Looking for an ultimate chronic pain solution? Focus on flexibility and diversity 3
Mar 03, 2020
Part three - Mental flexibility
Mental flexibility keeps suffering at bay with any kind of health problem. Studies have shown that mental flexibility has a critical impact on disability in chronic pain patients. In my years of working with chronic pain patients, I have observed problems with the opposite of mental flexibility - a rigidity that makes efficient problem solving at the level of common daily tasks difficult. This is not a common flaw of people with chronic pain, but a result of trauma accumulated over a lifetime. Trauma tempts us to simplify in times of crisis and find a solution - quickly! Simplifying means not considering a broader perspective, which leads to similar solutions to a variety of different problems, a rigidity so to speak.Think of the simplistic mode as black and white thinking, generalisations, all or nothing principle, instant gratification motivations and others. It is a good mechanism nature has endowed us with, it works perfectly in crises, with the crisis occurring every now and then. But to live a long and fulfilling life in a complex post-technological society, it's just not good enough.
Trauma throughout life
In my work at the tertiary level of healthcare, I have found that complex post-traumatic stress disorder is a common feature in people with chronic widespread pain. These people come to the higher levels of the health care system because no therapeutic intervention offered at the lower levels of the health care system (e.g., medications, interventional pain medicine, physical therapy, even surgery, etc.) works on the manifestations of complex post-traumatic stress disorder (emotional flashbacks triggered by common everyday situations that cause intense physical reactions such as pain, restlessness, irritability, sleep problems, comfort eating, over-exercising, workaholism, exhaustion from people pleasing, substance abuse and self-medication, etc.). Complex post-traumatic stress disorder is difficult to identify clinically. But it simply means that an organism has been stressed too many times over time (from birth, or even before!) to recover in between. I mean - to recover physically and mentally. However, the ability to recover varies from person to person and throughout life. A "major trauma" event (such as an assault - physical, sexual; the loss of a child in an accident; the loss of a comrade in combat) can put us in a state - stuck in trauma non-resolution and so - is diagnosed with post - traumatic stress disorder. In such cases, it is easier to recognise the situation. The major traumatic events are hard to forget, except for major traumas in childhood.
Chronic pain and multiple cuts in everyday life.
But, chronic pain is - for many sufferers - more or less a storey of "multiple cuts". And then comes "the big cut" (e.g., a scheduled surgery, an infection, the loss of a job, financial hardship, experiencing a major conflict at home or at work because you are unable to meet other people's expectations, usually blaming some pre-existing pain in the body...the list is as long as there are people with chronic pain), which acts much like "the big trauma" and can exacerbate symptoms of post-traumatic stress disorder. "The not-so-special event" that acts like "the big trauma" may be at the root of a general depletion of resilience (see previous posts on metabolic flexibility and dietary diversity that explain the problems of metabolic unsustainability and the microbiota not supporting the body well). It has already been proven in many studies that symptoms of post-traumatic stress disorder critically affect the overall functioning of people with any type of chronic pain disorder, and also that - in not so rare cases - the major trauma event (as defined in the trauma checklist) is not identifiable. Speaking of post-traumatic stress...
What is stress anyway?
Any homeostatic disturbance, e.g., within the body (visceral or somatic nociception, lack of energy or hunger, dehydration, inflammation and immune challenge, respiratory distress) or outside the body (external events that trigger a response, e.g., mechanical stress, other people's behaviour, information on the internet or social media, sounds, lights, smells, temperature changes, even air pressure, etc.) requires some overall body capacity to counteract. Any time the body's capacity to counteract a particular disturbance fails, we experience it as discomfort or stress. Stress manifests itself at different levels of the organism's functioning, don't just think of it in psychological terms. Overall human resilience is critical to bouncing back compounded disruptions. Resilience is enabled by smooth energy production at the mitochondrial level (in the body and brain!) that does not create excessive oxidative stress. Supporting our allies with a healthy microbiome plays an important role here. Resilience is not synonymous with willpower against all odds, too much willpower applied to weakened physical resilience as defined above will make you even weaker physically and possibly psychologically. Of course the body needs such disruption to thrive, "use it or lose it" or so called "good stress". The catch is in acknowledging the body's current state, recognising the body's and mind's reactions to disturbances, and "working" with the reactions rather than "fighting" them. Any stress that is not digested through behavioural adjustment acts like trauma.
**Summarising.
The more traumatised you are, the less mentally flexible you are, the more self-imposed over-activity through inefficient rigid problem-solving strains your depleted physical resources. The solution lies in recovering from trauma (of whatever kind, cumulative, from a single event, which is rare, by the way) to regain some of your mental flexibility, playfulness, curiosity, open-mindedness... all the "psychological skills" that help us navigate through the uncertainties of daily life in a post-technological society. Right now, I don't see any shortcuts to recovery from complex trauma that can be done at home, alone, without outside help - from trained and experienced health professionals who understand the impact of complex trauma on health.
You are welcome to read other posts in this series:
[Looking for the ultimate solution to chronic pain? Focus on Flexibility and Diversity: Metabolic Flexibility] (https://soundnsafe.com/blog/looking-ultimate-chronic-pain-solution-focus-flexibility-and-diversity)
