Brian Doane, Ph.D. - Licensed Psychologist
Prior to December of 1999, I experienced many injuries from years of sports, working blue collar jobs, and the general shenanigans of the guy who is always first to say, “I’ll try it.” Despite those life choices, I had always recovered relatively quickly and moved on to the next adventure. At age 18 my luck ran out. I was standing at the top of a ski hill looking at a jump someone had built several yards down the slope. I was a decent skier at this point but had rented a snowboard that day to try something new. After a few moments of discussing strategy with a couple friends, I heard myself say, “I’ll try it.” Now, it’s important that I don’t give anyone the wrong impression as to the difficulty of this jump. It was probably high enough to propel someone, at most, three feet into the air. Ten year old kids were hitting it like a speed bump. How hard could it be?
So down the hill I went, leaving common sense at the top. The goal was to gracefully land with the snowboard parallel to the ground and instantly inflate my ego as an athlete. It went about as you’d expect for someone who had only strapped onto a snowboard for the first time an hour ago. While in the air, I somehow managed to twist my body in such a way that the snowboard and my head swapped places. My breath and ego were knocked out of me. As I sat up to unclip my boots from the board, a stinging sensation went down my leg.
After an inconclusive x-ray and several months of physical therapy, I eventually scheduled an MRI. I had ruptured the L5 disc in my lower back and the only option was surgery. In that appointment I learned surgery would be helpful in reducing the pain down my leg but I’d likely have back problems for the rest of my life. I remember getting into my car that day, shutting the door, rolling up the windows, and crying as I hid from the world. It was one of those weird cries where you feel the intensity of an emotion but you’re not ready to let it out and ends up sounding like a donkey honking for food at the zoo. And like many 18 year old men, I had no idea why I was crying. In retrospect, it wasn’t the surgery that was scary but the loss of my perceived invincibility. I was afraid of what would change. The surgery was successful to a degree but I have lived with chronic pain ever since.
Chronic pain differs from acute pain in that you eventually form a relationship with it. Of course you don’t want to know pain this intimately but it’s always right next you…waiting for the right moment to say hello. In the sitcom The Office, Michael Scott is the regional manager of a small paper supply company. He is offensive at times but his misdirected and childlike passion for the workplace can be endearing. Toby Flenderson is an HR representative who attempts to embody
professionalism, order, and accountability. When Michael inevitably does something inappropriate, Toby is right there to redirect him. This often infuriates Michael to the point of repeated unsuccessful attempts to fire him.
We can easily liken Toby with chronic pain. If you behave in a certain way, he will reprimand you. But even if you’re minding your own business, he may still walk into your office for an unwanted chat. You don’t have the authority to fire him and he rarely takes any days off work. You’re stuck with Toby. So you can either despise Toby because he seems so intolerable, or you can not like him but learn to work with him.
Working with Toby
Understanding Toby’s Intent
Before you can effectivly work with Toby, it’s going to be helpful to understand him. Start by consulting with one or more physicians who are trained in your area of concern. Medical professionals can rule out other contributing factors and set limits to what kind of pain is reasonable for you to manage on your own. While the doctors are experts in their area of practice, you are the expert on you. I would suggest reading about your symptoms, diagnosis, and medications to help make informed decisions with your doctor’s consultation. If you’re like me and avoid going to the doctor, don’t be like me. You need all the information you can get to better understand Toby.
You may also find it helpful to reflect on why the company has hired Toby. The purpose of pain is to communicate something is wrong. It’s trying to help you make decisions about modifying your behavior to heal. Now in some cases the message is incorrect and there is nothing wrong with
your body, or you’ve already got the message and would like Toby to get out of your office.
I recently crashed on my motorcycle and had to have my shoulder reconstructed (twenty years later and still up to the same shenanigans). After the surgery I remember thinking, “Okay body I’ve got the message. Don’t move my arm. You don’t have to be reminding me 24/7 with this much intensity. I get it!” Toby pestered me for months after the surgery but I needed his constant prompts to stay still, use ice, and keep my energy level subdued so the body could focus on healing.
Even though you don’t like what Toby has to say, it is important. He’s trying to tell you something that’s just as significant as your stomach’s incessant growling for attention when hungry (if you want to continue with The Office analogy, the stomach is probably Andy…roo doot doot doo doo). Maybe this is the 1000th time you’ve had to listen to Toby drone on and on but he’s trying to help you. Intentions are important when forming and maintaining relationships. Even the most annoying of friends stays in your life because there’s often a redeeming quality. The pain can be irritating, come at the worst times, or even piss you off. But it’s helpful to remember that it’s trying to help…even if misdirected. So when your joint flares up or your legs start to ache, think to yourself, “Message received Toby. Thanks for letting me know.” This little trick isn’t going to suddenly make the pain go away, but it will help reduce any frustration and prepare your mind for the next step in working with Toby.
Learn Toby’s habits and triggers
There’s often a pattern with chronic pain. For most people, chances are Toby follows a routine. In the case of my back, if I bend at the waist, sit in a soft chair, sleep on an old mattress, hunch over in the car, or run long distance, I can guarantee Toby will make it his number one priority to have a lengthy conversation about my choices. I’ve also learned that Toby tends to be more active when it’s colder outside but less active if I’ve been sleeping well. I’ve learned his habits so well, I can look at a chair and know exactly how long I can sit it in before Toby makes his way from the back of the building to my office.
Some of you may be thinking you already have a solid understanding of your Toby’s habits and triggers. Others may be convinced there is no pattern. And you may be right. But one helpful way to be certain is to begin a log. The second that you notice Toby walking towards you, write down the day, time, what you were just doing, how much (if any) medication or drugs are in your system, duration, and the intensity of the pain using a 1-10 scale (10 being the most pain you’ve ever felt). There’s a free printable log under the "Forms" section of this website or download one of the many logging apps on your smartphone. I really like PainScale-Chronic Pain Coach available through iOS and Android platforms because it’s free and has a section to write your own notes. Try logging for at least a dozen entries and see if you start to notice any themes. Feel free to add other variables like eating, sleep, stress level, mood, etc.
Learn how to live with Toby
Now that you understand Toby’s purpose and can see his patterns, it’s time to learn to live with him. Before getting into the practical application of coping skills, I’d like to mention one thought that will help you get the most out of these coping skills.
Pain feels intolerable because you’ve decided it’s intolerable.
Yes this sounds simplistic and my apologies if it’s offensive to those in constant agony. But the message here is that you have a significant amount of power in deciding how you want to interpret your pain. If you have a migraine and you’re telling yourself, “This is the worst. I can’t move. It will never go away!” then it is very likely your migraine is going to flourish. I’m not suggesting you pretend like you don’t have a horrible migraine, but I am saying you aren’t allowed to lie to yourself. If you can move with your migraine, don’t tell yourself you can’t. If all your migraines have gone away in the past, don’t tell yourself it will never end. Toby isn’t smart enough to know when your thoughts are exaggerating your suffering. He’ll listen to what you tell yourself and fall in line. If you’re having a migraine, try telling yourself, “I don’t like this and it’s hard to move but it only lasts a few hours and then I can just fall asleep.” Unless your pain is imminently going to kill you, you can handle it. You don’t have to like Toby, but he will always be tolerable.
One of the more effective treatments for chronic pain is Mindfulness Meditation. You may be imagining meditation as someone sitting cross-legged on the floor while chanting. And while that’s one form of meditation, it’s not what I’m suggesting. Mindfulness meditation is essentially paying attention to the moment of right here and now but without passing judgement. So you can be walking to the store, sitting in your living room, or standing in the shower and practice mindfulness meditation. You’re focusing on everything that’s happening right now…sounds, smells, thoughts that pop up, and even Toby. But the trick is to avoid having a judgement about it because the goal is to simply notice and move on. Pain loses its power when we stop having an opinion about it. What’s Toby going to do if you start criticizing or yelling at him? He’s going to yell back even louder. If you’re indifferent, he may start speaking softy and you may begin to notice something else.
Practicing mindfulness meditation can be frustrating at first but many of my clients report improvement after a few weeks of commitment. If you’d like to learn more, I’d recommend reading, Mindfulness Meditation for Pain Relief by Jon Kabat-Zinn, downloading one of the many available mindfulness apps for your phone (Headspace, Calm, etc), or searching “guided mindfulness meditation for pain” on Youtube. If you're learning mindfulness meditation on your own, make sure you begin with "guided" meditations. These will help you know what to do and are better at helping beginners stay in the moment.
If you’ve had chronic pain for some time or are trying to recover from a debilitating surgery, the pain can trick your mind into not trusting your recovery. For example, I had surgery to repair a broken hand from playing football. Months after the surgery I was nervous about working out because lifting anything heavy caused some pain in my hand. My surgeon, physical therapist, and every website on hand surgery said the bones were as strong as they were ever going to be and it was safe to work out. Even though Toby wasn’t around as much, I became afraid of him to the point of avoiding things I enjoyed like working out.
If you’ve been medically cleared for an activity but are still worried that the pain, visualize when you were able to do that activity in the past with little to no pain. Spend a few minutes doing this and then act as if it’s true. So for my example, I would get ready to work out and visualize both hands gripping the weight and completing the movement. Then I walked over to the weight and did it. When my hand didn’t fall off my arm, I did it again and again. I still noticed the pain but learned to accept it rather than be fearful of it. Over time, it went away.
The last part in learning to live with Toby is remembering that Toby is often invisible to most people in your life. If you have chronic pain, you may struggle to find the balance of telling others about your pain and feeling like a burden. Many people with chronic pain have to work very hard to manage it while everyone else is oblivious to their efforts. This is often frustrating. I recently read that a famous company asks each applicant during the job interview what animal they are and why. One of the more interesting responses was, “I think of myself as a duck. On the surface it looks like I smoothly glide across the water, but underneath I’m paddling non-stop.” When a client is comfortably sitting in my office and nonchalantly telling me about their pain, I sometimes wonder how hard they are paddling in that moment.
When Toby makes an appearance, you may need to take a break, sit or lie down, sleep, or just be left alone for a bit. This will be confusing to others who do not know or remember that you have a Toby. It may be helpful to advocate for yourself by educating those closest to you about what you need. In my experience, most people want to help but don’t know how, and end up saying or doing something that is not helpful or even hurtful. If you’re comfortable, tell people about your pain and just as important, tell them in very concrete terms what they can do to help. You might say something like, “If I tell you I need a break, it means I need to be left alone for at least 10 minutes. That is the best way you can help." They now know how to assist you instead of trying to fix something they can't fix.
I truly hope this article is helpful for those who struggle with chronic pain and their loved ones. It can be so challenging because often there just isn’t a cure…it becomes about managing it. So if you have a Toby in your life, don’t fight him. Work with him.
Disclaimer: It’s strongly encouraged to consult with your physician to rule out any medical conditions that may be contributing to problems with pain and get seek consultation before making major changes to diet or routine. The information presented in this article is not intended to be psychological advice or therapy but educational in nature.
Dr. Brian Doane is a licensed psychologist and owner of Tampa Bay Counseling Services. If you’d like a free consultation regarding pain or mental health concerns, give him a call at (813) 853-5360 or check out his website at www.tampabaycounselingservices.com