The 7 Psychological Stages of Chronic Pain:
The 7 Psychological Stages of Chronic Pain were modeled from Elizabeth Kubler-Ross’s “5 Stages of Grief” and developed by licensed psychologist, Dr. Jennifer Martin.
Many people experience chronic pain and illness. However, the way we adjust and cope with chronic ailments can vary. Among the broad range of emotions we may experience, there are common feelings that most people share in the presence of chronic pain. Furthermore, some may outwardly express their emotions while others may internalize what they’re feeling. Regardless, although these stages are universal, they are not linear. The order, length, and intensity of each stage varies greatly and often individuals jump back-and-forth throughout the stages. As you continue to read through the 7 Psychological Stages of Chronic Pain, we hope to provide you with helpful information as you guide yourself through these areas.
Denial & Isolation:
When we are faced with disruptive life events or an onset of pain, it is a normal response to deny the reality of the situation. In the case of chronic pain, our first thought may be, “this isn’t happening, it’ll go away” or “the doctor is wrong, there must be a cure for this.” We do this at a subconscious level to avoid overwhelming emotions that we may be harbouring. It is our first defence mechanism to protect ourselves from what we are experiencing. This stage may be dangerous as it can prevent us from seeking appropriate treatment.
Bargaining, Pleading & Desperation:
In attempt to gain control of our situation, we often begin to ruminate on the past, reflecting on ways we think we could have changed the outcome. Thoughts such as, “if I went to see a doctor sooner we could have stopped the pain when it happened” or “if only I didn’t play sports when I was younger then I wouldn’t be in this pain now” are forms of guilt in attempt to bargain between ourselves and the past. This soon becomes desperation as we convince ourselves that we could have done something to prevent the issue and that there must be a way to fix it.
As our denial and desperation begins to settle, we are left with the reality of our state and the pain of the situation emerges. This becomes most prominent when our pain prevents us from doing the things we used to do. Our intense emotions and vulnerability are typically expressed as anger, which is often aimed at strangers, inanimate objects and even loved ones. We often blame others for our pain and may even resent those who have caused us pain (i.e. drivers in motor vehicle accidents) or those who have delivered bad news (i.e. healthcare professionals.) Although this stage may feel endless at times, it is a necessary stage of the healing process.
Anxiety & Depression:
It is extremely common and normal to experience deep feelings of depression and anxiety during this battle of chronic pain. Feelings of worry and regret often accompany depression as we mourn the life we once had before our pain. We worry about medical and treatment costs, ruminate on unsuccessful outcomes of these procedures, and can often isolate ourselves from those who are trying to support us. This phase is often eased with time, clarification and reassurance leading into the next steps.
Loss of Self & Confusion:
This stage is arguably the most difficult and can either be associated with depression or experienced separately. We begin to lose sense of who we are and aspects of our lives that once were. For example, being unable to maintain the active lifestyle you lived previously, giving up a career or being unable to participate in social events greatly affects our well-being. We may not recognize who we have become and may be questioning what life has to offer now that the quality has changed.
Re-evaluation of Life, Roles & Goals:
In the setting of any chronic ailment, we are forced to re-evaluate our life roles and goals and how it pertains to the future of our careers and relationships. An example would be acknowledging that we may no longer be capable of completing the demands of our role as a nurse, but seeing our capacity to be a leading role in education for prospective students. Shifting our thoughts allows us to redefine who we are, what our goals are and encourages us to maintain a positive perspective. It is this step that is crucial when accepting the reality of our condition.
Acceptance, Adaptation & Integration:
The last and final stage is a deep personal experience where we allow ourselves to grieve and accept the status of our permanent chronic pain. t is this stage when we become calm and withdrawn peacefully, without the attachment to emotions such as happiness or sadness. It does not necessarily mean that we are “OK” with our pain, but we recognize that this is the new reality and take appropriate steps to adapt. We must find what brings us joy in our current state and adjust our outlook accordingly. This stage is very difficult to reach and takes various lengths of time to achieve.