Daily Routine

Chronic Pain and Self Regulation: Wearing my Cranky Pants

Since the beginning of the year I have been making a serious effort to stimulate myself intellectually. For many years the act of designing and making fiber arts has satisfied my need to use my brain. But as I get healthier I have become more restless and have required more thoughtful stimulation and conversation.

During the first several weeks of 2018 I was making a good effort towards intellectually stimulating activities. I was writing regularly, participating in some Skill Share courses and enjoying the rigor of using my mind.  In February I had a 22-day migraine. By the end of these 22 days I was unable to string two sentences together. I thought, “is this migraine really affecting my intelligence? Was it fatigue that was affecting my intellect, or was there something more at play?

After the horrible month that was February I started collecting scientific journal articles that addressed migraine and cognitive function. I’ve been slowly reading through them, noting what research might have to say about cognitive function and migraine.

In June I again had an experience that made me question how my migraine may affect other aspects of my life. This migraine was so intense that I do not recall experiencing that much pain in recent memory. By the end of the week I felt hopeless and extremely depressed. I didn’t want to be in pain, I didn’t want to feel angry that I had very few options available to me, I didn’t want to be sad about the things I was missing out on. Yet, no matter how hard I tried to overcome these emotions, I just couldn’t.

Then, I came across a helpful review article that didn’t specifically address migraines, but compiled research on many types of chronic pain (Nes et al. 2009). A research review gathers studies that have been published on a particular topic and discusses the combined results.

In this review, Nes et al. (2009) addressed how chronic pain contributes to decline in cognitive function and self-regulatory demands. Cognitive function involves our activities that involves perception, thinking, reasoning, and remembering and executive function gives us control over our cognitive abilities, allowing us to organize and complete daily tasks.  Self-regulation involves all our cognitive, emotional, and physical behaviors and determines how we function in the world. Executive function and self-regulation operate together regularly. The review focused on widespread, multi-symptom pain conditions such as Fibromyalgia, rheumatoid arthritis, and chronic headaches.

The Problem

What the review showed was that self-regulation is a limited resource. Meaning that after a difficult task involving executive function or cognitive ability, other self-regulation tasks may be more difficult. Many of the conditions studied are already characterized by decreased cognitive function, sleep disturbances, and social distress. Furthermore, the pain experienced by patients during flares in their condition resulted in additional decreased cognitive function.

In order to manage and cope with these chronic pain conditions, a significant amount of self-regulation is needed, through emotional, social, and/or behavioral control. When patients reach a level of self-regulatory fatigue, their ability to cope on in each of these domains decreases.

For example, cognitive regulation fatigue may result in avoidance of tasks and feelings of helplessness. In emotional and social fatigue, it becomes more difficult to control our emotions, and properly interact with friends and loved ones. This can lead to worry and rumination over our conditions and situation, as well as social isolation.

Behavioral regulation involves our decision making, planning, as well as participating in care and treatment with our doctors. When pain interferes with these skills, we can fail to act accordingly in social situations, fail to plan or make decisions, and avoid physical exercise which is often beneficial for chronic pain patients.

After reading this, I had no doubt why I was so cranky after a week of intense pain. I had depleted my self-regulatory reserve. I was simply cognitively, emotionally, and socially fatigued. So, what can I do about it? Am I doomed to one-word conversations, and wearing my Cranky Pants™ every time I’m in pain? Maybe not.

What To Do

Treatments that take a multidisciplinary approach to chronic pain seem to be the most effective if handling chronic pain and preventing self-regulatory burn . One particularly useful approach is Cognitive Behavioral Therapy (CBT) which focuses on changing unhealthy thoughts or beliefs. In the case of chronic pain, this can involve acceptance of an illness or pain, challenging the belief that the illness is somehow our fault (or that we contributed to it), learning coping strategies for living with chronic pain as well as stopping unhealthy thought processes such as worry and rumination.

I have had great success with CBT, I feel that the time I took in therapy to adjust my thoughts and accept my illness was a turning point in my life with chronic pain. It’s obvious from my recent experience that I need to refresh my coping skills to handle my next bout of intense pain. Other aspects of my particular multidisciplinary approach are mindfulness practices such as guided imagery, physical exercise such as gentle yoga and walking, massage, and a well-established medication and supplement regimen.

However, it is also clear that not everyone may find success with approaches such as CBT, as the authors point out. Treatment is often energy-demanding, which can cause us to fail when we run out of self-regulatory resources. I know when I was participating in intense therapy it was exhausting physically and mentally.  However, it may be possible that these interventions could increase our self-regulatory strength, making it easier to continue the process of learning to live with chronic pain. Practice makes perfect, after all.


Reference: Nes, L.S., Roach, A.R., & Sergerstorm, S.C. (2009). Executive functions, self-regulation, and chronic pain: A review. Annals of Behavioral Medicine, 37:2, 173-183.

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