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When is a good time to start to ‘accept’ chronic pain?

Posted Nov 26 2008 12:28pm

Acceptance is a real buzz word in many chronic health and wellbeing writing at the moment.  This is partly due to the popularity of Acceptance and Commitment Therapy and similar therapies, and possibly also due to the wide range of health problems that don’t respond to medical interventions.  As that wonderful movie said ‘Perhaps this is as good as it gets ‘.

Some studies show that acceptance is one of the greater predictors of ’success’ in a pain management programme (eg McCracken & Eccleston, 2003; Morley, Davies & Barton, 2005; Paez-Blarrina et al., 2008).  And it’s certainly something participants ask about often in the pain management programme I work on - when should I start to accept this pain?

I can’t exactly answer that question - but I can make some observations.

To accept doesn’t mean to give up hope: it does mean recognising the situation right now.  I think acceptance means recognising that life continues whether your pain is there or not, and making a decision to remain engaged in that life anyway.

Perhaps describing the journey of a person with pain might help identify key turning points for deciding when acceptance becomes increasingly important.

Onset of pain - this can be sudden or gradual, an accident, an illness.

At some point the person decides to seek help - this point depends on a lot of factors, well-explored in the literature of pain.  Some factors are: distress, poor sleep, the meaning of pain, influence of media, influence of other people, disability or loss of function.  Someone somewhere decides that this person should not be experiencing pain and needs to find out what it is, and get it fixed.  Until someone decides the pain ’should not be there’, pain rarely is a problem! A good person to read on treatment seeking is Dr Norton Hadler - not only is he a respected rheumatologist, he is also a great writer with a social perspective on health, health care, and medicine in particular.  The Last Well Person is a great read, although you’ll need to be prepared to have ‘traditional’ medical views challenged.

Once a person decides to seek treatment, the first step is usually a diagnosis. This is great if the diagnosis is directly related to a conceptual model of what is going on - not so good if the pain problem is multifactorial, as is so often the case.  If the diagnosis is confirmed and a treatment provided, with any luck that will be the end of that. Relatively speaking anyway.

But for those people who find their pain doesn’t settle, or the treatment is unacceptable (some people just don’t like surgery, medications or needles), then it’s time to start down the acceptance route, IMHO.

The problem is that diagnosis is not an especially accurate science.  It’s based on the prevailing model of cause - treatment is also usually based on that model.  Diagnoses provide a useful handle on a group of symptoms that seem to go together - but not necessarily, because as we know, there are lots of different names for the same group of symptoms, each dependent on a particular model of function or dysfunction. Diagnoses help label a group of symptoms, help us as clinicians talk to each other about similarities between people - but they don’t explain why this person has come to seek help now with this set of problems associated with their symptoms.

A model that seeks to ‘fix’ or ‘cure’ or ‘reduce’ pain will have pain reduction or elimination as its focus.  Sometimes seeking the ‘fix’ or ‘cure’ can take a long time.  And each time a new ‘fix’ or ‘cure’ is tried, time is added on to the period before a person can readily start to focus on living their ‘normal’ life again.

Why?

Because people who hold on to the hope of pain reduction as their only way forward find it really difficult to consider remaining engaged with ‘normal’ life when their pain hasn’t gone and a new cure is being offered.

A model that looks at explaining why this person is here today presenting with these problems and resources goes a much longer way toward solving the problems associated with pain, rather than simply eliminating the pain. The problem with this approach is that it’s pretty complex, there are no simple assessments with simple solutions.  And it’s really difficult to identify commonalities between people because there are a much wider set of factors to consider.  The good thing about this approach is that it’s possible to help people re-engage with living despite their pain if it doesn’t reduce.

Once a diagnosis or explanation of the problem has been reached, then it’s time for interventions.  And monitoring of whether the interventions have worked.

To me, the real definition of ’success’ is whether the person is starting to re-engage in life again.

Life may not be the way it used to be.  That means some regrets, sadness and losses at times.  At the same time it also presents opportunities.  Acceptance starts once the person reaches a point of ‘creative hopelessness’ : recognising that continuing to strive for ‘life the way it used to be’ isn’t fulfilling.

When is it a good time to start to ‘accept’ chronic pain?

When the NOW isn’t fulfilling values, and moving forward to fulfil those values means making changes.  So it’s not a time measured in days or months, it’s not even a stage of treatment such as whether to continue with pain reduction or move to pain management.  It’s simply a period when NOW isn’t satisfying and the person is prepared to look to making changes to create a new lifestyle that is satisfying.

Well, that’s my take on it anyway.  Can I help with this? I think if I can help a person point out the consequences of their chosen pain, help them review what is important to them and see whether what their life holds right now is leading them towards what is important, and help them resolve their own ambivalence, then maybe I can just a little.

McCracken, L. M., & Eccleston, C. (2003). Coping or acceptance: What to do about chronic pain? Pain, 105(1-2), 197-204.

Morley, S., Davies, C., & Barton, S. (2005). Possible selves in chronic pain: Self-pain enmeshment, adjustment and acceptance. Pain Vol 115(1-2) May 2005, 84-94.

Paez-Blarrina, M., Luciano, C., Gutierrez-Martinez, O., Valdivia, S., Rodriguez-Valverde, M., & Ortega, J. (2008). Coping with pain in the motivational context of values: Comparison between an acceptance-based and a cognitive control–based protocol. Behavior Modification Vol 32(3) May 2008, 403-422.

      
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