Accceptance therapy for migraine?

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Pain Acceptance Linked With Reduced Disability, Pain Interference in Migraine

Migraine sufferers often avoid triggers and activities thought to precipitate migraine. In line with the fear avoidance model of pain, however, some findings have shown that avoidance can lead to headache disability by reducing pain thresholds and preventing pain habituation.2,3 In addition, psychological factors have been found to have a greater influence on the fear-avoidance cycle than symptoms like headache severity, suggesting that targeting such factors in patients with migraine may improve outcomes.4

In contrast to avoidance-style coping, pain acceptance consists of 2 components: pain willingness — the recognition that pain avoidance efforts tend to be ineffective — and activity engagement, consisting of participation in life activities despite being in pain.5

This study was looking at overweight women in particular with a BMI over 25.  There were 126 subjects. They found there was reduced headache disability with acceptance and less disruption there was in their lives. It is limited due to its focus but the idea is that acceptance therapy is beneficial with chronic pain and may very well be with migraines as well.

This is a strategy my psychologist takes. You should engage in life because you will be in pain anyway. You should do all the strategies to manage that pain, but also not avoid interaction, social activities and other things due to pain that will always be there.

I find it a lot more difficult with chronic migraines than say, when I only had fibromyalgia. The Limit is a harder line. You see you can’t exceed your pain limit and push through the pain all the time. For me, that lead to depression and suicidal ideation. Loss of hope. Too much suffering for coping strategies to encompass. For that reason, my pain psychologist acknowledges that working full time is impossible for me. Working part-time is likewise very problematic. When I exceed my pain limits and try to function like that, and fail to function, I cease to want to thrive and exist. Clearly counterproductive to coping. So you have to acknowledge that pain has limits. You can only cope with so much. Only function with so much. Acceptance or not, that is a Hard Line.

But chronic migraines are chronic pain and we do have lives to live. We cannot hide in our cave every time we have a migraine or we would be in there every day. We do have to do things with migraines. Even socialize with them. Do housework with them. Go for walks for exercise with them. Limited errands with them. Just not with pain levels at 8 or above. We are limited by our pain levels and, therefore, the lower functionality that comes with those levels.  Likewise, we can be limited by bouts of vertigo, vomiting, and diarrhea. And we can’t push those limits without risking our mental health. In the 6-7 range with have lower functionality and can do limited housework and limited errands and limited socialization. Not on the same day. But we can. It tends to make the pain worse. Aggravates things. Sometimes so much worse you have to leave early, get home as soon as possible, or immediately stop what you are doing.

Acceptable with Fibromyalgia is a lot easier. You pace, moderate and stay within your limits. Rest on flares. Self-care on flares. But the rest of time just ensure you pace, rest when you need to and never exceed you limits. You can live a well-rounded, mellow and careful life. Mind you mine has gotten worse over the years but I still follow this and it works well. Migraines, daily, on top? A lot harder process. Pacing means nothing to migraines. They come on regardless if you pace. Pacing doesn’t prevent the pain from being worse or better. It just is.

So we can have acceptance and try to live our lives within the capcity we have. It is just limited capacity.

 

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A tale of doubt

Chronic illnesshasbeatenonmy self-esteemmyself-worth.I feel ashamed for being ill and people reinforce this.I feel embarrassed and people make me feel like I should be.

I know I have a self-worth problem. It developed over time from the guilt of being in pain, missing work and being told I should feel guilty about it. Started to feel pretty worthless. Then my functionality began to suffer. Too much pain once migraines become daily with the fibromyalgia in there. Even though I was out of that negative situation I was now reinforcing those beliefs. That I was worthless because I couldn’t function. I struggled to just get to work. I missed too much and wasn’t able to be that productive when I was there. Reduced to part-time. Still had problems maintaining. Went on leave and that is where I am at now.

Problem is it causes a lot of doubt about what to do work-wise. I know I am intelligent. I know I have some capacity to think through pain, as we all adapt. What I have a problem with, daily, is reliability. The pain variability is dramatic. It can start at a 6 and amp up to a 9 in 2.5 seconds. It can be a 8 or a 9 all day long… and you can’t function or think through that pain. Reliability basically goes out the window for anything that needs consistency or doesn’t have real flexibility.

Reliability- Nope

Dependability- nope

Pain variability- yep

Pain constantly-yep

Can’t drive- yep- due to now the vertigo gets worse from driving 15 to 20 minutes. All the time. Passenger or driver, I get it. Clearly driving with it is out though.

And I now doubt my capacity to do a damn thing. It seems like the simplest of jobs I could think of I tried part time. And it didn’t work. I now have doubts about anything else. It worries me immensely.

I can write. Pain or not. I have that. Making money at it… another story.

If plans.

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My psychologist wants me to come up with a plan to use for my time since I am off work.

I thought it would make more sense to wait until I am approved for the disability. Despite being suicidally depressed, having FM and chronic migraines ironically this doesn’t necessarily make me disabled in their books. They think surely you can work a job, rather than die. And I think rather would die, or so my brain seems to go when I am amped up by the pain of working and failing to achieve work standards. And then they go I think you are significantly improved, so we are not going to keep you on disability, and should actually work full-time. And I go I’ll give it a go then… a couple months later… yeah I think I’ll try that dying thing instead. The last time I rather thought I’d make it at least three years before suicide was an option again, but not even close to that. I think because I hit the time frame of five years since my last attempt and statistically that is a range where people attempt again. So how very statistical of me. I told them I was suicidal the last time (well they knew since it was after the second attempt), depressed, had FM and chronic migraine and they only approved me for a few months. So hardly a sign they will approve me this time. A sign I have to watch My mental stability for sure. But not a great sign these guys particularly care that I am crippled by pain and depression. Makes me despondent with the process to be honest.

So planning how to use my time instead of working may be moot for so many reasons. Nevertheless my psychologist is the optimist and can’t see why I would be declined. I get it, everyone knows I shouldn’t be working except those in power to make the choice. It is ironic. I could be wrong, one never knows. Maybe it will work out fine and that would be a profound relief. I am tired of thinking what will happen if I don’t.

But I still have to do the exercise. So what will I do with my day?

  1. Housecleaning- I can’t really houseclean when I am working. The fatigue, the pain levels… there is nothing left. And my day off is me laid out recovering with nothing left in me for anything else. So if I am not working I am going to do my Mom’s idea of 10-15 minutes of cleaning a day. I have a lot of fatigue and pain so can’t manage much a day… this is a good daily amount. On a good day… I could try for more. But my min, daily should be Achievable.
  2. Exercise- likewise with exercise I have not been able to do it while working. Can’t exercise on a day off and increase the pain on a work day… too painful. Too fatiguing. So I will start my physio exercises and stationary biking. Stationary biking will be slow again with the FM and EDS… usually 2-5 minutes start and then it is a slow arduous process to increase. Took me six months to get up to 20 minutes. But gotta start somewhere.
  3. Writing- As my hobby I will be writing more. Blogging more and the social media that comes with this. Raising awareness more and maybe I can find ways to do more with that. I also have my fiction writing which I will focus on more. NanoWriMo which is a writing month of November is coming up so that will keep me quite occupied. I have a novel planned out for that and everything.
  4. Meditation- Focusing more on my meditation. Always never found the time to do it when working. There is no time to do it. No place to do it. So I will get into the routine of that again. It is difficult to do with chronic pain, but I think worth it.

And that is all I have so far. Hard to think of things other than the things I am supposed to be doing for my health like the mediation, physio and exercising that I can’t do when working. And the housecleaning I can’t keep up with.