# The 2 Stages of Chronic Pain ##### Untangling Pain ---  --- ## tl;dr - One pattern in chronic pain is pushing through warning signs because life and responsibilities do not stop. - Fatigue, headaches, IBS, or flare-ups can be red flags, but we may use painkillers or caffeine and keep going. - A crash can then lead to a boom-and-bust cycle and a more sensitive system. - Fear of another crash may shift us into avoiding movement altogether. - As the world shrinks, everyday activity can start to feel dangerous even at low levels. > [!abstract]- Transcript > > I tend to find that chronic pain often follows a pattern or stages, if you like. > > So the first one is pushing through the pain. So when we first start to experience pain, we push through. We're persistent with it. > > And then when things don't work out, when things don't work and we're trying to push through and we keep getting this pain, there becomes a fear of pain and an avoidance, and that's what we're gonna look at now. > > So starting off with this persistence, this pushing through pain. Quite often for women we have this tendency to push through and maybe a belief that stopping and resting it isn't an option. That we're not allowed to be injured, to be in pain, to be sick. We're not allowed to have anything wrong with us. > > We're not allowed to stop because we just have so many responsibilities to meet. We have people to care for and we have work to do and we have shit to do and stuff that rely on us to be our best selves. So when we are in pain, when we maybe hit this protect by pain line and the fire alarms are going off, we ignore it, we mask it, we override it. And we have this drive to keep going no matter what. And sometimes even pushing harder because there's no room to slow down, right? We can't have this thing stop us, so we just keep going. > > But pain isn't something that we can ignore. And in all honesty, I'm not just talking about pain. I suppose I'm talking about stress and anxiety and a feeling that something isn't right. We've talked about this before about our nervous system and how it can affect us and we really can't ignore it. > > Because even when we push through this protect by pain line, it's the body's early warning system. That something isn't quite right, and again, it could be not necessarily pain, it could be fatigue or IBS symptoms or migraines and headaches. But instead we keep pushing because we're not allowed to stop. > > Right? > > And we reach this flare up line where pain or other symptoms, whatever they might be, they're not just a warning anymore, they're a clear red flag. The problem is, instead of stepping back, instead of resting, instead of listening to our body. > > We turn to painkillers. We turn to caffeine. We ignore the signs, and we just keep on. We just keep working. We just keep looking after everybody else, even when our body is screaming at us. > > It's only when we reach this tissue tolerance line when something becomes serious, does the body actually force us to stop. And that stop it isn't just for days anymore, it's for weeks, for months, and for years, in some cases. > > Each time this cycle repeats itself, the body adapts and not in a good way. So the protect by pain line drops, as does the flare up line, as does the tissue tolerance line. So the nervous system becomes hypersensitive, it becomes overprotective. > > This means that pain becomes more frequent and harder to escape. So over time, the activities that we were doing that were once manageable, now become painful and the threshold for discomfort lowers. So you can see this in this chart. We've started off and we've pushed through the protect by pain line we've carried on because we just can't stop. > > We push past through the flare up line, pushing through right to our tissue tolerance line, to the point where our body literally says no more, and it forces us to stop. And we literally become incapacitated. As a result we do less, we, we can't physically do anything anymore and our bodies do not have the physical capacity that they had before. > > They're not as strong or resilient, and as I said, the protect by pain line, the flare up line, and the tissue tolerance line -they all reduce. And if we keep doing this over and over again, over time, you can see how this affects us and how this creates this boom bust pattern. > > What I've seen over the years with so many clients is that something shifts. Quite often, a lot of them start with this boom bust pattern. And then like I said, something shifts and instead of pushing through pain becomes something that we fear and we begin avoiding anything that might produce pain. > > And even the thought of movement can create anxiety. What if this movement causes more pain, or what if it leads to another injury? Or what if it means I'll be stuck in bed for another week? Or I won't be able to do the things that I need to do. > > When this happens, when we try and do a little bit more and then we reach the protect by pain line and the fire alarm starts sounding, we panic, so we back away. And when this happens over and over again, the brain learns to make pain earlier and earlier. So the protect by pain line drops even further, as does the flare up line, as does the tissue tolerance line. > > So we basically become deconditioned and become afraid of any pain. > > And sometimes it's not even pain. Sometimes it's a discomfort, something that feels a little bit different for us, then that can scare us that things are gonna be bad. > > When this happens, the nervous system starts to interpret this as confirmation that, yes, this movement or this thing that we are doing, it must be dangerous, right? Again, the protect by pain line drops because it's trying to protect us more and more, and the danger alarm systems become hypersensitive. > > So again, pain appears at a lower level of activity or even at rest sometimes. Our world begins to shrink. Even everyday tasks can become daunting and become scary to even try them. Next lesson → [[Untangling Pain – Module 4 Lesson 11 – Graded Exposure & Pacing|Graded Exposure & Pacing]] %% ## Extra ## Version 1: Full Pushing Through the Pain I tend to find that chronic pain often follows a pattern or stages, if you like So the first one is pushing through the pain When we first start to experience pain, we push through We’re persistent with it Quite often for women, we have this tendency to push through Maybe a belief that stopping and resting isn’t an option That we’re not allowed to be injured, to be in pain, to be sick We’re not allowed to have anything wrong with us We’re not allowed to stop because we just have so many responsibilities to meet We have people to care for and we have work to do and we have shit to do and stuff that rely on us to be our best selves So when we are in pain, when we maybe hit this protect by pain line and the fire alarms are going off, we ignore it, we mask it, we override it We have this drive to keep going no matter what And sometimes even pushing harder because there’s no room to slow down, right? We can’t have this thing stop us, so we just keep going Pain Isn’t Just Pain Pain isn’t something that we can ignore And in all honesty, I’m not just talking about pain I suppose I’m talking about stress and anxiety and a feeling that something isn’t right We’ve talked about this before about our nervous system and how it can affect us and we really can’t ignore it Because even when we push through this protect by pain line, it’s the body’s early warning system That something isn’t quite right Again, it could be not necessarily pain, it could be fatigue or IBS symptoms or migraines and headaches But instead we keep pushing because we’re not allowed to stop Hitting the Flare Up Line We reach this flare up line where pain or other symptoms, whatever they might be, they’re not just a warning anymore, they’re a clear red flag The problem is, instead of stepping back, instead of resting, instead of listening to our body We turn to painkillers We turn to caffeine We ignore the signs, and we just keep on We just keep working We just keep looking after everybody else, even when our body is screaming at us Reaching the Tissue Tolerance Line It’s only when we reach this tissue tolerance line when something becomes serious, does the body actually force us to stop And that stop, it isn’t just for days anymore, it’s for weeks, for months, and for years, in some cases Each time this cycle repeats itself, the body adapts and not in a good way So the protect by pain line drops, as does the flare up line, as does the tissue tolerance line So the nervous system becomes hypersensitive, it becomes overprotective This means that pain becomes more frequent and harder to escape So over time, the activities that we were doing that were once manageable now become painful And the threshold for discomfort lowers So you can see this in this chart We’ve started off and we’ve pushed through the protect by pain line We’ve carried on because we just can’t stop We push past through the flare up line, pushing through right to our tissue tolerance line To the point where our body literally says no more, and it forces us to stop And we literally become incapacitated As a result, we do less We can’t physically do anything anymore and our bodies do not have the physical capacity that they had before They’re not as strong or resilient And as I said, the protect by pain line, the flare up line, and the tissue tolerance line – they all reduce And if we keep doing this over and over again, over time, you can see how this affects us and how this creates this boom bust pattern From Pushing to Avoiding What I’ve seen over the years with so many clients is that something shifts Quite often, a lot of them start with this boom bust pattern And then, like I said, something shifts Instead of pushing through, pain becomes something that we fear We begin avoiding anything that might produce pain Even the thought of movement can create anxiety What if this movement causes more pain? Or what if it leads to another injury? Or what if it means I’ll be stuck in bed for another week? Or I won’t be able to do the things that I need to do Pain Becomes Fear When this happens, when we try and do a little bit more and then we reach the protect by pain line and the fire alarm starts sounding, we panic So we back away And when this happens over and over again, the brain learns to make pain earlier and earlier So the protect by pain line drops even further, as does the flare up line, as does the tissue tolerance line So we basically become deconditioned and become afraid of any pain And sometimes it’s not even pain Sometimes it’s a discomfort, something that feels a little bit different for us Then that can scare us that things are gonna be bad Nervous System Hyper-Sensitivity When this happens, the nervous system starts to interpret this as confirmation that, yes, this movement or this thing that we are doing, it must be dangerous, right? Again, the protect by pain line drops because it’s trying to protect us more and more And the danger alarm systems become hypersensitive So again, pain appears at a lower level of activity or even at rest sometimes Our world begins to shrink Even everyday tasks can become daunting and become scary to even try them ## ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-29.jpeg|women & Pain Part 4 slide-29.jpeg]] ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-30.jpeg|women & Pain Part 4 slide-30.jpeg]] ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-31.jpeg|women & Pain Part 4 slide-31.jpeg]] ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-32.jpeg|women & Pain Part 4 slide-32.jpeg]] ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-33.jpeg|women & Pain Part 4 slide-33.jpeg]] ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-34.jpeg|women & Pain Part 4 slide-34.jpeg]] ![[Meta/01 Attachments/Calm Shit down - build shit up BLOG.assets/women & Pain Part 4 slide-35.jpeg|women & Pain Part 4 slide-35.jpeg]] --- ## Watch the lesson %%