Chronic Pain: Being Resilient About Resilience

Chronic Pain: Being Resilient About Resilience

mark ibsen

Mark Ibsen, MD

Recently, I have read several articles about resilience. There was a surprising amount of response-pro and con-from the Pain Community.

It has me thinking about resilience as it applies to ALL of us. Some folks, suffering from chronic pain, who are really hurting hear talk of resilience and feel they are being criticized or seen as inadequate. The cancer community went through this conversation 25 years ago when Dr. Bernie Siegel wrote his seminal work: Love, Medicine and Miracles.

Dr. Siegel, or “Bernie”  as he prefers to be called, made the case for empowerment and self-healing around cancer and terminal illnesses. Some who read his books were offended, concluding, as chronic pain patients might today, that they must be inadequate if they hadn’t healed their own cancer yet. The point of the book was to share Dr. Siegel’s success with his program called “Exceptional Cancer Patients.”

He found that patients who were ready to powerfully engage with this cancer, express their feeling and re-engage with the joy of living all did better. This, of course, was in no way meant as an indictment of those who did poorly: some of them just had nastier cancers.

I can see something similar going on in the chronic pain conversation-often when pain is kicking your ass, you just don’t feel very resilient.

But resilience is about coming back, isn’t it? It’s about getting off the mat. It’s about creating resilience where none existed before.

And pain, being such a f—- terrorist, doesn’t want to let you up off the mat.

So, as I’ve been thinking about this over the past month, here’s what came to me. We all have plenty of resilience to everything that is NOT currently kicking our ass.

We just don’t always have resilience to what is currently dominating us: unremitting chronic pain.

So when someone, who is well-meaning, encourages us to be resilient, it might be good to develop some resilience.

Some of us are just tired. We don’t know how to summon the energy. And we certainly don’t care much about hearing from people who we think don’t know what they are talking about as they offer us “coaching” about how to get off that mat.

But then the theme from Rocky comes on-or maybe the one from Chariots of the Good or some other miraculous stuff happens.

Maybe the doctor writes that prescription you need or the pain decides to terrorize someone else, or maybe you get a good night’s sleep and feel like writing that letter to your Governor about the problems in treating chronic pain in your state.

I guess that’s it.

Someone’s else resilience is useless to you. You (We) must generate our own. Those who have generated resilience just want to contribute.

Let’s let them.

If someone in a boat throws us a line in the water, we don’t have to take it as an insult, we can just grab the rope.

Stay in the game.

Don’t give up.

That is resilience.


Give Up.

That can be resilience too.

We just don’t know, do we?

Editor’s Note: Dr. Mark Ibsen is from Helena, Montana. Recently he stopped prescribing pain medication for patients at his emergency room practice because of pressure he has been receiving from Montana regulatory officials. He is an outspoken advocate for pain patients and has written previously for the National Pain Report.

Authored by: Mark Ibsen M.D.

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I wasn’t going to write anything but a comment I read really burned my ass. I lived with acute pain for many years working 2 and 3 jobs to support my kids after my husband passed. Each year I got worse and finally 4 years ago chronic pain took over my life. No mater how much I tried to fight it like I had for years. I just couldn’t anymore. I lost my job when I went from crutches to a walker. But it was because my hips and back couldn’t even hold me up any more. My once happy times with my kids and friends turned into a nightmare when the pain would make me pass out. I knew then I could not go without pain killers any more. I had surgeries, injections and now settled on pain killers as they say I did so much damage to my spine by pushing myself so hard with a body riddled with OA that it is like being held together by a string. Every step I take with my walker is met with resilience!! Some days I can make it around the home a little and other days it’s a hopeless battle which ends with tears and more pain then I can bear. So don’t anyone tell me I am not resilient because I worked my ass off for years being resilient and now not so much at 63.

Payne Hertz

The opposite of “resilient” is “weak.” No matter how you parse it, when you tell people they need to be more resilient you are telling them they are weak. This is why people get offended by it, not because they think resilience is a bad thing.

It doesn’t help that the “resilience” message is being delivered by a group of people who traditionally have accused us of being whimps, malingerers and drug-seekers who just need to toughen up and take the pain. Every time you use that word, it just sounds like more of the same old same old.

The simple fact is chronic pain can wear down and destroy the health of just about anyone. No matter how tough you are or how tough you think you are, water wears away granite eventually and years of dealing with pain can wear you down no matter how “resilient” you are.

Yet many people preaching resilience to us seem to think the natural and normal emotional and behavioral reactions to pain are dysfunctional and can be controlled with the right mental attitude. This is just the old “positive thinking” canard rearing its ugly head again. Anyone who has survived years of chronic pain knows this is false, and that there is a limit to human endurance and the ability to overcome pain.

It’s funny, but when I look at a single mom with severe chronic pain who has somehow survived 20 years of torture while raising 3 kids on the pittance she gets from SSDI, I don’t see someone who needs a lecture on resilience. I see a hard-core survivor who can probably teach your whole profession a thing or two about resilience.

Maybe it’s time doctors start becoming resilient to the idea that there are flaws in their thinking that need to be corrected by listening to people who have actually survived dealing with pain. Until then you are like civilians telling combat veterans how to be soldiers.

Tootie welker

How resilient we are and the difference between people can sometimes involve conversations around the psychological theory on locus of control. This is not meant as a positive/negative duality statement. Some people are born with a stronger internalized locus of control where for some it is more external. What this means is some people are affected more by aspects “outside” themselves, which can at times allow themselves to feel as victims; while those born with a stronger internalized locus of control may feel as though they have more direct power over their lives. One is not better than the other; it is just one theory on how people approach the reality they interact with. The good news is one can change, to a degree, where their personal locus is located! By developing a more internalized locus of control can help chronic pain patients feel in more control over their pain. It doesn’t make it go away but can change our relationship to and with it. During periods of acute pain it’s harder to do this but when it’s not feeling so acute, we can decide we are NOT going to allow it to control our lives. It helps us change our attitudes towards our pain from my pain keeps me from doing anything to, while yes I hurt but I really enjoy doing X and today, even though I hurt, I am STILL going to do X for 15 minutes today and push the pain back a little from my focus. With practice we can learn to take back our control a little. It doesn’t happen overnight, it takes effort and work but if we support each other we can. Don’t get discouraged, don’t beat yourself up if you can’t right away. And on days of acute pain you’re not going to even want to try. And that’s ok. Love yourself, ask for help