Pain Procrastination and Broken Cycles

Here’s a thing. Whilst I’ve been attending to things other than blogging, for a variety of good and not-so good reasons, I’ve discovered something interesting. When I have a task that I don’t want to do, my unconscious mind does everything in its power to make it a difficult as possible to do undertake the task. Now, I used to think of this as procrastination, I’ve procrastinated all my life, putting things off until the last possible moment and then working away like someone who’s working hard to win the hard working competition by working harder than a hard worker would normal work when working hard. And so on. But perhaps there’s more to it than that.

You see, I’m just that little bit more self-aware than I used to be and I reckon that I actually run two types of procrastinatory algorithms in my library of mental sub-routines. You could call them the Good and the Bad. Which unfortunately leaves me as being the Ugly, but there you go. In previous musings I’ve let you into the secrets of how I use procrastination as a means of cramming more good things into the time when I ought to be, by the standards of those who subscribe to dainty elephant-eating etiquette, working consistently towards achieving the goals and sub-goals beloved of the aforementioned munchers of pachyderm micro-morsels.

My view? Basically, stuff the perceived wisdom of those elders and betters who achieve their goals a small sub-goal at a time spread out over a sensible time period to avoid stress. I belong to the relatively smaller world of folk who would rather not have elephant for every meal and are better suited to a sampling wide variety of fare secure in the knowledge that when the time comes, as surely it will, there is more fun and productivity to be gained by diving into elephant feasting for a week or so and eating my fill whilst achieving the same ultimate goal in a fraction of the time.

What I’ve discovered and what I think has up until now obscured the view and prevented me from identifying a propensity to working better under pressure by choice, is that I also self-sabotage when there’s a task ahead that I dread. I’ve always had tasks that I dread, it’s just that up until now  my reaction to these has had the same outward appearance as those tasks that I put off because simply because I subconsciously know that I’ll perform more efficiently if I do. It’s only really now that I can tell the difference.

So what constitutes dread. For a start, it is not the difficulty. I can do hard. I can do intricate. I can do complex. I’m particularly good at dealing with a task where I’ve no idea how it’s going to pan out or what I am actually going to do – it’s enough simply to know that there must be a way through it, even though I may have absolutely no idea what that way might be when I start. I just know I’ll get through it. A bit like realising that getting lost is always temporary. If it wasn’t, you’d be lost forever.

In essence, I’ve got a project on at the moment which has really made me look at why I have delayed it and deferred it beyond reason. It turns out that my particular flavour of dread is a task at which I think I might fail because I fear that I am less skilled or knowledgeable than my peers. Where I think I might finally get found out as the fraud that the back of my mind whispers to me that I really am in moments of self-doubt.

That was a bit of en eye-opener. Useful though. Now I know what is going on I can do something about it. So I have. I looked it full in the face, worked out where it was in the cycle of repetitive failure and broke it. The beast of a task is now two thirds done and under control, on time for the deadline.

And as is usual in these posts, there’s the twist and turning of the imagination and the concurrent dealings I’ve been dealing which have uncanny parallels. As you know, in my brave new world of Cognitive Hypnotherapy, my particular focus is on pain management, fertility issues and stress related difficulties.

By co-incidence, over the same three weeks in which I’ve been wrestling with beastly workloads, I’ve fallen across a host of information on chronic pain. Articles, blogs by sufferers, on-line communities, scientific papers and the like. Almost without trying, it seems that I’ve had three weeks of soaking up more and more fascinating information. It all just makes me more and more convinced that what I’ve set out do achieve is exactly right. It is really quite stunning just how many people there are out there who suffer with chronic pain that proves incredibly difficult to treat. Until you have a reason to look, you tend to believe that good old western medicine with its multi billion pound/dollar pharmaceutical industry has got it all under control.

Not so.

There however some hopeful signs. More and more is being researched and written about how pain, particularly chronic pain, manifests itself and the mechanisms which produce it and cause it to repeat and repeat and repeat, despite whatever medical interventions are thrown at it. This is where the parallels with my self-sabotaging procrastination struck me. Bear with me, I’ll explain.

There are situations where, neurons get so used to pain that they display similar attributes to muscle memory, you know, where neural pathways develop which allow ever faster replication of muscle co-ordination and movement with less and less conscious thought. It appears that the same can occur with pain. the neurons get so used to perceiving pain, that they do it with less and less stimulation. They get better and better at telling you you’re in pain.

In addition, there’s a type of gating system in the spine which helps to regulate the perceptions of the three types of nerves which transmit touch-related feeling, (high-level short-term pain & lower-level chronic-pain and then touch itself). It seems to operate in ‘centres’ in the spine where these three nerve types pass in close proximity to each other. Whichever is the stronger of these impulses tends to get priority and closes the ‘gate’ for the others, suppressing their perception. For example, if touch is the strongest, then any other pain related sensory information is over-ridden and doesn’t get through. Likewise if one of the pain sensations is strongest, then the touch related information is less important and becomes restricted.

Here’s an interesting thing. What you think about appears to have a major effect too. Well it must do, if you think about it. Consider this, if touch happened to be the strongest impulse, then that sensation would get through. However, if there wasn’t any way of down-regulating that information then we would spend all day at the office being fully aware of the feel of the fabric on our arms, the shoes on our feet, the pressure of the chair on our well rounded backside and so on. So there’s a mechanism which shuts this information down and allows us to concentrate on issues which are far more important to our lives.

In essence, if we are in an already-safe-so-it’s-OK-to-carry-on kind of a mode then we send a deregulating signal down our spines which also shuts the gate. It’s called descending inhibition. This is what means that we simply don’t notice the touch of the clothes we wear unless something draws it to our attention. We aren’t constantly aware of how hot or cold or just right the temperature of the room is and so on. It also means that people who are in pain but who are experiencing something more important at the time, ten not to notice the pain. Think battlefield wounds, think sports injuries, think children playing happily with grazed knees. Think Manteo Mitchell who ran the last 200m of his 4x400m Olympic relay with a broken leg. He knew he’d broken it too. He still ran it in in 46.1 seconds. Amazing.

The thing is, this system also works in reverse. If you are in protection mode, not feeling safe, then your brain is on the look out for anything that might be dangerous; anything that might indicate you are under attack. And what’s its primary warning system? Pain. So what do you think your body does if it’s in protection mode, feeling defensive? It puts it’s pain sensor system on alert and opens those pain gates up wide. Just in case. The difficulty is, if you’re already in pain, it becomes ever more difficult to down-regulate the ‘gate’. Descending inhibition becomes almost impossible

So here’s one possibility of how the cycle might run where there’s apparently no residual physical issue causing the very real levels of pain that can be experienced by a chronic sufferer. Long term experience of pain tends to send most individuals into a state of self-protection, whether physically, (holding yourself to restrict movement which exacerbates pain), or mentally, (from feeling just down and fed-up, those low levels of energy which tell you to give up and stay in bed, right through to serious levels of depression and anxiety).  And what does your brain do when you’re in a self-protective state? It triggers those self-preservation early warning systems and looks for evidence of attack. Open those gates, boys, we need to be ready. Here you go again. It can be a cycle which is extremely difficult to get out of.

The good news, (really, there is some), is that this cycle appears to be able to be interrupted at any point. And if it is successfully interrupted, the cycle breaks and the body has a chance to reset the pain gates. Western medicine is adept at interrupting this cycle at two main points. The site of the initial source of pain, (interventions which assist the healing process) and reducing the pain itself back to manageable levels with a variety of analgesics  Unfortunately, it seems that if these tactics fail, there isn’t much else that medics have up their sleeves.

So how does this sort of cycle work? In essence, we ‘do’ chronic pain in the following way:

• Something triggers the perception of pain.
• We react unconsciously to the pain and map it into what we expect the pain to mean for us. If we suffer chronic pain, the brain jumps into its routine reaction and without us even noticing.
• This triggers an emotional reaction and given that pain is an alarm stimulus, we are likely to react in a negative emotional way
• The emotion triggers a set of unconscious behaviours. This is often self-protective behaviour such as lethargy, muscle stiffness, depressions and anxiety. The purpose of this could be self-restrict movement and enforce rest, designed to encourage recovery and prevent further damage.
• It is only really at this point, once all these automatic responses have been triggered, that we realise the conscious perception of the pain.

Now, even though pain medication can be very effective, if it doesn’t work and there’s no apparent physical cause, the only recourse open to western medicine is to try again. Usually with more powerful pharmacology. As our Mr Maslow said, (he of the eponymous hierarchy-of-needs fame), ‘If your only tool is a hammer, every problem looks like a nail’. In essence, if it didn’t work the first time, hit it harder.

Perhaps one way out of this maze is to find someone with tools designed for use at other points in the cycle as well.

You never know, it just might work.

What’s to lose?

Except maybe the pain.

here to stay or gone for good?
© Tony Burkinshaw 2013

Related articles

• Relieve Chronic Pain By De-Stressing, Study Says (huffingtonpost.com)
• Patients With Chronic Pain Benefit From Pain Training For Primary Care Providers (medicalnewstoday.com)

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