End of year roundup

It’s summer in New Zealand, and although the vagaries of Kiwi weather are always with us (33 degrees predicted today – but a southerly tomorrow and a drop of probably 10 degrees in half an hour!), we’re gearing up for our usual Christmas and New Year close-down. I’m also taking a break over the next three weeks, taking to the rivers (bring on the trout!) in Sweet Caroline the Caravan, complete with blue sky ceiling with tiny puffy clouds!

To end the year it’s common to come up with a top 10, so these are my top 5 posts from the year. They’re not always the ones with the most hits, they’re ones that I’m particularly pleased with. Over the next three weeks, why not take a browse through some of my favourites, and if you’re still stuck for reading matter, head to the “search” page and type in a term – or you can simply click on a Category or a Key Word and voila! there will be a bunch of posts to trawl through. Enjoy!

1. Talking past each other: One of the weirdest things for me is being both a professional working in the field of chronic pain, and also being a person living with chronic pain. There’s a certain dread among some health professionals when they find out a person working in the field also has the condition – a bit like “so you’re in it for yourself”, “you’re living out your own issues”, “you’ll get over-involved”. Harsh. I got interested in pain management some years after I developed persistent pain. My interest began because the people I was working with (return to work programmes in the 1980’s) often had chronic pain, and I wanted to know more about how to help them. For many years I didn’t let anyone know I also had this “thing” they were trying to live with. I finally decided that being real, honest, authentic and not pretending I had it all together was far more helpful (and less stressful) than any kind of facade of professionalism I could apply. I can’t say whether what works for me will work for anyone else. I don’t always have answers. I can only say I know what it’s like to walk alone, trying to work out what will help and what won’t – and that’s a very lonely road to walk. For that reason I’ll be there, a one-woman cheering squad on your side.
2. Telling someone they have chronic pain: Being given good advice when I first found out I had chronic pain would be one of the most important reasons I think I have learned to find wiggle room with my pain. It’s not the kind of message healthcare professionals are trained to deliver. By and large we’re taught to fix, cure, mend, heal or DO something. Chronic pain is one of those problems for which there are no easy, single bullet answers. There’s usually a mix of things that will give support – and a bunch of things that won’t do a thing, or may even harm. This post synthesises some of the things that I have found out about giving that “bad news”.
3. Am I nuts or do I just have pain?: People living with chronic pain deal with stigma often. There’s an unwritten “moral” compass that people living around us use to identify whether someone is faking, mad, or just lazy. Is chronic pain a mental illness? Personally I would argue not – but then again, how do we define what is, and isn’t, a mental illness? Some super-slippery concepts here, but I prefer NOT to classify chronic pain inside a set of psychiatric labels. I think it’s stressful enough to live with chronic pain without the sense that it’s a mental health problem, because, after all, it’s experienced in the body. And while some of the factors involved in chronic pain are neurological, brain-based, and affect mood, thoughts and behaviour, there are many other health problems that are also influenced by the same set of issues. Personally, I don’t like labels that lump people together as if, because they have a predominant symptom, the problems arising from it are all the same. Many of you will know I use a case formulation approach – by using this approach a clinician acknowledges that there are many factors influencing the “what it is like” to live with chronic pain, and it gives priority to the everyday concerns of the person rather than trying to squish him or her into some sort of square box. I’ve got curves, they just don’t squish like that!
4. Case formulation: I have written a few posts on case formulation – so here’s a list of them! I hope they’re useful 🙂  Case 1; Case 2; Case 3; Case 4; Case 5; Case 6; Case 7; Sorry if these are slightly out of order, and believe me, there are some more I haven’t yet listed!
5. Who are you? The effect of pain on self: Nothing prepares us for the onset of a chronic illness. I mean it. Even if you KNOW you’re going to get something, when it’s finally given the label there’s a certain reality that can’t be shaken. All the assumptions of what we can or can’t do, our capabilities, our future goals, our assumptions about how life will be – these get shaken when we get told “I’m sorry, but you have _________”. Learning to deal with this new reality is both fascinating (to an outsider) and extraordinarily hidden (to the person and those outside). We don’t really know how people come to terms with having to give up aspects of self, adopt new habits, develop a focus on parts of self that weren’t previously valued. It’s an area of learning to live with pain that has been touched on, but needs far more attention, IMHO.

OK, so a random selection of posts from the last year, and a couple from years before. If I get time before I head out in Caroline, I’ll post another set – but in the meantime, I wish you a peaceful and safe holiday period, and hope you’ll build dreams and start actions for a fabulous 2016.