Acceptance with Resilience – Living with Chronic Pain




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Several years ago, I happened to be reading a research article about people who had lost limbs in landmine explosions, when I ran across a psychological distinction that I’ve seen validated many times since then. It seems that one of the major factors determining the quality of recovery for someone who has suffered this kind of traumatic injury is the attitude that the person chooses to adopt once he or she has had a chance to adjust to life as an amputee.

I believe this research regarding landmine survivors offers a crucial insight for people living with chronic pain.

The Choice Waiting at the Fork in the Road

All people studied in the landmine survivors report had similar reactions in the immediate aftermath of their traumatic accident. They could hardly believe what had happened to them. They got angry at those who had buried the landmine where they could step on it. They grieved the loss of their limbs. They felt disoriented, disconnected, and disempowered.

All this was a normal and natural reaction to sudden trauma. But what happened after these people had received medical treatment and the reality of what had happened to them had time to sink in?

From that point on, the landmine victims tended to diverge along two separate psychological paths.

Those taking the first path let their injury negatively affect their thinking about most everything that mattered to them. They felt badly about themselves and their lot in life and had little expectation of enjoyment in the future. They considered themselves to be fundamentally different from others, often disconnecting from family and friends and leading an unsettled life. They gave up work, gave up the hope of intimate relationships, and lost sight of their dreams.

Your attitude has everything to do with your quality of life while you’re dealing with chronic pain.

As you can imagine, those in this first group did not have good long-term outcomes. Following the initial shock of their accident, they arrived at a point of accepting the reality of their limb loss (as they needed to do), but it was not a kind of acceptance that would help them move on. On the contrary, it was an acceptance that left them mired in grief and misery. The researchers termed this response acceptance with resignation.

But others had another response to the same kind of loss. Along the alternate psychological path, some landmine survivors chose to make the most of what remained of their lives. They sought to derive meaning from their traumatic event and turn it into something good. For them, their amputation was a part of who they were, but it didn’t define who they were. They considered themselves to be fundamentally like everybody else, and they welcomed support from others and inclusion in the activities of everyday life.

Their outcome? These people had better physical health, a greater sense of overall well-being, and more thorough social and economic integration into their communities. They were benefiting from what the researchers labeled acceptance with resilience.

The landmine survivors all reached a fork in the road of their recovery. Some took a path that led to a higher quality of life; others headed toward a worse destination. It all depended on the attitude they chose:

Acceptance with resignation.
Or acceptance with resilience.

What You Do with What You’ve Been Handed

People living with pain face a similar choice. They incur some kind of unexpected disease or injury, and instead of their pain going away as its initial cause heals, the pain crosses the boundary from acute to chronic, forcing them to recognize that they now have a long-term, possibly lifelong, presence of pain in their lives. That’s when they have to make up their minds about what they’re going to do with the pain.

They face many decisions, everything from finding medical providers to requesting work accommodations to adapting to new family dynamics. But the crucial choice that affects all the others is what personal attitude they are going to bring to their new condition.

They will see themselves either as patients first or as people first. They will be either passive victims or active champions of their own cause. They will have either acceptance with resignation (I’m stuck with this pain and the lousy life it has given me) or acceptance with resilience (yes, I have pain, but I am still going to live well!). They may not consciously realize they are making a choice of attitude, but they are. And their attitude will have an immense influence on the kind of life they can expect to live from that point on.

After years of observing how people react to chronic pain, I have identified some commons signs that people are merely resigned to their pain problem:

  • They have a “Why me?” attitude and blame others for their condition.
  • They constantly look for others to care for them while refusing to take responsibility for their own improvement.
  • They look for drugs or other therapies to medically treat the pain and are not interested in maximizing what they can do to help themselves feel better.
  • They isolate themselves. Or they go to the other extreme and develop clinging, dependent relationships with their caregivers and family members.

With reactions like these, people in pain inevitably fail to feel any better and may in fact feel worse over time. They may survive, but they don’t thrive. They are in a place of “stuck-ness.” People often look down on them and don’t want to be around them, thus reinforcing their feelings of victimhood. They are depressed and they are a cause of depression for others.

In contrast to this first group, people who are determined to be resilient in the face of pain tend to exhibit very different behaviors:

  • They reject the idea that they cannot function or improve.
  • They push forward, mentally and physically, despite their bad lot.
  • They accept external support to bolster their own internal strengths.
  • They are engaged with others as much as possible and look for new opportunities for social engagement.
  • They don’t wear their pain on their sleeve, yet neither do they feel embarrassed about informing others of their limitations.
  • They have pride and self-esteem.

People who are resilient are physically active and mentally alert. They report lower pain than they otherwise might, and in the midst of their pain they find ways to achieve meaning, purpose, and fulfillment in life. They are involved with other people as equals, making a contribution in their families and community. They appear to others as heroes, and consequently they inspire the people around them to overcome their own obstacles.

The outcomes for this second group are so much more appealing than what the first group experiences. It’s sad to note, then, how common are the signs of passive resignation to pain.

I don’t mean to pile on people who are having a tough time adjusting well to their new reality of pain. Nor do I want to minimize the struggle a person has in maintaining hope and making forward progress when facing awful pain. It’s a titanic challenge that calls for the best that lies within anyone. Nevertheless, I want to highlight the importance of attitude and urge all people in pain to think seriously about the outcome they are choosing for themselves when they adopt one attitude toward pain or another.

Virtually all people with chronic pain eventually accept the fact that they have a nemesis in their lives. But how they accept the reality makes all the difference, whether it’s acceptance with resignation or acceptance with resilience.

If you have pain, which are you going to choose?

Reference

Ferguson AD, Richie BS, & Gomez MJ (2004). Psychological factors after traumatic amputation in landmine survivors: the bridge between physical healing and full recovery. Disability and rehabilitation, 26 (14-15), 931-8 PMID: 15497924

Image via HildaWeges Photography / Shutterstock.

Lynn Webster, MD

Lynn R. Webster, MD, is one the nation’s leading researchers and experts in the field of chronic pain management. He is the Vice President of Scientific Affairs of PRA Health Sciences and immediate past president of the American Academy of Pain Medicine. Practicing medicine for over three decades, Dr. Webster has authored Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners. As developer of the Opioid Risk Tool (ORT), he is considered a world authority on how to assess patients for abuse risk with opioid medications, and in trying to help physicians safely treat pain patients while actively working within the industry to develop safer and more effective therapies for chronic pain and addiction.
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