
Tomb – just a canal-bank seat for the passer-by. 

Prime your mind for joy 

Here are some ways we can prime our minds for joy: 

  1. Practice mindfulness in all things. A tasty morsel of food, birdsong, a hug from a loved one. Mindfulness should not be reserved for specific times. It is possible in all situations. Ruby Wax has a lovely book on this, and a video here
  2. Look deeply, notice more. 
  3. Give and you shall receive. Compliment someone. The reward is in the doing. 
  4. Practice active kindness. As Seneca said: “Wherever there is a human being, there is an opportunity for kindness”. 
  5. Practice gratitude. Consider a gratitude diary each night, noting three things you are grateful for. 
  6. Use your rational mind, observe your thoughts. Cognitive behavioural therapy is a great tool for this. 
  7. Engage your mind in “flow” activities. Mine are reading, writing, and playing music. 
  8. Exercise for endorphin release and a boost in happiness. 
  9. Hug loved ones, as often as possible. We may be starved of hugs at present, but once we are allowed, revel in them. Here is a nice video praising hugs
  10. Spoil your body with good food.

Pain & Resilience 

 

“There is a natural firmness in some minds which cannot be unlocked by trifles, but which, when unlocked, discovers a cabinet of fortitude” – Thomas Paine 

Living with chronic pain is a continual challenge. We often need to dig deep into our mental and physical reserves to cope. Mining our minds can sometimes reveal hidden treasures, untapped resources we didn’t need to draw upon until now. 

Post-traumatic growth 

Post-traumatic growth refers to the transformational role that traumatic events can have in creating positive personality changes in some people. Facing adversity can lead to improved relationships with others as our need for social support increases. A positive outlook, with a renewed sense of gratitude, may result from dealing with and coming through tough times. 

Although the theory has many critics, and there is clearly no straight line between trauma and growth, facing adversity can sometimes lead to greater strength of mind. Humility in the face of pain may bring improved compassion for others. Learning and re-learning our fragility may help us appreciate life a little more. 

Unlock your cabinet of fortitude 

To unlock your own cabinet of fortitude, here are some ideas: 

  1. Engage your rational mind with Cognitive Behavioural Therapy. Harry Barry has a wonderful book on this. 
  2. Learn to accept and embrace your thoughts and feelings with Acceptance and Commitment Therapy. Here is an introduction
  3. Learn to discipline your mind, little by little, and free yourself. Jocko Willink has a good book on this. 
  4. Try journaling and expressive writing. There is a proven connection between expressive writing and wellness
  5. Challenge yourself – within reason and with medical advice – and test your limits. Learn your baseline for physical and mental activity and try to push a bit. 
  6. Be a friend to yourself. You are your company, alone, and around others. Be good to yourself, as you would be to a close friend. 
  7. Seek consolation and wisdom in philosophy. I personally practice the philosophy of the Stoics, but there are many to learn about. Alain de Botton has a wonderful book to get you started. 
  8. Meditate on our place in the world. Sometimes, when we are caught up in our struggles, taking the cosmic view can help. Here is a thought-provoking video on this. 
  9. Learn to pace yourself to preserve energy and take control of your days. 
  10. Seek help and seek to help others.

 

 

 

Pain & Pacing 

Chronic pain naturally creates changes to our daily habits and activities. 

We are forced to give up some activities entirely, while reducing the intensity of others. 

As pain ebbs and flows day to day, and hour to hour, we risk falling into the ‘overactivity/underactivity cycle’ (Nicholas et al, 2011), visualised below: 

(Image from https://publicism.info/self_help/pain/9.html

On a good day, we try to play catch up and become overactive, causing a heightened pain response, leading to increased rest and underactivity while the pain eases. 

This cycle is mentally and physically draining, and can lead to physical deterioration as our body swings between peak activity, or none. According to Nicholas et. al (2011), even short periods of inactivity can lead to: 

An increased risk of heart conditions 
Obesity 
Weakness of bones 
Muscle wasting 
Depression 

The key to breaking this cycle is pacing: sustaining a moderate level of activity throughout each day. 

Here are some tips for how to build pacing into your day, and break the burnout-inactivity cycle. 

1. Divide big tasks into smaller ones 

If you want to clean the house, do it room by room, and spread it out over a couple of days, instead of trying to do it all at once. 

If you do a weekly shop, and need to carry heavy bags as a result, consider bi-weekly shopping trips to lessen the load. 

2. A few small wins 

“George Washington’s favorite saying was “many mickles make a muckle.” It was an old Scottish proverb that illustrates a truth we all know: things add up. Even little ones. Even at the pace of one per day.” – Ryan Holiday 

Read another chapter of a book you love. Phone a friend to catch up. Cook a tasty breakfast. Small wins matter. 

3. Write a list 

Write a list each night of what you aim to do the next day. Not only will this help you sleep better, but ticking them off feels very rewarding. 

It can also help you manage your activity expectations. Did you try to do too much, or too little? Test yourself and see. 

4. Schedule small breaks throughout your day 

Effective time management is pain management. Short, regular breaks will ensure you don’t overdo it on one task, leaving you drained for the rest of the day. 

If you spend 20 minutes baking, sit down for 30 minutes and relax. This way, you will end up doing more, with less risk of pain peaking. 

5. Try mindfulness 

“Being able to focus on relaxing the body, noticing the breath and body sensations as being there just as they are, can help manage pain, as well as reduce depression and anxiety symptoms.” – Mayo Clinic 

Mindfulness is proven to be effective in managing chronic pain. Take time out to practice this, and you will return to your day refreshed. 

Here is a 10 minute mindfulness video from Jon Kabat-Zinn, an expert on mindfulness for pain: https://www.youtube.com/watch?v=QCNXi_0lsCk 

6. Make a plan and record your progress 

Make a note of your current activity levels to set a baseline, and decide on a plan – with help from a health professional – to gradually increase your activity. Record your progress. 

Having a plan to follow will keep you on track, flag any specific issues, and your incremental improvements will motivate you and boost your confidence. 

As Plato put it: “Never discourage anyone…who continually makes progress, no matter how slow” 

 

References: 

‘Manage Your Pain’ (2011): https://www.amazon.co.uk/Manage-Your-Pain-Michael-Nicholas/dp/0285636790 

‘A Few Small Wins’ https://ryanholiday.net/all-you-need-are-a-few-small-wins-every-day/ 

‘Mindfulness for Chronic Pain’ – https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/use-mindfulness-to-cope-with-chronic-pain 

‘Writing a To-Do List May Help Your Fall Asleep’ – https://psychcentral.com/news/2018/01/13/writing-a-to-do-list-may-help-you-fall-asleep/131170.html

Pain & Isolation 

This is the first of is a series of articles aimed at providing counsel and consolation to people living with chronic pain. The author lives with chronic pain from a rare autoimmune condition. 

According to Chronic Pain Ireland, an estimated 1 in 5 people in Ireland live with chronic pain, and its prevalence increases with age

Chronic pain is usually defined as: 

“pain without apparent biological value that has persisted beyond normal tissue healing time”. It is also defined as pain that either persists beyond the point that healing would be expected to be complete (usually taken as 3-6 months), or that occurs in disease processes in which healing does not take place. (Chronic Pain Ireland

Chronic pain introduces a variety of challenges to those living with it. This series – part practical advice, part philosophy – aims to address some of these, providing counsel and consolation. 

Although these articles are aimed at people living with chronic pain, they may help anyone facing physical or psychological pain, temporary or otherwise. 

In our first piece, we will talk about pain and isolation. 

A Lonely Place 

“There’s so many different worlds 

So many different suns 

And we have just one world 

But we live in different ones” 

– Dire Straits, Brothers in Arms 

Mark Knopfler expressed it beautifully. We live in our own mental worlds. When pain is present, headspace diminishes and we can feel isolated, confined. Pain can feel like a place of its own, a lonely world with a population of one. 

We try to explain how we feel, but the understanding of others is naturally bounded by experience. Sympathy and compassion provide essential comfort and consolation, but they cannot always plumb the depths of our feelings. People do their best, and we are lucky to have them on this journey. 

Imprisoned by Inactivity 

Physical isolation is also common with chronic pain. We may be immobilised, housebound. Even if we are active, we need to rest more than most, recover, conserve our energy. We’re easily fatigued and stamina is left wanting (see the ‘Spoon Theory’). There is nothing wrong with being alone of course, but when pain forces our hand, it can be harder to accept. 

In a hyperconnected world, where Social Media shows all the wonderful things our friends are doing, we can experience a further blow, the reminder of what we cannot do. The pain of missing out. We grieve for our loss of vitality. 

Alone Together – Dealing with Isolation 

There are several ways we can tackle the physical and psychological isolation that comes with chronic pain. 

DEPERSONALISE THE PAIN 

It is easy to feel wronged, victimised, singled out for suffering. But you are not the only one feeling lonely and isolated. We are alone together, all who feel pain in this moment. Our journeys are unique, but by depersonalising the pain, we can see its universality in life. 

Pain may be inevitable, but we can meet our trials with courage. The Stoics have many wise things to say on facing adversity. Here is Seneca: 

“If you meet sickness in a sensible manner, do you really think you are achieving nothing? You will be demonstrating that even if one cannot always beat it one can always bear an illness. There is room for heroism, I assure you, in bed as anywhere else. War and the battle-front are not the only spheres in which proof is to be had of a spirited and fearless character: a person’s bravery is no less evident under the bed-clothes.” — Seneca 

CONNECT WITH FELLOW TRAVELLERS 

It has never been easier to find support groups for health issues, whether through your local community, or online via forums, websites, Facebook groups or otherwise. This is the positive side of Social Media, where fellow travellers connect to share advice and console one another. Chronic Pain Ireland are a great place to start in Ireland. They run workshops nationwide on living with chronic pain. 

HELP OTHERS 

Sometimes, the best way to get out of your own head is to provide solace and companionship to others. Chronic pain may limit our activity, but it can’t stop us from helping others who are suffering. Pain can be a portal to compassion, if you let it. 

LET PEOPLE IN 

It’s easy to put up walls when pain is peaking. Sometimes we need space, sometimes healthy distraction. But shutting yourself off can compound stress and isolation. We need each other, and though complete understanding may be difficult, our loved ones deserve our confidence and trust. Sometimes a hug will do more to change a day than any words. Let people in. 

BUILD AN INNER CITADEL 

There will be times, however, that we need to retreat into ourselves, and rely on our will to endure. The Stoics spoke of an Inner Citadel, which must be built, maintained and reinforced. We are stronger than we know. Adversity is the true test of character. Resilience is a learned trait. Here is a great piece on this

We hope some of these tips will help. Isolation can be a difficult aspect of chronic pain, but it need not break us. 

In the next article, we will look at Pain & Pacing. 

 

Further Reading: 

https://www.irishtimes.com/life-and-style/health-family/chronic-pain-how-to-live-with-it-and-manage-it-1.3604323  

http://www.nuigalway.ie/research/centre_pain_research/documents/st12_national_uni_ireland_galway_pro.pdf 

https://medium.com/mind-cafe/a-stoics-guide-to-suffering-well-963ecd3fcb9c 

https://classicalwisdom.com/philosophy/stoicism/marcus-aurelius-stoicism-and-pain/