Avoiding

There are two extreme ways of coping when a pain problem strikes.

Most people adopt a mixture of the two, with one more at the beginning and another later on.

However, some people get stuck with one strategy and find it very difficult to change.

Over-activity is the commonest and thereby the most troublesome strategy, with most people pushing themselves and suffering afterwards.

Avoiding activity is the other way of coping with pain. Extreme avoiding is much less common but it can be a problem.

We always have an emotional reaction when we have a pain. We always interpret it in some way and then have some sort of feeling about it. Emotions about pain vary greatly but are naturally mostly negative.

When we have a pain, we can chose to confront it or to avoid it. Pushing hard to complete activities is a form of confronting the pain. Avoiding is the opposite..

Avoiding is dependent on high levels of anxiety about what is going on in our back or other painful areas. If we fear what has happened inside our body and that further stresses might damage it further, we will tend to avoid activity and rest until we feel it's better.

Unfortunately that is not how it ends. The pain may not get better, at least in the short term, and we start having all sorts of complications.

Several problems occur with these types of very common behaviour. Scientific work shows that rest is not a treatment for back pain and may be a factor in ensuring a worse outcome in the long term.

People who avoid activities may have a series of problems:

Loss of confidence in their ability to do these activities

Decreased strength and fitness from underuse of their body

Loss of role at work or at home as they do not do the activities expected of them

Depression/sleeping problems

Overdoing when they do try an activity, as they are unfit.

Pacing is one of the most useful skills to learn if you have pain. Many people with pain tell us this. It's not easy but it works! Try it.

Typical Over/underactivity Scenarios

Helen has chronic low back pain.
She wakes up one morning and notices that her back pain, usually bad in the mornings, is much better than usual. "Great", she thinks, "now I can get all the things done that have been building up, and I can cook the family a good dinner as I have not done that for so long."

She spends the morning cleaning the house, getting the shopping and starting to prepare the dinner. As the afternoon goes on she notices her back pain becoming worse but continues so she can get done all the things she has planned.

By the evening her back pain is so bad she is forced to stop all activities and lie down. The pain is much more severe for the next few days and Helen is unable to do anything useful
Michael has chronic low back pain.
Since his injury at work he has found that almost all activities and postures give him pain. He is only comfortable lying down in bed at night and on the sofa in the day.
Overall he does very little and admits he is very unfit and has gained weight. When he does do something he is so unused to it that it's very easy for him to overdo it and be much worse after. This puts him off trying to be more active or doing any exercise

You can see how Michael is the avoider. It is likely he is fearful about what is going on in his back and is afraid to confront the pain by getting up and doing things. He inteprets his pain as being an expression of the serious damage which has occurred and must be rested.

If Michael keeps his strategy up over the long term he will become very unfit and disabled. Initially he would have avoided heavy or repetitive jobs, eventually he was avoiding almost everything.

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