For this specific post, we are moving away from our usual evidence-based content. What I’d like to do is to share some experiences I observed as a chiropractor, and with that give you some idea of what to expect in the coming months.
Kübler-Ross’s five stages of grief
Most of us would have come across Kübler-Ross’s work on grief. While the model he proposed are specific to bereavement, there are some aspects that are worth considering.
In his stage theory, he suggested that grief can be experienced through five predictable stages. They are: denial, anger, bargaining, depression, and finally acceptance. More recently, a sixth stage–meaning– has been to his work.
It is true that living with chronic pain or injury is not like bereavement. However, there are parallels between the emotional experiences involved in both circumstances.
Emotional impact of chronic pain
When discussing musculoskeletal conditions such as back pain or neck pain, we don’t tend to bring the emotions involved into the conversation. Even though, from our personal experiences, we know emotions is a huge part of living with pain.
Quite often, we see that people get frustrated by their symptom experience. For example, they may find themselves unable to focus at work because of their neck and shoulder aches. This often lead to frustration, and sometimes even depression.
Interestingly enough, depression and pain is not a one-way relationship. Not only does having chronic pain increases your risk of depression, having low mood on its own can increase your symptom experience!
This is why we refer to as a bidirectional relationship. Pain can negatively affect your mood. Low mood can likewise worsen your pain!
What to expect in your first few months
This is largely an anecdotal post. What I am sharing is based on the observations I have made over the last couple of years. The objective is not to tell you what you will experience. Instead, it is to give you an idea of what other people go through so you can know what to expect.
If you are reading this post, I am guessing your pain has been going on for a while. Clinically speaking, we consider all pain over 12 weeks as chronic or persistent.
This is usually an indicator that it is time to seek professional help (i.e., it is looking like it won’t be going away on its own).
Similar to Kübler-Ross’s proposed stages, we find that denial is often the first stage pain patients go through. They are usually dismissive of their pain experience as “nothing”.
You may also have dismissed your family or friends’ concern for you. Quite often, we do hear of clients refusing to seek professional help despite the repeated requests from their loved ones.
Bargaining? Is it all just in the mind?
The stages of grief model is slightly different when it comes to bargaining. In the model, bargaining is more of a ““I will never be angry at my wife again if you’ll just let her live” situation.
In recovery, however, bargaining is trying to push your body or your symptom experience to see what happens to it.
To some extent, you may consider it an extension of denial. You are bargaining with your body because you are not convinced that your body needs help.
This will likely go on for a few weeks or even months, as they patiently for their pain to self-resolve.
Some knee pain continue to persist even after months of rest. In such cases, it makes complete sense to seek professional help. However, runners will often decide at this point to train even harder! Some even believe that their symptoms will resolve once they get back to their previous training routine.
So, they start running more. They start to push themselves harder. They are bargaining with their condition.
Needless to say, this never ends well.
Anger: When nothing you do yourself seems to help.
I am sure you have had many people come to you with advice on what you should do about your condition. You would have been asked to try this or try that, because it worked for my . . . somebody.
Good news is that you have people who care about you. Bad news is most of these advices are not congruent with the latest clinical guidelines.
The frustration and anger comes when you invest time, effort, or even money into small things that have been purported to help but find yourself getting nowhere. For some of you, your condition may be deteriorating fast!
For those who over-pushed themselves in their bargaining phase, the anger is real.
It’s a lot of why me.
It’s a lot of reasoning with yourself to convince yourself that you have done what is supposed to work. But nothing seems to be helping.
There’s really not much to say about this. It is a totally reasonable response. You have invested effort into helping yourself. When you don’t get results, anger is a normal and expectable emotional response.
The problem with not seeking (evidence-based) professional advice is that while you perceive yourself to be doing what is good for you, they are often what doesn’t help. Some of them may even be worse for you (e.g., delay recovery)!
Feeling flat and jaded. Suddenly, things don’t look so bright and cheery anymore!
I think this is a normal phase that follows anger. Even in seemingly trivial day-to-day anger episodes, we do experience a flatness or sense of emptiness once the anger has subsided.
Similarly in recovery, we do see the same response.
Once you are past the anger stage of “nothing works”. You lose a little hope. You realise cannot push yourself anymore. You realised you have wasted tons of resources, or at least time, into your recovery.
I think this is a crucial period because you start to evaluate what you have actually done. You also start to see the downside of your own attempt at self-management more clearly.
Just to clear, we do believe that self-management can work. We also do believe that the wait-and-see approach does work.
The problem is optimism bias. Most people overestimate their likelihood of being able to achieve a successful recovery outcome on their own. If you are reading this, you probably waited too long (i.e., more than 12 weeks) to look into professional options for your recovery.
Despite the awful experience of being in this stage, we think that this stage is pivotal for transition to the next stage (acceptance). We think that it is through the self-reflection, and realisation that things are not going as smoothly as you imagine, that leads you to rethink your recovery strategy.
Acceptance! You are finally here.
There are two main types of acceptance. The first is to accept that you need to do something about your pain. This is when you may start to seek out treatment options that have lower barrier. Examples include Salonpas, Tiger Balm, massage, YouTube advice.
We consider all of this low value care because they typically don’t help patients like yourself attain their recovery goals.
The second is to accept that you need professional treatment. Someone who actually knows what they are talking about, and who can guide you to where you want to be in the future.
The first acceptance is probably somewhere between the denial and bargaining stage, where you think you can DIY your recovery when you actually cannot.
The second acceptance is probably a truer experience of acceptance is. It’s when you finally accept that your condition is not getting better and you do need more than what you have had done previously.
This is usually when people start to look for treatment options that are outside of what they are familiar with. This is when they start to adopt a beginner’s mind, where they put aside their biases and preconceived notions of what recovery should be like.
This is also when you start to consider seeking out an evidence-based treatment approach for your recovery. This is probably what led you to this post!
What is the takeaway for me?
If your symptoms have only just started (i.e., less than 12 weeks ago) and you are just surfing the web for creative pain solutions, that’s totally cool. Keep doing that.
If you have been living in pain for prolonged period of time (> 12 weeks) or even years, then you probably need a mindset shift.
What you are doing or have been doing is clearly not working. You need a different fix.
We have amply discussed that pain is not just physical. There are lots of other psychosocial factors involved as well. This is why pain doesn’t equal damage.
Similarly, recovery is not just about “fixing” a physical problem. There are tons of factors that will influence your treatment outcomes. Whether you like it or not, your emotional responses do influence the decisions you make. That may delay your recovery by leading you to choose broscience-based treatments.
To book in for an appointment with us, and discover the difference an evidence-based approach can make, reach out to us via the contact form below. We can partner you to help you help yourself find your freedom from pain.
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Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.
Our goal? To make our own services redundant to you.