What Pain And Onions Have in Common

Chronic pain comes in many shapes and sizes, and can have a hurricane-like impact on your life.

They both make you cry.

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Sorry about that.

The title of this article is not just a set-up for a terrible joke. I actually have something more substantial to say about chronic pain.

What’s up with chronic pain

Chronic pain is a diverse condition that range from mild to severe, intermittent to constant and from daily annoyance to disabling. It can be a symptom of another condition, chronic illness, injury or unexplained (by current health care technology).

Chronic pain doesn’t necessarily mean forever pain. It means pain that has persisted on a near-daily basis for 3-6 months or longer (the exact cut-off point can vary). Some actually prefer to use the term long-lasting pain as language can shape our perception – so using the term ‘chronic’ can make it self-fulfilling prophecy where you don’t seek treatment because you don’t believe anything can be done about it – which isn’t necessarily true (again, pain comes in all shapes and sizes).

It’s very prevalent, affecting about 20% of the population (that’s a lot!!) – of which 40% report it’s frequently limiting their ability to work or do other normal life activities. It’s actually the leading cause of disability and it’s associated with a reduced quality of life, including increased risk of anxiety and depression.

And it’s that last bit I want to talk about today. How the problem with chronic pain is not just chronic pain.

Chronic pain is more than pain

You see, the problem with chronic pain – or the problems that comes with chronic pain – is not limited to the uncomfortable bodily sensation.

That’s where the pain onion comes in.

The Pain Onion Model

The Pain Onion. Adapted from illustration by Smertecenter Syd

The pain onion is a model that illustrates the consequences and additional challenges chronic pain patients face aside from the fundamental pain. They accumulate like layers, building around the pain.

This can lead to a downward spiral where the pain worsens the outward layers, the outward layers can affect the experience of pain and increases the total amount of suffering, each layer enforcing the others.

The layers can look like:

  • Social isolation
  • Family/relationship trouble
  • Loss of work, reduced income
  • Loss of identity, confidence, sense of self,
  • Overwhelm, fatigue and cognitive effects
  • Loss of valued activities
  • Loss of independence, feeling like a burden
  • Persistent negative emotional reactions – like depression and anxiety

Even in isolation, each of these suck. And there’s no easy way to deal with them.

Another way to look at it is: For some forms of chronic pain, there’s no well-established treatment. But that doesn’t mean there’s no way to reduce the suffering. Instead of just looking at the pain, look at the other layers of the onion.

Maybe you can work on acceptance of your new body & self.

Maybe you there’s way you can make (or encourage others to make) hangouts more accessible to you.

Maybe you can meet up with other people who’s in a similar situation.

Maybe there’s places where you can get support in doing all of these things.

Though there unfortunately isn’t a universal answer to this, there are actionable steps you can take!

Personally, I’ve had immense benefit from meeting up with other (young) people with chronic pain or chronic illness after connecting online. The first time was for a party with 50, and I felt so nervous before hand. I am not an outgoing person! But I went anyway. And the best way I can describe it is one giant hug of empathy, acceptance and validation. Since then I’ve also been to a couple of meet ups at a cafe. And it has made a huge different in how I see myself and my situation.

I know I’m not weird or a particularly special case for being dismissed by doctors not taking my pain seriously.

I know not to be ashamed of my diagnosis.

I’ve found people in similar situations to look up to, and a community of support when I need it.

You can’t put a price on that!

The two arrows

Do you know the buddhists parable of the two arrows? That’s another way to illustrate how sometimes our natural reactions to pain (however normal and understandable) can increase our suffering.

I’m no storyteller. But imagine you’re walking through a forest, when – suddenly – you’re hit by an arrow. The archer has already nocked a second arrow How do you react? That determines whether you’ll be hit by the second arrow too.

The first arrow represents the pain at its core. It’s unavoidable (possibly for physiological reasons), and out of your control.

The second arrow represents your reaction to the pain. It gives the possibility of choice. What exactly being hit by the second arrow means to you, is individual. It can be engaging in excessive worrying. Negative self-talk for needing rest or not being perfect. Seeking out temporary distractions rather than facing the situation. Drowning the pain in bad tv and food. Things which, in the long run or when done in excess, actually worsen your situation.

Pain is inevitable, suffering is optional

There’s nothing I’d rather do than serve up and easy solution for anyone with pain, illness or suffering* here. As far as I know (and please, please correct me if I’m wrong**) there isn’t a universal approach that works for anyone and any circumstance.

I hope this model can help you and/or the people close to you better understand the complex consequences of a life with chronic pain.

Gif that says lots of love, Anne xx

* In the first version of this post I had typed surfing instead of suffering. Not that I have much experience with surfing, but I suspect the suggestions might not be as helpful for someone dealing with that.
** No, celery juice isn’t it!

Sources

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Living with chronic pain is living with so much more than the pain. The pain onion offers a model for understanding the effects of chronic pain.

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