Your Brain is Trying to Protect You: Part One

Did you ever touch a hot stove as a kid? It hurt, right? Hopefully you were leery about touching a hot stove after that, and learned that touching the stove when it's on leads to pain and should be avoided. 

The fact that you learned to avoid a hot stove is your brain at work protecting you. Likely you got the message after only one time, and didn't have to repeat that lesson over and over to learn not to touch that hot stove. Rick Hanson, a psychologist, talks about how we are wired to register negative experiences more quickly than pleasurable ones. He explains that for our survival it is more important for us to register that a certain insect bite can be fatal to a person than that the flowers beside us smell nice (Hanson, 2013).

So when your brain learns (very quickly) that a certain movement or situation causes pain, it becomes cautious. Avoiding things that are painful helps us survive and helps us know what parts need rest so they can heal. 

This is great.....until it becomes a problem.

The problem comes in when this "what is harmful" map becomes outdated or overgeneralized and begins to steal activities from us. Sometimes injuries can heal, but when you move that part of your body, your brain still says "Bad news, Bad news! What are you doing?" Your brain can become hypersensitive to that part of your body, so any message from that area becomes an alarm.

Your brain can also begin to generalize and gradually become sensitive to more and more movements and situations over time. That insect that was dangerous, so maybe all insects that look similar are dangerous too, and your brain learns to avoid those. If your brain takes this even further, then maybe the field you were in when you encountered that insect is dangerous. Maybe all fields are dangerous. Maybe simply going outside is dangerous. 

We're not saying the pain isn't real or the fear isn't justified. However, sometimes this protective mechanism can began to limit activities. An example of this process could be a person with chronic back pain that began after an injury from helping a friend move. The injury began by lifting very large objects in a way that caused tissue damage. Later it turned into chronic pain. The person could become reluctant to help anyone move after that. This probably won’t have a huge impact on the person’s day to day functioning, because this situation doesn’t occur frequently, and there are usually other options. The disruption to daily life comes if the same emotional reaction gets applied to similar situations that do occur frequently. For example, maybe the person notices that even lifting smaller objects like groceries now increases his pain. Or lifting his children or grandchildren. Or maybe he has a job that involves lifting and carrying, and he is now afraid of how his work will impact his pain (and vice versa). 

There are other valid reasons he may feel afraid to move. He may have been told by a well-meaning health care provider to avoid certain movements. He may have heard the idea that bed rest is the best thing for a back injury (an old way of thinking, but still believed by many people) (National Institute of Neurological Disorders and Stroke, 2014). He may have been told over and over that pain always equals harm, so he may be afraid of doing more damage to his body. 

As his brain tries to protect him, this can translate into an emotional reaction. Where at first he was cautious, he may become anxious or fearful. Frustration occurs when pain and the fear of pain limits movements. If it is limiting activities that aren’t important to him, it’s not a problem. The problem comes when it affects movements that ARE important.  

In healthcare talk it’s about the pain related fear and avoidance model. At its root this is where the fear of creating or worsening pain causes a person to avoid certain activities or situations. Pain avoidance has received a bit of a negative reputation, but if you look a little deeper it is just one of your body’s ways of trying to keep you safe; it has its roots in protective behaviour. It’s a totally normal and logical process.  It is not a character flaw or a weakness. So instead of feeling like pain avoidance is a “negative” give yourself (or your client) a pat on the back, your brain is just doing its job.

If the way your brain does that job is becoming problematic for your life, then it’s time to make a decision about whether you want to change it.  As a physiotherapist we know would love to say “acknowledgement is 50% of the solution”. In order to reclaim parts of your life, it can be helpful to examine the reasons and thoughts behind avoiding certain movements and activities. As you examine those, you can learn the difference between avoidance that is helpful to healing and fear that is disruptive for your life. If you are a health care provider, it’s essential to talk with your clients and find out their perspective on how avoidance is affecting them. Then you can empower them by tailoring your approach and utilizing individualized strategies that will help them live the life they want to live. “If you can learn about [avoidance], and acknowledge it when it occurs, then you can begin to challenge it and change it. It’s not an exaggeration to say that overcoming fear-avoidance is essential if you want to self-manage pain successfully. It’s really that important” (McAllister, 2103).

Please join us next time as we look at some of the ways we can begin to challenge and change these behaviours.

Acknowledgment:

Diagram by Ashley and Colleen at Reclaiming Life. Graphics used are from Freepik.com (background, man lifting boxes, hurt and anxious man, thief, superhero, light bulb and shield).  

References:

Hanson, Rick. [The Rush on Shaw TV].  (2013). Interview with Neuropsychologist - Dr Rick Hanson.

[Video file]. Retrieved from https://www.youtube.com/watch?v=9gK9DyvWuGA&feature=youtu.be on September 5, 2015.

McCallister, M.J. (2013). Institute for Chronic Pain Blog: Fear-Avoidance of Pain. Retrieved from http://www.instituteforchronicpain.org/blog/fear-avoidance-pain/ on August 31, 2015.

National Institute of Neurological Disorders and Stroke. (2014). Low Back Pain [Brochure]. Bethesda, Maryland: National Institutes of Health Department of Health and Human Services. Retrieved from http://www.ninds.nih.gov/disorders/backpain/low-back-pain-brochure.pdf on September 5, 2105. 

Spoon Theory

No online discussion of a chronic condition would be complete without including the spoon theory. The spoon theory is widely shared on the internet, probably because so many people can relate to it. It was written by Christine Miserandino of butyoudontlooksick.com. She is a woman with Lupus, but her words apply to many chronic conditions. From our perspective, this explanation applies very well to chronic pain and the associated fatigue.

We may not do it justice if we try to summarize it, so before you read any further, please read the original spoon theory explanation here or have a listen to the author here.  This theory creates a common language for people in pain and their supporters to understand the impact of pain and fatigue on everyday life. Please take a moment to review it, then don't forget to come back and read our perspective.

Basically spoon theory is about having a limited amount of energy and endurance, and having to make hard choices every day about how to use it. Think back to the last time you felt under the weather, things like getting dressed and cooking seemed extra hard.  With a chronic condition everything takes more energy. On top of this pain takes energy, so it’s a double hit. Things you didn't even have to think about before having a chronic condition, become very effortful. Even “simple” things like having a shower or visiting with a friend can take up a huge percentage of your daily energy.  Before having a chronic condition, you may have been able to go about your day knowing that even if you were tired, you would have enough energy to get through everything. With a chronic condition, life becomes a giant balancing act. You have to juggle your basic needs and responsibilities with others’ expectations and activities you would like to do. This juggling act often includes multiple days at the same time. Questions such as: “If I go out today with a friend, while I be able to go grocery shopping tomorrow?” or “if I shower now, will I have enough energy to get ready after?” become a constant thought.

Spoon theory is a way of taking an abstract thought (such as "I need to decide wisely where I spend my energy”) and making it concrete so people can understand. It helps explain the concept to people who have never had to make hard decisions about daily tasks. Activities cost “spoons” and one has to decide how their going to spend their spoons for the day. If loved ones read and understand this, it can help simplify communication. Instead of having to say "I can't do that right now" (which might feel like you're letting them down), you can simply say "I don't have enough spoons for that."

To put spoon theory into occupational therapy terms, it's all about pacing and energy conservation. It's about respecting yourself and your body enough to realize you don't have an endless supply of "spoons," and that's okay. You can plan your activities throughout the day to maximize your use of the "spoons" you have (pacing). You can also think about the way you do tasks, to reduce the amount of "spoons" they take (energy conservation).

The ideas behind this spoon theory has helped both of us begin to reclaim our lives. The great thing about spoon theory is it helps you understand that you are not completely powerless. By understanding how much energy things cost, you can use it to help stop the cycle of pushing and crashing. You can learn ways to lower the cost of activities and develop strategies that will give you more spoons. Choices can be made about how to spend your resources. You can learn to recognize how many spoons you have available on a given day and how the cost of activities changes from day to day. You can borrow spoons from following days or save spoons from previous days. You can decide what tasks are the most important and what tasks would be a bonus. 

For example, consider a man with fibromyalgia, who wanted to spend a day at the zoo with his wife and young children. He knew the zoo could be an exhausting and over-stimulating place to be with children, even for someone without a chronic condition. For him, the zoo could be a near impossible venture because of his pain and fatigue. But because of his understanding of pacing and energy conservation (spoon theory), he was able to not only go, but enjoy the day. He and his wife used every strategy they had to plan this day to be successful. They planned the zoo trip for a Monday, but kept Tuesday as a back-up plan in case of unforeseen circumstances like weather changes or a flare-up of symptoms. They also planned for the next day to be a rest day, so he could recover. That Sunday, he rested and saved his spoons. When Monday came, he (fortunately) felt up to the trip. He rented a scooter at the zoo to reduce the number of spoons he would need. He and his wife had no expectation of seeing every exhibit, and just decided they would enjoy the day and see what they could. When he needed a break, his wife took the kids on a ride and he rested. After the trip, he and his wife both knew he had used his spoons, and respected his body’s need for recovery. She took over the childcare and supported him in getting the rest he needed. 

Understanding spoon theory doesn’t 100% guarantee success. Both the man and his wife were aware of the risk of a flare up. But by using the strategies they’ve developed they were able to set the stage for an enjoyable day. They had learned not to take the simple pleasures of life for granted, and they were both grateful that they were able to experience a memorable family outing.

One common feeling that can come with pain or any chronic condition is a sense of powerlessness. By using strategies to maximize your spoons and being patient with what you have, you regain some sense of control. Through this process, you can respect your body’s needs without letting pain make all the decisions. We hope this helps you create the freedom needed to do what matters most. 

Acknowledgements:

Graphic designed using Tagxedo at http://www.tagxedo.com/

References:

Miserandino, C. (2003). The Spoon Theory. Retrieved from http://www.butyoudontlooksick.com on August 21, 2015.