What non-physical activities are good for chronic pain?

One of the struggles of having physical chronic pain is that we assume our pain is physical. As such, we tend to veer towards physical activity to aid our recovery. However, chronic pain is usually multifaceted in nature and, although exercise is first-line treatment, it is sometimes not enough. As a chiropractor, I do subscribe to taking a holistic approach, which includes looking at non-physical activities that can improve a person’s pain experience. In this post, we will discuss the activities that could potentially be helpful for people living with chronic pain.

Taking naps and doing absolutely nothing

Did you know Singapore is one of the most sleep deprived country in the world? The average adult needs seven to nine hours of sleep per day. If you are not getting enough, you can probably do with a nap. Of course napping is definitely a privileged activity cos most working adults can’t afford to nap, but if you can, it’s a wonderful activity.

According to an article by Lee Kuan Yew School of Public Policy, sleep deprivation cost Singapore US$12 billion a year. That is almost 3% of our Singapore’s gross domestic product. This is a result of absenteeism, reduced productivity and the use of healthcare resources.

Sleep and napping may seem very trivial but can have significant effects not only on your health but also your work performance, and even the people around you!

P. S., If you are really struggling to sleep, go for the next best thing: Rest in bed.

P. P. S., Bed rest because of pain is not recommended. In this case, my recommendation to nap or rest in bed is to improve rest. Not as an intervention to reduce pain through inactivity.

Praying

When it comes to management of chronic pain, I don’t think prayer does come to mind. Especially within a secular context. In Singapore, potentially because of our multi-religious society, it could be more challenging to talk about how our faith can be used as part of our recovery.

Research shows that 61% of people use prayer as a response to their pain. Over 70% of Singaporeans subscribe to a religious affiliation. So, I think, it’s fair to consider that prayer is something that many Singaporeans do. Even if we don’t talk about.

I do see the conflict though. When we think about healthcare, we think secularism. We think God has no place in it. We think God is compatible with science. But you’d be surprised to learn that a study in 2020 reported that praying was beneficial for pain.

If you are Christian, you may want to consider that Lent is just a couple of days away. Lent is a 40-day period where Christians traditionally fast and pray to prepare themselves for Easter. You can consider it as a time to meditate more seriously? And meditation on its own can help with chronic pain.

Mindfulness practice and meditation

I personally feel that mindfulness practice is a contemporary, secular repackaging of praying to cater to people who are areligious. Meditation is still used within a religious context but there is also areligious spirituality.

When it comes to areligiousness, we have spiritual but not religious (SBNR). It refers to people who believe in something greater than themselves, but I guess just not God. Examples of people who may be SBNR are pagans to those who practise reiki crystal healing.

From my personal encounters with people who are SBNR, they come from some sort of organised religion, decided it’s not for them, but still want to keep some aspects of being in a religion.

Interestingly, a BBC article published over a decade ago reported that “spiritual” people are more likely to have depression or anxiety.

Mindfulness practice helps with chronic pain

I previously already wrote at length about mindfulness practice for chronic pain. If you are interested to learn more, you can check the post out.

If you are looking to learn mindfulness practice in Singapore, you can check out Brahm Centre. For those who are open to virtual programmes, Oxford Mindfulness is definitely worth checking out. I attended their 8-week programme and it was wonderful.

P. S., Virtually all research that report positive findings for mindfulness practice are based on their 8-week programmes (e.g., MBSR, MBCT). If you are looking to use mindfulness practice as an intervention for your pain, I highly suggest going for the 8-week ones.

Journaling

There are lots of journaling styles. They are all done differently and have different purposes. The most intuitive type of journaling would be to keep a pain log. In keeping a pain journal, you can have a better awareness of your pain. For example, what are the minute changes of your symptom experience from day to day.

A lot of times, people report their pain to be always the same. Yet journalling will reveal that that is usually not true. Most of the time we feel our pain is the same because don’t check in on our physical sensations enough. So we only remember the painful episodes where our pain actually “catches” our attention. In those moments that we don’t feel pain or less pain, we pay less attention to them.

Painful moments are also more salient than non-painful ones. With that in mind, it’s totally reasonable why we don’t register moments when our pain feels better.

Journalling, such as a pain log, can help is identify these moments. Journally can also be detailed to include the physical activity or behaviour when the pain or occur, as well as our emotional state or cognitive processes. These will give us a better understanding of how our pain behaves. If our pain is more influenced by our physical activities or perhaps our emotional state (e.g., stress).

Antecedent-consequence journaling

This approach to journaling is really popular among psychologists. As part of the ABC (Antecedent-Behavior-Consequence) Model, it is often used to elicit behaviour change.

When using the ABC model, people will observe and take note of what occurs right before and after a behaviour that they would like to change. The idea is help people identify the motivators or contributors that predict a certain behaviour. And in doing so, hopefully allow modification to allow for successful behaviour change.

Antecedent: Mum nagging at me to do my homework.
Behaviour: Didn’t do homework cos I am sick of my mum nagging at me. Played computer game instead.
Consequence: Angry mode for the rest of the day and didn’t end up doing homework cos too hungry.

Let’s say the above is an journal entry specific to the behaviour of working on homework. From the entry, you can see that the homework is not really the issue. Possible what needs to be worked on is the emotional regulation. It could also help recognise that if the homework was done in the first place, the nagging would not have occurred and neither the negative emotions that followed.

Usually the journaling is done across multiple weeks to have a better idea of what actually is going on.

Gratitude journaling

There is gratitude journaling and there is also positive journaling. Gratitude journaling is about reflecting and jotting down what you are thankful for on a regular basis. Typically people list a couple, maybe three to four, things they are grateful for every day.

When I did the MBCT programme with Oxford Mindfulness, the homework was to list ten items. The point was to push your limits a little and really dig into what are the goodness in your life.

Positive journaling, on the other hand, focuses on the good or positive things that happen to you. I guess you don’t really have to be grateful for them. haha!

In gratitude journaling, you can be thankful for negative things cos of the potential, future upside. I don’t think this would be possible in positive journaling.

Which journaling to choose?

If you want have a better understanding of your physical sensations, a pain log is the better way to go. For those who are hoping to understanding the cognitive processes or emotional responses associated with certain behaviour, the ABC (Antecedent-Behavior-Consequence) model would be a better help.

Sometimes with chronic pain, there is a sense of helplessness or things are not going your way. If so, gratitude journal is helpful. Gratitude journaling directs your attention to what are the things in your life that could be good. Sometimes they are not obvious. But that doesn’t mean they are not there.