Chronic Pain Causes Complicated Grief
Chronic pain is physically miserable and brings about complex psychological challenges. Sufferers of chronic pain cope with mental and emotional reactions and adjustments to the primary misery of the actual pain as well as the secondary miseries of limitations of activities, financial stress, interpersonal stress or lack of social support, and conflicted or negative views of the self. These sources of misery are ongoing and trigger a complex grief process.
Let’s examine the less complicated grief process, reasons that grief can be complicated, how chronic pain causes complicated grief, and what you can do to address your grief associated with your chronic pain. Having a good understanding of the psychological aspects of coping with chronic pain can help you craft the most competent wellness plan to help yourself through your journey. It can also help you decide if , and when, you need to take extra steps to address your mental health needs.
Understanding Grief
Grief is our psychological reaction to a change or loss and includes a mix of evolving emotions, thoughts, and often impacts a wide range of domains of your life. While for a long time, an influential model of grief suggested that grief is a linear process that happens in stages, we currently think of grief as a set of tasks. These tasks are not sequential, and we are often accomplishing more than one task at the same time.
The tasks of grief have been clearly described by psychologist William Worden who defines them as (my rewording for relevance to this article):
Accept the reality of the loss
Experience the pain of grief
Adjust to life after the change or loss
Maintain a sense of connection to life before the change or loss and craft a new life
You can find an excellent discussion of Worden’s grief model by Dan Bates on the Psychology Today blog here.
It’s important to not see those four tasks as one leading to another but as separate tasks on which we can focus at the same time. We can also see that this task model allows for a wide range of individual grief reactions and ways of working through grief. It also allows to a mix of evolving emotions and this is distinct from the older model that promoted the idea that we get stuck at various points in denial, anger, bargaining, and depression.
Grief can be complicated when any of the tasks are more challenging due to circumstantial factors. Any challenge or barrier to being able to react to a specific change or loss, have optimal feelings and reactions to those feelings, or make clear and rational adjustments can complicate the grief process.
Why Chronic Pain Causes Complex Grief
Grief doesn’t only happen when someone dies. We can grieve any time we have to make significant adjustments to a change or loss. Chronic health conditions cause a grief reaction when it affects what we can and can’t do or affects our sense of who we are. We grieve our life before we were in pain.
One reason that chronic pain sufferers face complicated grief is that the experience of pain may be fluctuating. For example, a person suffering chronic pain from episodic flare-ups of a chronic health condition (for example, lupus) would be experiencing again, and again, the onset of the grief process. Each episode would be a new (though familiar) affront to a pain-free life. So, the grief process might be triggered anew with each episode as well as from the limitations or adjustments that might come with the new episode. The grief process could also be—at the same time—overarching and related to the long-lasting experience of the chronic condition. Each episode changes the game in regard to the new life to which you are adjusting.
A second way that chronic pain from chronic health conditions produces complicated grief is when there is not clear diagnosis or clear and effective treatment plan for relief. Less complicated grief is relatively more straight-forward when the change or loss is more clearly defined. Ambiguous loss produces complicated grief.
Over the years, I have worked with many patients who have faced unclear evaluations for what seemed to be serious health issues and some had to go for long periods of time in that state of not knowing what they were actually dealing with. Of course, many of these patients were mentally expecting, or reacting to, very dire worries about their health status or mortality. All of those (often very reasonable) imaginations were triggers for a new level of the grief reaction. In such an ambiguous situation, how could one accept a reality that isn’t defined and to what, exactly, are you adjusting?
A third way that chronic pain complicates grief relates to feeling the emotional pain associated with the grief trigger. Chronic pain causes chronic stress and also induces brain changes in the parts of the brain and endocrine system related to stress and emotional regulation. This is part of the reason that sufferers of chronic pain are more likely than the general population to suffer from clinical anxiety and depression. So, the chronic pain can contribute to stress and emotional dysregulation which complicates the healthy and optimal feeling and working through the stress and emotions related to the grief trigger.
What You Can Do
Understand that coping with chronic pain includes adjustments that trigger a grief response
If your reactions to your health issues look like grief, that’s because they are. Your health issues may be causing you misery, limiting your range of activities, affecting your self-worth and sense of who you are, and producing challenging emotions and stress. All major changes and losses in life cause the grief response, though it is widely varied in how it shows up across individuals. Just know that you’re not crazy if you feel like you are grieving and, yet, it doesn’t feel like typical grief after loss of a pet or loved one.
Prioritize psychological self-care
You may not be able to readily solve the fundamental causes of your pain-related misery. If you’re like many people, your chronic pain is related to a long-standing set of health issues that might be resistant to improvement. But, you can do things that have very positive affects on how you experience and handle the secondary levels of misery we have discussed in this article. When we handle stress more effectively, new stress is subjectively less stressful. So, while you might not be able to handily turn off your pain, you can improve your mental and emotional and social wellbeing such that the stress related to your health issues doesn’t contribute so much to your overall stress load.
Explore wellness practices that address chronic stress
There are many wellness practices that help with chronic stress. Mindfulness Practices, Concrete Thinking and The Body Scan are three types of practices that can have a very beneficial impact on chronic stress. Mindfulness has been shown in multiple studies to have a beneficial effect on chronic pain with research showing an improvement in subjective pain from 20 to 40 percent!
Consider working with a coach to learn wellness practices tailored to coping with chronic pain
Because these issues are so pervasive (more than 50 million people in the United States suffer from chronic pain), some of us therapists have become competent as coaches to work with people to teach effective cognitive-behavioral techniques to help with chronic pain. Coaching is more focused and limited than general therapy. You don’t have to get a diagnosis to receive coaching services. Because the focus is more limited, you likely won’t engage in as many sessions as you might in a more widely focused therapy process.
Get professional support
Chronic pain can cause severe and debilitating anxiety and depression. Some patients develop mental health issues secondary to the chronic pain which worsen the subjective experience of the pain and can become their own problems separate from the underlying health issues. If you are having anxiety or mood issues that are troubling or debilitating, I suggest that you work with a Mindfulness-Based Cognitive Therapist to address those issues.
If you’re looking for a competent professional, you can call the customer service number on the back of your insurance card, look up local mental health providers, or do a search for your area on a listing service like Psychology Today.
Jon
Bonus Tip: One Strategy To Help With Grief
Because grief is a process of adjustment that often affects many parts of our self, it’s a pervasive experience. That means that it shows up pretty much all the time. We don’t have natural boundaries where we can expect to have relief. But, this can be emotionally exhausting.
One strategy for mitigating the emotional fatigue that somes from unremitting grief is to schedule a time to grieve.
This may seem strange as your desire is to actually have less grief, not more! But, this actually does have the effect of reducing the overall focus on the experience of grief. Paradoxically, when we resist grief too strongly and too much of the time, it will just pop up anyway.
How to practice:
Schedule a time to allow yourself to grieve for five to ten minutes. Literally decide on a time on a specific day to set aside any other focus and give yourself some space to feel what you feel related to your chronic pain. Identify your feelings which might include anger, frustration, or other feelings. Let yourself think whatever thoughts you have about your situation. Don’t filter or edit your thoughts. Just pay attention to all the thoughts that are related to what you think about suffering chronic pain.
At the end of your time. Let go of this focus. Do something distracting. If you have trouble with making the transition from the exercise into doing something distracting, count backwards, slowly from twenty-five to zero. Do it slowly and out loud.
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