You must grieve the loss of a “normal life.” You are living a daily existence that is not what you would like it to be. You need to be active in processing your grief. Grieving frees up hope, which is needed to move forward. You have lost what you used to be able to do. You also have to grieve the loss of what you wanted to do in the future but now can’t plan to do. If you don’t grieve through these feelings, you become “stuck.” If you are stuck, you cannot live successfully with chronic pain. Grieving is a complicated process. I have found the following steps most important in working on grief:

1. Accept your loss.
2. Process your anger, fear, sadness — toward your doctors, the pain, God, your family, yourself.
3. Make adjustments — physically, emotionally and environmentally.
4. Acknowledge your mood.
5. Come to terms with chronic pain.
The longer you take to start processing your grief, the longer you delay getting back to your life.

If you are so depressed your sadness is clouding your life, get help. If you are being treated for the physical pain but not the psychological issues, it is not enough. If you are on an anti-depressant, talk to the doctor who prescribed it. Sometimes anti-depressants or related medications are prescribed at lower levels for sleep or other issues. There are so many kinds of medications. You might respond
better to a different one. You may need a higher dose or a combination.
Speak up and let the right people know. Depression is curable. Be open to do what you need to feel better. Sometimes a support group, counseling or seeing a psychiatrist can help. Do not accept feeling depressed as a part of your pain. Treat depression. Don’t be a martyr.

So many people tell me they expect depression because of their situation.
Let me share a story about Laura. Her children deserted her in a nursing home. They only lived a short
distance away but never called. Her legs were so swollen with edema you could feel her pain by just looking at them. She was confined to bed most of the time. Various traditional and experimental treatments had failed.
Laura was on anti-depressants but remained depressed. I met with her once a week for a year. She processed through her grief and anger. She came to accept her situation without giving up hope.
She became grateful for the staff who had “adopted her” by checking in on her constantly and even visiting on days off and holidays. She appreciated being able to do mending for other residents and fondly reminisced about when she was a seamstress. She felt productive again. She accepted love and friendship from staff and other residents. She remained hopeful that she would gradually improve, and she relied on her faith. She lived the same life without depression.

Well meaning people may tell you that you have no right to feel sorry for yourself. You should be putting on a brighter face to the world. You could be doing better than you are if you would change your attitude.
Your feelings are yours. Do not let others attempt to manipulate your feelings. Yes, it helps to be optimistic when you can. Often, this requires a process of feelings where you are sad and/or angry first. Even when you have processed through issues, there will be more issues to sort through and days that aren’t so good.
A lady with chronic pelvic pain told me everyone criticized her because her granddaughter has cerebral
palsy. They would say to her, “How could you even think of your pain when this little girl has such a
burden to carry?”
Your life is yours. You can’t compare how you should feel. Denying your situation keeps you from accepting it.
When you accept your pain, you can be free from its chains. You don’t have to defend yourself when you are being questioned. If it’s a self-care decision, saying you feel it’s appropriate is enough.
Practice accepting.

Open your heart to the present moment, even if you don’t like the moment. There is something to be gained from everything that happens — a lesson learned. Perhaps you’ll approach situations differently or avoid certain ones. Looking at an incident from another perspective can also be enlightening. Being open to different types of people, information and circumstances can facilitate learning and growth.
Many times we automatically shut our minds and hearts to whatever is going on in the present moment.
Before shutting down, analyze why. Is it because it’s different?
There are times when it is healthy for us to protect ourselves. But we should also periodically analyze our instinct for self-protection—we may be closing off new opportunities for growth out of fear.
I recently worked with a woman in her mid-30s named Lisa. She has chronic pain as a result of a bad car
accident. Lisa has had surgeries and physical therapy, but her chronic pain continues. Her doctors don’t
understand why her pain is still so severe. They tell her there is not a medical explanation for it, and they don’t know what else to do. Lisa came to me reluctantly at her doctors’ insistence. I encouraged
her to try relaxation techniques; bio feedback; visualization; meditation; cognitive/behavioral techniques— the list goes on and on. Lisa continually refused everything, stating she is not “new age.” Lisa expected her doctors to cure her. Lisa is missing out on so many opportunities for self-growth, as well as options that could help reduce her pain. When I look back at my own journey with chronic pain, I see many benefits from almost everything I’ve tried, as well as the varied people I have met along the way. Meditation has helped me enjoy the moment and feel a closer connection with God. Visualization has helped me achieve health goals as well as personal and career goals. Cognitive/ behavioral techniques have helped me change self-defeating patterns, helping not only my chronic pain,
but my entire life.
Personally, I have experienced the most significant pain relief from alternative approaches like cranial
sacral therapy, acupuncture and chiropractic subluxation. Not everything works equally for all people.
It’s worth the effort to try them and see what works for you. I am so thankful I have tried and continue to implement many different approaches and that I have consulted with many different kinds of
practitioners and professionals. Different perspectives have broadened my own. Sincere caring and
kindness from people so different from myself has touched me deeply. I am healing because of my open
heart. My life is deeper and more meaningful as a result. Whenever you can, open your heart to the present moment; it could be a healing moment you’ll be glad you didn’t miss.

Forgive friends, family, clergy, and doctors, anyone who has in any way caused, aggravated or misunderstood your pain.  When you hold on to your anger towards others, you are holding on to your pain.  You also have a role in your pain.  You make choices everyday.  Some choices may have been the wrong ones.  Forgive yourself.  You did the best you could at the time.  You know better now.  You are wiser now.  Learn the lessons and move on.  Tell others you forgive them.  Pray for strength to forgive.  Look at yourself in the mirror and tell that reflection you forgive.  Hurt and anger, like other emotions, are similar to the layers of an onion:  realize that you can forgive at one level, and then, when more layers are peeled away, you may find the strength to forgive more.  Each time you work on forgiving and are truly able to let go, you are closer to healing.  When you forgive you give the gift of peace to yourself.  It is a healing gift. 

Exercise 

1.      Write down everyone you are angry with or have been hurt by:____________. Have you forgiven everyone? If not….

2.      Do you know what is keeping you from forgiving? Sometimes it’s a fear that if we forgive, they will hurt us again. Can you pinpoint your block with forgiving each person?

3.      Once you identify why you are not forgiving someone, can you identify a flaw in your reasoning? If it’s to punish someone, the reality is you are hurting yourself. 

Sidebar tip 

Tell yourself you forgive someone, even if you don’t. Say it over and over to yourself several times a day. Tape affirmations up that reinforce you are a forgiving person. Pray to God for strength and grace to forgive. Surrender the person to your faith. When you are ready, pray for them; they need it. Pray for yourself; you need it.

You don’t have to wait to feel forgiveness to practice it. Often, the opposite is true. If you practice forgiveness, you will start to feel it. It feels good! 

Sidebar tip for family 

Be aware of your boundaries. You may hold others responsible for things that your loved one doesn’t and vice versa. Everyone has a different perspective. Don’t judge differences.

 Relax! As hard as this is when you are hurting, it is the best thing you can do. When you are in pain and you fight against it, you become more anxious and add to your pain. Breathe deeply. Listen to soft music. Meditate. Pray. Get a massage. Talk on the phone. Do whatever is within your power to help you relax. Find professionals who believe you, get the best medications or treatments, and practice relaxing.

When you have a good day, pace yourself and take care of yourself.

I used to push myself too hard to catch up on things when I was having a good day. Often after a good day, I would collapse or consequently have several bad days. I would then feel depressed and start obsessing that I would never have another good day. I would focus on my fear that the last good day really was my last and gradually I would become more depressed. Eventually I would start to feel better and then on a “good day” I would overextend myself again and the cycle would be repeated.

Now I take care of myself on good days, too. I pace myself, gradually doing more over a period of good days instead of all on one day. Now, when I overextend myself or have a bad day or days, I am gentle with myself. I remind myself what I need to do and that better days will come. I encourage myself to be grateful and not to panic. I tell myself this is not a permanent decline but a temporary backslide. Better days are ahead.

Always have something you’re looking forward to.  Whether it’s a vacation, a weekly phone call with someone special or private time set-aside just for you, make it your job to keep a sparkle in your life.  Anticipate something special every day.  When it’s sunny outside, I look forward to a few minutes of feeling the sun on my face.  I schedule alone time each week with my kids.  I keep things flexible.  Sometimes we just hang out and talk or watch a game on TV.  We might play a board game, go out to eat or see a movie.  It depends on my energy level and mood and theirs.  I talk with my mother at least once a week on the phone.  I used to fold laundry when we talked.  Now I sit back and give all of my attention to her and our phone call.  I enjoy it so much more.  I look forward to that time to relax and cherish my mother.

My very first client, Charlie, will forever touch me.  Charlie was blind with numerous aches and ailments.  His wife, Ethel, had problems with her hip, which limited her walking, but she enjoyed good health overall.  I would see them one to two times a week.  I would visit with Ethel and then take Charlie out to do banking, grocery shopping and errands.

Ethel complained constantly and was miserable.  She had visitors and phone calls.  Charlie did the cooking and most of the household chores.  Ethel watched T.V.  Charlie always had a smile on his face.  He would tell me he looked forward to going out all week.  He was so appreciative of clerks in the store who would help him.

He anticipated sunny days, friendly exchanges with strangers, and making something new for a meal.  He looked forward to the smallest things and relished them.  Charlie always found the sparkle.

Find ways to create joy in your life every day.  It’s up to you to find the sparkle. 

Exercise

1.      What do you look forward to?

a.      Do you have something daily, even if it’s small? If not, start now. Write out everything you can think of that you look forward to: 

2.      What can you create or add to your life to give it more sparkle? 

Sidebar tip 

Create a wish box. Decorate it with pictures from magazines of activities, things or people that you want more of in your life. Write down 3 specific things you would like to have in your life that you don’t have now. Is it a vacation somewhere, a mate, energy to do certain things? Don’t limit yourself. It’s your wish box. Update it every year. 

Sidebar tip for family: Encourage your loved one to have dreams and goals. Don’t tell them something isn’t possible. Who knows?

BE PATIENT

Patience takes a long time, often much longer than we want to wait.  We want the pain to end right now.  If we work at being healthy every day, the changes may seem so incremental we don’t notice.  One day we think back and remember that one year ago, or ten years ago, it was worse.  We still want it to be better.  Keep practicing being healthy and have faith that one year from now you’ll feel better.

My elderly aunt was a geriatric nurse.  She shared books on gerontology with me and encouraged my interest in working with the elderly.  For the past ten years she was in a wheelchair with numerous aches and pains.  The words of advice and direction she used to give her patients, she quickly forgot.  Her situation seemed hopeless to her as she slowly deteriorated.  Her husband unexpectedly died and at eighty years of age she was moved into a nursing home.  She became determined to move out of the nursing home.  That was not how she planned to live out her life.  With physical therapy and patience she slowly started walking again.  She put everything she had into small accomplishments, she persevered day in and day out.  She knew she had to be able to take care of herself in order to move out.

After eight months, she was able to move into her own apartment.  For ten years she felt too bad to try and she became worse and depressed.  In only eight months she was functioning and happy to be on her own.  Practice patience while you work on being healthy.

1.      Do you have a goal that you are working towards? Write down your goal as specifically as you can. For example, my aunt wanted to move into a senior retirement apartment. What’s yours?

2.      In order to reach a goal, there are objectives or action steps that need to be accomplished. May aunt knew in order to move, she would have to be able to do her own personal care. She knew that would involve standing independently, walking short distances, transferring herself and doing her own hygiene care and dressing/undressing. My aunt had to do strengthening exercises, gradually building her endurance and muscle tone. She also had to learn how to use adaptive devices to help herself with dressing and undressing. She started out small and built on her accomplishments slowly. What action steps do you need to take to reach your goal?

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LET GO OF GUILT

Many people with chronic pain feel guilty.  I did.  I must have done something.  If I were really a good person this would not be happening to me.  Is God punishing me for a past sin?  Am I just weak?  If I tried harder, did more, would this pain exist?

Or is it that I am being selfish?  Others are in worse situations.  I felt guilty.  I felt sorry for myself.  I felt guilty others were in worse shape.  I felt guilty I hurt.

Bertha is a 95-year-old lady with severe fibromyalgia. She was diagnosed about three years ago. Two years ago she was in a car accident, after rehab, she has been in a nursing home unable to improve to the point where she can go home and take care of herself.

Bertha is very critical of herself. She is disgusted with herself for not improving. She feels guilty that she’s not doing everything for herself. She feels she still has to manage all her own financial affairs even though this stresses her.

The more she pushes herself physically and beats herself up emotionally, the worse her pain becomes.

Bertha is in the process of letting go of her guilt. She is increasingly accepting her health, her pain and her limitations. She is being easier on herself. She doesn’t feel guilty or responsible for everything. Many things are out of her control. She says the Serenity prayer daily. She is surrendering to her faith. She is finding the positive in herself and her circumstances.

When I meet with Bertha now she smiles and jokes. When she has a flare-up, she accepts that she can’t do as much. When she is doing better, she is fully enjoying every moment.

Bertha tells me she is still working on letting go of her guilt. It’s a process. I see so much progress already. Things didn’t change, but she is.

Guilt is destructive.  Guilt weighs down spirit.  Guilt stands in the way of progress.  Let go of guilt.

Exercise

1. Do you often feel guilty or responsible for your chronic pain? If yes, do you know why?

2. Do you feel guilty or responsible for     people? If so, who and why?

3. Write down which things in #’s 1+2 that are in control.

4. If there are things within your control in #3, write down what you can do to rectify or resolve them.

5. Now, you can write down what you can’t control.