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Acceptance as an Intervention for Chronic Pain

October 1, 2013

In reflecting upon the importance of acceptance in the context of dealing with chronic pain, some may mistakenly believe that acceptance means giving up or giving in to the pain and to negative thoughts such as “I can’t do anything” or “My life is over.” Real acceptance, however, doesn’t mean giving up. On the contrary, acceptance means living in the present moment and experiencing the present moment, instead of reacting to it and being controlled by it. From this non-reactive stance, it becomes easier to determine which factors concerning chronic pain are within your sphere of control and which are not. Acceptance enables a creative realism in which you discipline yourself to focus on those aspects of chronic pain that are controllable and to forego attention on those that are outside of your control. Instead of mulling over depressing conclusions, the soul is called to experience the present moment that is always pregnant with possibilities that exceed us, for our infinite God is always at hand in our finite present.

For instance, if you suffer from rheumatoid arthritis you may find that your physical activity is limited.  A negative thought—such as “I’m going to have to give up all the activities I once enjoyed such as running or bicycling”—may cross your mind and make you feel depressed, but you can choose not to react to the pain with what-if thoughts, you can choose not to continue to focus on that negative “all-or-nothing” limitation until it strangles you. Instead, you can recognize the pain, you can acknowledge the thought, and then you can make your choice: you can re-focus your attention on potential activities that you can enjoy such as swimming or walking and decide when to do just that. In such a scenario, you accept your limitations, but refuse to be disabled by them. Rather, you choose to focus on that which is within your scope of control.

In their article, “Patient Functioning and Catastrophizing in Chronic Pain:  The Mediating Effects of Acceptance”, the authors cite numerous studies that demonstrate acceptance actually assists the chronic pain sufferer in enjoying daily life: “with regard to chronic pain, this line of reasoning suggests that sensations of pain, even when intense, need not inhibit success at living a meaningful life, nor do they need to be fought against, ignored, suppressed, or conquered before success can occur.  Although the notion that it is possible to live with these difficult and distressing aspects of chronic pain is somewhat counterintuitive, there is increasing supportive evidence for acceptance of chronic pain, with a general finding that greater acceptance is associated with less disability, distress, and utilization of healthcare resources.”

There is an interesting correlation between this approach within cognitive therapy for chronic pain and the ancient fathers’ teaching on the relationship between the nous and negative thoughts.  As you may recall from previous posts on the subject, whereas the thoughts tend to orient us towards the past and the future, the healthy nous is firmly grounded in the present in a state of total acceptance. In the case of chronic pain, we can contrast catastrophizing thoughts such as “what if the pain gets worse and I can’t do anything?” that are accompanied by feelings of anxiety about the near or distant future and the healthy nous that reaches out to God with the prayer “Lord Jesus Christ have mercy on me” and perceives Christ’s grace in the present. The fathers consistently taught the important spiritual discipline of watchfulness and the necessity of fully engaging in the present while warding off thoughts that race blindly into an unknown future.  At its core, acceptance is a spiritual principle taught by the fathers and recognized by cognitive therapy in dealing with all circumstances of life as well as the unfortunate circumstance of coping with chronic pain.

In reflecting upon the importance of acceptance in dealing with chronic pain, two principles are paramount.  First, acceptance, unlike the swarm of one’s thoughts, is a choice that does not occur automatically. This makes it not only more difficult, but also more praiseworthy. It offers to those who find their options limited by their situation a new choice for action.  Secondly, acceptance requires struggle and a desire to no longer be at the mercy of the negative and harmful thoughts often associated with chronic pain.  Perhaps, it might be helpful to view thoughts about chronic pain as we would view temptations to sin.  In both instances, acceptance is key. We can choose to give our thoughts and temptations substance by assenting to them, remaining with them, and elaborating on them. Or we can look at the thought and say you are just a thought. We can look at the temptation and say you are just a temptation. And then after acknowledging and accepting things as they are, we can keep our heart focused on the good, the beneficial, and that which leads us to eternal joy.

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