How to Navigate Pain

With The Activity-Safety Meter


Pain is a tricky thing.


Intuitively, we often feel that pain is telling us that we’ve sustained an injury or that we’ve damaged our body in some way.


And of course, there were many times in the past that we had an injury accompanied by pain.


But what about the times when we’ve injured ourselves or damaged our bodies without feeling pain?


How many times have we cut our skin and had no idea, only to notice much later that we’d gotten blood on our clothes and on the surfaces around us?


How many videos have we seen of athletes sustaining gruesome fractures (bone-breaks), which were only noticed by the athlete after unknowingly trying to put weight through their fractured limb and falling to the floor under their own weight?


And what about the times where we do have pain without an injury or any signs of bodily harm?


How many headaches and stomachaches have we had, which come and pass without any obvious associated factors?


How many episodes of seemingly random knee pain, back pain, neck pain have we had, which show up one morning upon waking, stay with us for a few days or weeks, then pass like the wind?



How do we make sense of all of this?

What is pain? Why is pain?


Instead of thinking of pain as a sign that we’ve injured or damaged our bodies—which doesn’t fit all of the diverse scenarios of life—we can think of pain in a manner that does fit with the complexities of life:


Pain is a measure of the state of our being. Above all, it’s a measure of safety.


When our bodies (read: our entire human organism) don’t feel safe, the components of the brain-body stress system—the neurobiological systems that regulate body state—become activated (1).


These include:

  • The circadian clock

  • The hypothalamic-pituitary-adrenal axis

  • The autonomic nervous system

  • The immune-inflammatory system

  • Brain stress systems that underpin salience detection, arousal, pain, and emotional states

All the components of the stress system are interconnected and form part of a larger, integrated system that ensures effective energy regulation, promotes health and survival, and protects the individual from a broad range of threats (1). Pain is an integral part of these interconnected systems.


Pain serves to alert us that the body is in a state of stress. It’s one of the few responses that we’re aware of so it’s very important indeed. Without this alert system, we would likely not have survived as a species.


Importantly, pain doesn't exist in the body, nor does it exist in the mind, it is an organism-wide response. It encompasses our entire being.



Navigating Pain


As our understanding of pain broadens, we naturally start to wonder how to navigate pain when it shows up.


Namely, we wonder: When is it safe to experience pain and when is it not?


There are two common—and opposite—ways that we often misstep when attempting to navigate pain. And then there is The Middle Path.


1. The Push-Through Problem


This approach to navigating pain includes pushing through the pain no matter what, usually with the belief that it will make us stronger or it will make the pain go away.


This is a reasonable approach in many ways. The body is constantly adapting and changing based on the demands we place upon it, so it makes sense that challenging ourselves and our bodies would make us stronger, mentally and physically.


The problem arises when we push so hard that we crash. We push, push, push, during a certain activity, or for one day, then feel so beat up afterward that we can barely function. We lie in bed or on the couch, temporarily incapacitated from the relentless pushing.


This up-then-down, boom-bust cycle is a common pattern, and it’s not how our bodies adapt. It’s too much, too fast. It’s like learning to swim by jumping in the deep end of a swimming pool; it generally doesn’t go so well.


2. The Avoidance Problem


The other common approach to navigating pain is to avoid that which is painful, usually with the belief that it will help the body heal and thus help the pain to go away.


This approach is also quite reasonable in many ways. When we’ve sustained an injury, for example, it’s important to give our bodies time to rest and heal. This is also true when we’re stressed; taking some time to slow down can be very important.


The problem arises when we avoid anything that provokes any amount of pain for a prolonged period of time. This often leads us to do less and less until we cannot do much of what we love anymore.


This, like the Push-Through Problem, is also not how our bodies adapt. Our bodies need some degree of stress to be healthy. This is why exercise is so good for us; it is a means of putting a progressive, controlled amount of stress through our bodies, which makes them stronger and more healthy.


Rather than giving our bodies too much, too fast as in the Push-Through Problem, The Avoidance Problem is a problem of not giving our bodies enough.


The Middle Path


Somewhere between The Avoidance Problem and The Push-Through Problem lies The Middle Path.


This is the nuanced space of challenging our bodies (read: ourselves) in a way that helps us to heal and adapt, while not pushing too hard and making things worse.


This is really a space of paying close attention to the messages that we are receiving from our bodies and learning to interpret their meaning.


The good news is that our bodies are constantly giving us valuable information, so the more attuned we are to this, the more we can use it to our benefit. There are very simple bits of information that we can pay attention to that will allow us to make informed decisions when it comes to navigating pain.




The Activity-Safety Meter


I’ve created a tool to help you make informed decisions when it comes to navigating pain or other symptoms called The Activity-Safety Meter.


It's is a tool that I created for my patients to help them assess the relative safety in engaging in activities when pain or other symptoms are present. It’s based on my own reasoning process and how I answer these common questions that we’ve been talking through.


The tool is a 0-14 scale, based upon a series of questions about your pain or symptoms as they relate to a specific activity (e.g. walking, bending, lifting, running). Your answers give you a score, which provides you with some guidance on whether you’re on the end of “Good to go!” or whether you might want to “Stop & reconsider.”


(Click the image below to navigate to a free printable copy with included instructions)



Navigating pain can be tricky.


My hope and intent are that you can use this tool to help you navigate with a little more confidence in your safety as you move through the world.


If you’d like more guidance in navigating your pain and your path toward improved quality of life, you can learn about my pain consulting services here. I offer free consultations so that we can discover together if my services are right for you.

Stay well,

Andrew



References:

1. Kozlowska, K., Scher, S., & Helgeland, H. (2020). Functional Somatic Symptoms in Children and Adolescents: A Stress-system Approach to Assessment and Treatment (p. 383). Springer Nature.



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