Successful pain management requires one to consider alternative views of themselves and the world. These alternatives are not always welcomed or easily attained. They often involve reconsidering one’s goals as it relates to parenting, marriage, work, finances and for many involuntarily retirement.

 

Prior to having pain, most pain patients seldom consider their own needs or bodily changes. They use themselves as a tool to attain external goals. Chronic pain patients are required to moderate their external orientation and consider their own bodily needs or suffer frequent pain crises. Most chronic pain patients feel overwhelmed initially as they start this journey.

Pain patients are likely to ruminate about their physical condition, future, employment, importance and value. Rumination refers to a tendency to repeatedly think about situational factors, consequences and causes. Rumination means that one mulls negative and emotionally charged thoughts over repeatedly. This takes up precious time and energy that may better be devoted to solving the problem. Rumination tends to pull one into thinking more about themselves rather than focusing on the problem itself.

This constant focus on self, traps the person in their depressive or anxiety web. Research has shown that rumination decreases one’s ability to be flexible in thought. When ruminating about a problem, the rumination itself prevents the solution, not thinking outside the box. Now why would pain patients tend to get stuck with rumination? It has been my experience personally and professionally that we have all used rumination as an effective tool in our perfectionistic pursuits. If there is something we need to learn like a new computer program or a new routine, ruminating about it, focuses attention on the prescribed problem. This has worked for many of us, concentrating on a problem so long that we do not become distracted. Many of us have enjoyed the sense of superiority in our lack of distractibility in the face of fatigue and external distractions such as troubled family and work environments. It is something that has always helped us to outwork those around us; however, when it comes to dealing with our pain, rumination limits us by inhibiting our ability to look at alternatives.

In the same way that many of us still instinctively stick out our right arm to catch our children when we hit our brakes, many pain patients use rumination as an old successful tool that no longer is helpful and now even detrimental. Moberly 2010 found that rumination reduces the chance for goal attainment no matter how important the goal, while problem solving approaches seem to increase when the goal to be attained was rated more important. So it really doesn’t matter how motivated you are in succeeding in pain management, rumination is a roadblock to your success in managing your pain, mood and pain intensity. The most effective way of countering rumination is exemplified by the old story about the man who goes to the doctor and says “doctor it hurts when I do this” and the doctor says “well then don’t do it”. The most effective way of dealing with rumination is change the channel; think of something different. While this is very simple to suggest, it takes practice to develop a successful routine to counteract the negative affects of rumination. It involves finding something familiar and enjoyable to do that occupies your mind to such an extent that you cannot hold those ruminating thoughts any longer. Tasks such as reading a book, exercising, talking to a friend, playing a game, watching a movie are all frequently used by those who wish to get out of themselves and into something better. Remember these activities need to be familiar but also enjoyable. It makes no sense to attempt to read a book you are not interested in or play a game you don’t like. Finding those tasks is limited only by your creativity and access to those different activities. Remember breaking the habit requires a repeated effort and a plan of action distracting yourself once or twice will not be enough. This is a 24/7 job that becomes part of your arsenal in pain management. These techniques are useful for those with or without pain.

When you find yourself caught up in negative rumination, distract with something more enjoyable, resting your mind before making a plan to solve the problem. Problem solving involves a more mindful than emotional approach. Try these suggestions: 1) Write the problem and it’s alternatives down on paper. This helps the brain understand that a solution is being generated and therefore it does not have to keep running like the search button on a radio. Having it written out helps your brain know the job is done. Writing out a problem may help the unconscious mind come up with a creative solution. Albert Einstein used this technique and found that he could solve certain problems during sleep. 2) After your problem has been formulated, write down your assumptions about this problem and watch for negative, irrational aspects to your assumptions.

 

Many pain patients obsess and ruminate about their feelings of being a burden or a broken tool. The assumption is, they have no value unless they can do what they previously did. This is an irrational assumption and irrational assumptions will lead anyone into a depressive abyss. Ask yourself and at least two others if your assumptions are correct. 3) Break the big problems down into smaller components. This is often a problem for pain patients because we all tend to bite off more than we can handle. We feel as if we are getting by with something when we begin to break big tasks down into smaller, attainable ones, easier to accomplish. For example cleaning a room or a garage can be broken down into small steps that can be accomplished within most pain patient’s limits, each successive step moving toward the main goal of completing the overall task. 4) Problems that involve other people and familial issues are not totally in one’s control as cleaning a garage would be; therefore, it is always good to ask for at least three other people’s opinion of what should be done. One doesn’t have to accept their ideas but their input may trigger an alternative way of thinking. 5) Write down every scenario for every solution without trying to judge its merits. It is often helpful to change your prospective while generating ideas. For example, consider the problem from another person’s point of view, i.e., another employee, family member or maybe a stranger. This can help to give you a new perspective. Increasedbrainpower.com suggested a very fun and creative solving problem technique. They suggest randomly picking out an object you see when driving and ask yourself what this object might teach you about your problem. They gave an example of seeing a mailbox and wondering if writing a letter would help. Some of the ideas or associations will be funny and more emotionally relieving than productive. I may find it fun seeing a bulldozer or wrecking ball. It has occurred to me to drive one of those when in a traffic jam.

Let me know about your experiences of rumination and your techniques for countering it.


Gene Hawkins, Ph.D.