A bit more about acceptance


Because of time and energy limits, I have decided to change my post slightly today.  I was going to give some references and discuss values and goals a bit more, but that will need to wait until I have just a bit more time.  I’m sorry.

I’m working with a new group of people in the three-week pain management programme.  We were discussing what they wanted from the programme, because one of the challenges I put to them is that if nothing has changed in their lives in six months time, then there is little point in staying – so what do they want?

Often that challenge is met with stunned silence.  It’s like they have never thought about what they want for such a long time that it’s really hard to know what to say.

It’s at this point someone will say ‘I want to accept my pain’.  And then I ask ‘what does acceptance look like, what do you mean by accepting your pain?’

Lots of discussion ensues with this one – someone will say ‘but doesn’t accepting it mean you give up hope?’, another will say ‘Oh I’ve accepted my pain but…’, another will say ‘I’ll never accept my pain’, while some will talk about being able to get on with life despite the pain will mean they’ve accepted it.  Some think that accepting means liking their pain, which often gets others saying ‘oh but I could never like my pain’ (well, who would?!).  Finally someone will say something like ‘accepting might mean I just stop fighting against it and go with it’.

Yesterday, someone said in this session that they had found that fighting the pain only meant they felt angry and frustrated and futile – and they still had the pain! So they’d try to go with the pain, and had found that at least they felt more peaceful about it, and some of the emotional sting of having pain went.

The ACT approach talks of the fact that trying to control the uncontrollable is the problem.  Chronic pain (and other negative experiences) can’t be controlled to a large extent – and even when chronic pain can be reduced using medications, the emotional effect of having limitations placed on function (in the minds of the person experiencing pain) is often what the person is trying to control.  The efforts people put into not flaring up their pain, not having to experience fluctuations of pain invade their lives – and the pain itself is still there.

The range of things that people do to avoid pain fluctuations is incredible – from seeking all manner of medical and nonmedical treatments (often with unpleasant side effects, and certainly expensive both in terms of money and the time taken to attend the treatments) to hardly moving at all, limiting engagement in almost every activity including relationships, family, work, leisure… and the pain is still there, and does its thing, coming and going, peaking and ebbing… What saddens me is the amount of energy spent doing all these things to overcome, control or ignore the pain, and that energy could be spent living!

I’m a newbie at working with the ideas of acceptance and what ACT calls ‘willingness’.  But one thing I do know is that there is a huge cost attached to trying to resist pain, or to hold onto control.

The idea that all pain must be abolished or controlled or life is not worth living is pervasive in our society and especially our health care system.

Now I’m not saying I want a tooth pulled without anaesthetic, or that I’ll have no pain relief for appendicitis! But with chronic pain, once the evidence-based medical approaches have been systematically worked through, the chance of completely removing the pain of many people is slim.  Often the side effects of medications and other procedures are unpleasant.  The search itself for a way of controlling pain is time consuming and energy sapping.  Some people, despite medical best efforts, will continue to experience pain that is then going to fluctuate, because that is the nature of pain.

I don’t know when is the right time to start considering that pain will not completely go, or when is the best time to start becoming willing to experience fluctuations in pain without trying to control it.  I suspect it’s quite early on in the piece, especially if we’re looking at the evidence from the pain-related fear and avoidance model.  It’s fear that the pain will overwhelm that is so disabling – because fear is a negative feeling that most of us try to avoid and attempt to control.

Perhaps one thing I’m learning about acceptance is that it’s not an ‘all or nothing’ thing.  I don’t think we step from one day trying to control and the next allowing it to be.  I think it’s a process as people recognise that pain is present despite best efforts to control or avoid it, gradually experience that it is a variable experience with peaks and ebbs, and then gently make space for it – and start to do that things that are important and valued in their lives.

My hope for the people on the programme at the moment is that some of them will start to feel differently about their pain, and begin the process of moving from being a ‘pain patient’ to being a ‘person who happens to have pain’.

7 comments

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  2. I think things got better for me (in terms of feelings about self) when I chose (and told my Dr.) the medication regimine that I felt comfortable with.
    It isn’t perfect. I still have pain usually, but it is a level I can manage. There are side effects to the meds, and this is the amount I can tolerate. I have non-medicine things that also help me and I can choose when to use them. I can also choose to change this regimine when I decide that the benefit of the change is worth the negatives. This was empowering to me. I couldn’t take away the pain, but I could still make choices about my life.

    1. Hi kmom
      I’m glad you found a way to communicate effectively with your Dr and started to take control over what was happening. To me, this is part of moving from that ‘I’m a patient – so you’re in charge’ to ‘I’m a person, let’s talk’. A much more equal relationship in which both people are responsible for communicating effectively, but the choices are made by the person who is affected the most by them. I’m keen to know: how did you learn to do this? What helped you?
      Thanks for popping in to the blog, it’s always great to hear what you have to say.

  3. How do you help people get out of the ‘poor me I’m in pain, I cant do anything’ phase?
    It makes me sad that they put their life on hold, chase every treatment option around despite the costs and miss their families growing up because they cant take a step back and look at the situation realistically. I feel guilty about going out and doing things somehow, but I’m determined to carry on and do what I have set out to do despite the pain. In fact, I’ve found its so much easier to be busy than it is to sit at home wallowing (not to say I dont have bad days I do, I’m not perfect).
    I think I try to overcompensate the control thing though and everything else is super controlled instead, means I dont cope with change very well…early on in my journey of acceptance I wrote “I am optimistic about the future mostly, sometimes the thought of the future overwhelms me but I am not going to let this beat me, I am not CRPS, CRPS is not my life-it is not my identity.” I like how you say acceptance is not an all or nothing thing, I dont totally feel I have got a secure handle on it but I like to think I am a good way there. Thanks for all your writings, they really are insightful and very understandable, I really enjoy learning what you have to teach.

    1. Hi Felicia
      I don’t know how to help people stop the poor me thing, I think it’s often part of a process the person goes through at least for a while.
      I know with the people I see, they’ve come to pain management because they’re unhappy with having pain, so it’s helpful to acknowledge that. Then I often ask what they would like their life to be like, and ask them whether what they are doing now is working to get them what they want. That can create an opening to begin to work on things that can create confidence, hope and belief that life itself carries on and can be good.
      I love what you say about not being CRPS, that CRPS is just a diagnosis and the person you are goes on. And yes, it’s definitely a process where some days its much harder than others. Where’s that magic wand when you want it?!
      Thanks for taking the time to comment, and I’m glad you’re enjoying the posts.

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