Worry, anxiety, pain: musings on a flare-up

I have been in a bit of a flare for over a week now, it's been getting better with each day but I'd be lying if I said it didn't bother me, that I wasn't a bit worried (oh how I worry!). That I wasn't a bit bummed. Even with all that I *know* about pain science and my own pain experience, flare-ups still cause me a bit of concern, even though I *know* they needn't. Even though they're far less frequent and far less severe than they used to be. Even though there are no red flags, no cause for concern. Even with all that, worries can worm their way into my brain, nonetheless. I tell myself there's no need to worry (that totally works, every time. It especially works when someone else tells me not to worry), but some part of me will counter all my good sense with just one niggling doubt, one little thought that maybe, just maybe, I should be worried. It's pain, after all, shouldn't I be worried? And with that one little pernicious thought, I start to get all anxiousy all the time, feeling constantly busy and abuzz without actually doing anything. And, for some inexplicable reason, when I get into this mode I stop doing all the things that I know help most - my Headspace app, coloring, mindful walks, mindful movement, taking pictures, writing. Instead of taking time to calm my systems down I continue to ramp everything up with mindless busyness, niggling worry, and an underlying thrum of anxiety. (note: For me worry is about thoughts whereas anxiety is something I feel in every part of me.) And when my anxiety goes up, the pain goes up; it becomes a race between the two and I'm a hapless spectator.

Is it the pain or the worry and anxiety?

I can handle the pain, I've handled plenty of injuries and pain with no problem both before and after my chronic pain issues set in, including getting hit by a car as a teenager (open tib/fib fracture) and a bruised tailbone just last year (I'm not very good at cross-country skiing when hills are involved). But none of my pain experiences before or since have been like 'my pain', my chronic pain, which I react to much differently. Why is that? That's a great question, I don't really know yet (I have some ideas), though I'm trying to figure it out. It's obviously not the 'pain' that gets me so much as the anxiety and worry that come packaged with 'my pain' even when I *know* there is nothing to worry about, no cause for anxiety. I still go through these waves of uncertainty (not with every flare, but not never, either), these waves of doubt and worry, no matter that I know to expect flares, that I know how to get through them, that I know there's (likely) no damage to be concerned about. I still go through them even though I know that I've made it through every single flare previous to this one. There is still a lot of baggage that comes with 'my pain' that I haven't unpacked yet, apparently. *sigh*

Only human

I'm human, though, as are we all (even Adam Meakins! Check out his own back pain story, and he knows way more than I do).

Be like water That's why I'm sharing this. Too often we look at others and think that they have all their shit together and we're the only ones who don't. I share a lot of successes here, but I want to make it known that I don't have my shit together, either! I don't have all the answers. No one does. We're all just trying to figure this life stuff out, let alone this pain stuff. It's ok to not have all the answers, to be human, to be emotional. It's ok to feel frustrated or anxious or worried or sad. It's ok to have a bit of uncertainty. Life is uncertain, after all. We don't know what tomorrow will bring and we remember yesterday imperfectly, so all we really have is right now. And I don't want to live right now all anxious and worried. Sometimes I need to remind myself to live in the present moment rather than worrying so much about what this flare-up means or how it came about (read the 'why' behind our pain by Alison Sim for more on this) or being anxious about what the future holds or getting stuck in the past. Sometimes I need to remind myself to pay attention, to be aware that my thoughts, behaviors, and reactions affect my experience and that I can make a move and take some steps in a different direction. Sometimes I need to remind myself to be kind to myself, too. To be ok with being human, with not having total control, to just go with the flow. To be like water.

If we can recognize it, we can overcome it

Once I recognized what was happening I did what I could to put a halt to it rather than beating myself up (too much, anyway) over allowing it to happen (the worry and anxiety, not the pain. That part I can't control nearly as much). I went out for a jog (a very easy, slow jog. So slow that I wonder if people are staring at me in awe, amazed that a live person in real time can appear to be running in slow-motion). It allowed me time to get outside, to breathe, to be. To gain perspective and clarity. To stop the mindless chatter and quiet the thrum of anxiety. To feel confident, strong, and capable. To calm down. I'd definitely needed to get out of my head and my house for a while, both places I have spent a whole heck of a lot of time in pain (I've gotten pretty good at it there! Environmental context contributes quite a bit to my chronic pain experience, that's for sure). By getting out and doing I proved to myself that my hip isn't stupid, messed up, damaged goods and assured myself that I have no reason to be angry with it. My hip, 'my pain', is just a part of me along with all my other parts, after all. It's not the whole of me nor my existence. It is not my meaning, it needn't have a reason.

Gentle reminders

I seem to need to keep reminding myself of this at times or else I slip back into old habits, old thought patterns, old behaviors. Even though I *know* better. Acceptance isn't something we just do and are done with, it's something we have to live every day, and sometimes we need reminding. By getting out and doing I showed myself that I'm strong, capable and able, even when my pain is up. That life doesn't have to be put on hold, that even within our limitations there are endless possibilities for good livin'. I'm writing this as a reminder to all of you, too. To let all you patients out there know that this journey isn't linear and there is no one right way. There will be squiggles, loops, and switchbacks along the way that make us feel like we're going backward, but we're not. The trajectory is always forward. Most of the time I have little worry and anxiety about my pain, that's where I live most often. But sometimes I do. We have to talk about those times we're not cruising along so easily, too, if only to know that we're not stumbling along alone. And for all you practitioners out there, be patient with your patients and yourselves. No matter how long we've lived with pain, even those of us doing pretty damn well, chronic pain can still throw us for loops. We can know a shit ton of stuff about pain science and still have a very human experience of it. You may be getting through more than you think you do, and are at least planting seeds that may flourish later down the line, out of your view. (For more from Bronnie: changing patient beliefs.) Don't be afraid to be human, to be imperfect, to be unsure. We're all in this together, we're all human, we're all just trying to figure it out.

There is beauty amidst the storm

While I was out, I took this pic, a perfect depiction of how I was feeling at that moment. Sometimes the way can be rocky, ominous, daunting. It can feel insurmountable. But by putting one foot in front of the other, we can still navigate it. We have the skills, knowledge, and abilities to get through whatever comes along the path and we're better, stronger, and more confident because of the challenge, not it spite of it.

As always, thanks for reading folks! I'd love to hear your thoughts, stories, experiences, feedback. I think the more we talk about this stuff, the better able we are to figure out what helps and what doesn't, we are able to figure out how to apply the science to the lived experienced. These are lived experiences, after all, that go well beyond time in front of a doctor or in a clinic. 'Til next time!