The Pain Voice

Is that true?

Spring in Seattle is beautiful, and on Saturday mornings I love to garden. I listen to a podcast, pull weeds, plant new flowers. Because of chronic back and hip pain, I limit myself to one hour, and avoid twisting movements, like raking, or picking up piles of weeds from the ground.

But as long as I’m on my knees in the dirt, I can happily rip out or plant in and relish the sensation of one more joy I have clawed back from the jaws of chronic pain.

And yet, pain does not do my bidding. I can do all the right things and still be felled, as I was later in the day on Saturday. Or I can push myself in ways where I would expect to be crushed and be only mildly uncomfortable.

I want every action to have a reliable result. But of course, that is never how life works.

Which is why I’m writing about this here, and not in my journal because while few of us (I hope) live with chronic pain, many of us (I believe) fall into thinking we have more influence over ourselves and the world around us than we actually do.

What if the actions I take to avoid pain don’t work? How can I stay away from despair?

It is good to take action. Because many actions work. I have no doubt that my ability to still garden, swim, bike, and even walk short distances is because I have been so consistent in all the activities various medical professionals have suggested: PT, anti-inflammatory diet, acupuncture, massage, to name a few.

A PT I saw a few years ago, told me after an initial examination that I was essentially a disabled person. “Many people with your level of pain would just, you know, stop.” Stop working, stop gardening, stop swimming, stop trying.

I did not stop.

It is good to feel some sense of agency. I rarely eat dairy or nightshades (tomatoes, peppers) and it seems to help. I enjoy exercise, so adding some one-legged squats to my rotation and feeling my hips get stronger is great.

But taking the right action does not mean control. Saturday afternoon I was in so much pain I sat on the couch and wept. I don’t know why I hurt more that day. I had not done anything differently. I had done all the right things.

How many times have you done what you believed were all the right things and everything went awry? At work, in your marriage, with your health, or in your family? As an athlete, an artist, a father, a friend? You showed up with real intention, did your very best, and everything fell apart anyway?

Did you weep on the couch? Double down on your efforts? Give up?

After my ugly cry, I broke out a book I’ve used before, and written about, called the Pain Management Workbook. The author, Dr. Rachel Zoffness, talks about the concept of a Pain Voice. This is the voice in your inner community (my language from my book, not the author’s) which tells you that you are fucked.

• ·Everything you’ve ever done or tried has come to nothing.

• You are doomed.

• It will never get better.

• Nothing and no one can help you.

• Let us consider all the dire predictions of a future in which your worst options spool out from nightmare into reality.

Zoffness suggests we identify the Pain Voice with an image and name – male/female, what do they look like, sound like, and what do they say?

And then find/build/imagine an alternate voice, what she calls the Wise Voice, who can offer another perspective.

My Pain Voice tells me I will be stuck here forever with this level of pain, and I won’t be able to do any of the things I love, and I’ll be a burden on my family.

A Wise Voice might remind me that while this pain is intense, the reality is that I experience this level of pain for less than a couple hours a week. Most of the time it is quite manageable.

The first thing is to recognize where the Pain Voice is lying. No, I will not be stuck here. Your surly teen will get older and have a different perspective. Your difficult boss is only someone you interact with twice a week for an hour, not the 24/7 she is in your brain.

The Pain Voice exaggerates, worst-case-scenarios and projects into dank and difficult futures that are in no way inevitable.

A skillful Wise Voice doesn’t argue with the Pain Voice. It validates. Of course, it sucks to have to spend a sunny spring afternoon lying on an ice pack watching cooking shows rather than gardening outside. Chronic pain is a bitch.

Pressure Test

The Wise Voice pressure tests the assumptions.

Always in this level of pain. Not true. The pain is bad, but this level of discomfort is limited to a few hours a week.

I’ll be stuck here forever. You are trying new things, and have seen some improvement in the past, and there are additional things you can try in the future. It is difficult, but there are options. Let’s explore them.

I’m a waste of space for not working all day in the garden. Who told you that all of your days off needed to be spent in hard physical labor? Do you give yourself permission to just rest? Didn’t you want to finish that book? Would reading a good novel make you feel better than watching another cooking show?

My Wise Voice doesn’t try to push me into a place of gratitude. Which I appreciate. Otherwise, I’d have to fire her.

She does nudge me towards acceptance. This is the body I have, these are the resources available to me, and having a tantrum because in the genetic lottery I got my grandmother’s and mother’s bad hips isn’t a useful way to spend my energy. It does help me to make better choices than the ones I saw them make – choosing acupuncture and PT rather than unnecessary surgeries, staying active, eating well.

I write and talk about reframing narratives all the time – it’s a third of my book The Saint and The Drunk. So, I was surprised this weekend at how quickly I lost the plot and took the stories my Pain Voice was telling me as gospel. Which is why I wanted to write this.

What pain are you experiencing? In your body, your home, your work? Is there some part of you speaking with a Pain Voice, telling you it will never get better, you’re fucked, give up, spinning out various dire predictions?

Are all of those true? Inevitable?

The world is in pain

I can’t write about individual pain without acknowledging the global pain, the chronic assault that most of us experience when we read the news or consider all the genuinely awful things happening in the world. That is a pain. And, I would suggest, many of us have a Pain Voice weighing in on what is happening in the world, accepting as inevitable events that are in no way pre-ordained. The American Democratic system is under attack, but it still works. The dystopian AI future we read so much about is in no way inevitable. For me, the damage pouring like a firehose to the face from my screens feeds my sense of hopelessness and despair.

But it behooves the bad people in power to keep the rest of us so entranced in our despair that we don’t bother to vote, call our representatives, resist, challenge. What about literally turning the channel and watching content from Wise Voices rather than the doom-mongering Pain Voices?

Your pain is real, and awful, or at the very least difficult. Feel the fuck out of your feelings, the grief, the anguish, the anger, the despair. I had the ugly cry on the couch first, before anything else.

But if you’re moving through your life with this pain, this burden, this challenge, who do you want at your side? The Pain Voice screaming about worse case outcomes and the futility of any action or the Wise Voice calmly and effectively assessing the reality of what is happening, inviting acceptance, and then adjusting the negative narratives so the sharp edges don’t poke at you and make the pain worse?