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Commitment and Chronic Pain: A Potent Combination

acceptance & commitment therapy chronic illness chronic migraine chronic pain rare disease Feb 01, 2016

Commitment and Chronic Pain: A Potent Combination

Power of Pain (iPain) Resource Magazine 2016.
Written By: Dr. Melissa E. A. Geraghty, Psy.D.

Commitment. This word is often thrown about haphazardly. People can feel defensive about it.

Of course I am committed to improving my health! Can’t you see I’m trying?!
But really what is commitment? And how does it apply to living with chronic pain?

As a health therapist and a person living with chronic pain and physical disabilities, I view commitment from the perspectives of both a patient and a pain specialist. In my sessions with patients I utilize a mindfulness-based behavioral approach, Acceptance and Commitment Therapy (ACT--pronounced as one word). One way I work with patients on commitment is through committed action. Committed action involves actively setting goals which are guided by your values. Values are the aspects of life in which you deeply care about. They are the reasons that get you out of bed in the morning despite pain levels. Values serve as pillars for
how you want to live your life. Values cover several different areas such as work, education, leisurely activities, personal growth, health, and relationships. It is continually striving for your values that allow you to live a full life despite pain.

After setting goals based on your values, you then take manageable steps to achieve them. An example of a goal is asking a friend to bring lunch to your home. This goal is in service of the value of cultivating friendships. Note that in this example you may not be well enough to physically go out to lunch at a restaurant, but the goal can be altered for your friend to come to you. Setting small, achievable goals allows you to work towards your values without over- extending yourself.

Many times when we think of goals in the treatment of chronic pain, healthcare professionals and patients get stuck in the narrative of physical movement. For example, “My goal is to be able to walk half a block three months from now.” While goals like this can certainly be important for treatment if realistic expectations are set, what I am talking about goes further than just the physical aspect of treatment. I’m talking about you as a whole, viewing yourself from a biopsychosocialspiritual perspective. In other words, further understanding and nurturing your physical health, your psychological health, how you interact with others, as well as your spiritual health.

Having chronic pain is a commitment within itself. We are members of a club we never wanted to join. It is certainly a commitment we didn’t choose and are not thrilled to have, but it is commitment nonetheless. Commitment and chronic pain are a potent combination because they are directly linked to our well-being. Commitment to one's health involves having compassion and respect for oneself-- mind, body, and soul. Without these aspects, it’s as if we are stuck swimming in the middle of the ocean, lost at sea, without any land in sight. It is commitment that anchors us to the present. Commitment allows us to live a valued life instead of just merely existing.

Our healthcare professionals also serve as a commitment anchor. Great healthcare professionals hold us accountable with our treatment, while at the same time holding themselves accountable by thinking outside of the box when needed. As we know, chronic pain isn’t (and shouldn’t be placed in a standard box of treatment. Often we have to get creative and even more often we have to be our own advocates.

Sometimes with a new treatment or procedure comes hope. Many more times there is a period of waiting between when the treatment starts and when/if any improvement shows. It’s during this period where it is easy to throw up our hands in defeat and frustration, shake our fists at the pain monster, and maybe swear a little (or a lot). But if we repeatedly detour from the commitment to our health, we only suffer more physically and mentally. Commitment is noticing the detour and then getting back on track. The important part is that you are making continuous strives to uphold the commitment to your health.

Know that committed action does not look or feel perfect. Committed action is taking that millionth vitamin even though you don’t want to but your lab work shows you’re deficient in it.

Committed action is trying to move physically a little each day, even if every muscle in your body is yelling at you not to. It is doing what will benefit your health, as you value your health, even if you don’t feel like it.

If you are not quite ready to make a commitment to yourself regarding your health, just start right where you are at. Maybe you start by keeping your health-related goals because you want to improve the relationship with your spouse, family, friends, and/or fur babies. I personally understand that having to make one more medication decision, one more doctor appointment, one more phone call to insurance, can be all consuming, beyond irritating, and utterly exhausting. It can feel like there is always something more to do. Despite how tedious these processes get, engaging in these activities is movement in the direction of valued living. I believe that true commitment involves continuing to engage in goals based on your values long
after the mental state of when you made the commitment dissipates. Meaning, after the initial excitement of setting goals wears off or when having hopes up for a new treatment fades, you still have your values to lean on. Let’s face it, sometimes the most important and valued things in our lives aren’t so much fun. Going to a doctor appointment for the 4th time in the same week after sitting in traffic and then sitting in the waiting room may not bring joy, but it is so important and is based on our values.

The commitment you make to your health is a beautiful thing. It’s not selfish. It will have its ups and downs, but in the end it is about being gentle with yourself and reminding yourself that you are damn well worth it.

Stay Mindful.

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