Meet Jim: a 51-year old social worker and Approved Mental Health Professional (AMHP).
Jim is great at building relationships: people instinctively trust him, and he receives lots of compliments from people he works with.
Since his divorce 2 years ago, Jim has thrown himself into his work, happy to work late hours doing extra shifts on the AMHP rota. He loves this aspect of the work, but hates “routine” assessments, arranging care and form-filling, which he sees as not being “real” social work.
Jim came into social work as a result of caring for his mum, who had bi-polar disorder, when he was growing up. He wanted to be the type of social worker who makes a real difference in people’s lives.
Jim’s dislike of paperwork leads to conflict with his line manager, Julie. Julie says Jim simply isn’t meeting performance requirements, and if he doesn’t bring his recording up to date, he’ll have to go on a performance plan. Julie’s approach represents everything he disliked about the professionals who worked with his mum when he was growing up.
Jim has been off work twice with long-term severe back pain. The first of these periods was shortly after his mum’s death; the second was in the lead-up to his divorce. Jim still experiences chronic back pain, and is prescribed strong, opiate-based pain killers, but finds that these now do little to help. Doctors have told Jim that he has a herniated disc and narrowing of his spinal canal. While they admit that this doesn’t necessarily explain his pain, no-one has provided him with an alternative explanation. He survives on strong coffee, sweets, cakes, and a couple of beers in the evening when he gets home.
Jim uses a specialist keyboard, chair, mouse, and voice-recognition software, but still experiences severe pain whenever he is at his desk. By contrast, when he is out working with members of the public, he hardly notices the pain.
It has never occurred to Jim that his back pain might be related to current stress or his past experiences.
He doesn’t feel stressed: he loves his job, although he feels constantly frustrated with his line manager and fed up with the ethos of the organisation.
Do you recognise Jim?
Perhaps someone you know comes to mind, or you see signs of yourself in him. In fact, Jim isn’t one real person, but an illustration. Nonetheless, his circumstances are far from unusual. Back pain is the leading cause of disability in the UK according to the NHS, “accounting for 11% of the total disability of the UK population”.
When it comes to self-care, we may recognise some of Jim’s coping strategies as being less than helpful: his consumption of sugar and convenience foods, regularly drinking more than the recommended amount of alcohol and relying on stimulants. Sadly, Jim is now addicted to opiates which his GP prescribes, even though studies show that they are no more effective for this type of pain than paracetamol.
Did you notice Jim’s relationship with his manager Julie? He is at odds with her. She fails to recognise or encourage the positive feedback that he receives, leading to Jim feeling de-valued. A 2012 occupational health study tracked 2808 employees from 28 organisations over a period of 2 years. They found that ‘the most consistent predictors of back pain were lack of ….decision control, empowering leadership and fair leadership.’ Not sitting at a desk or other physical causes, as you might expect.
Notice the connection between the pain, and the job task that Jim hates the most and is in conflict with Julie about (case recording). When out and about in the community, Jim has to perch on the edge of sofas, sit on hard waiting room chairs or take long calls from his car. These circumstances are far from ergonomically “ideal”, yet when doing the part of his job which he enjoys, Jim’s pain fades into the background.
Research has picked up on the link between adverse childhood experiences and pain in adulthood. For example, Goldberg et al studied ninety-one patients with chronic pain. The patients were asked to complete questionnaires about their childhood histories and experience of pain. The study took into account sexual, physical, and verbal abuse; alcoholism; drug dependence; medications; major upheaval, childhood illness, death of a family member or friend, and separation or divorce of parents. The researchers found that 64.7% of the patients with fibromyalgia, 61.9% of the patients with myofascial (muscle) pain, 50% of the patients with facial pain, and 48.3% of the patients with other types of pain had experienced childhood abuse, whilst others experienced other adverse childhood experiences.
Other studies back up this link. For example, Anderberg, considering people with fibromyalgia, found that “Children who had experienced hospitalisation, institutional care, maternal death or familial financial hardship were more likely to be suffering from chronic widespread pain as an adult”.
You may have picked up on the fact that Jim’s long periods off sick with back pain coincided with some difficult experiences: the death of his mum, who he had cared for all his life, and his divorce proceedings. We can hypothesise that Jim had some difficult experiences while growing up, owing to his mum’s fluctuating mental health and the fact that he found himself in a caring role at a young age. His divorce is also likely to have been stressful.
So why do traumatic experiences and stress lead to physical pain? There are a number of theories, but a key one is the idea of neural pathways which develop in the brain. There’s a short video here which explains the role of neural pathways in chronic pain. Pain is a danger signal, and our bodies don’t necessarily differentiate between physical and emotional danger (think about the physical symptoms you experience when you are emotionally stressed).
If Jim came to ACACIA Freedom from Pain for support, I would encourage him to consider the following:
1. Does he need help to process his childhood experiences and stressful adult experiences?
Jim may well benefit from therapeutic support (I recommend an approach called ISTDP, because it recognises the strong link between physical symptoms and emotions, particularly repressed emotions).
2. What is he doing to take care of himself?
Is working long hours, eating convenience food and drinking alcohol serving Jim well? Aside from being unhealthy, these habits may be preventing Jim from looking inwards at his own emotional needs.
3. How might Jim’s back pain link directly to stress and grief?
I would help Jim to make the connections between his physical pain and his emotional state. Did Jim allow himself to grieve and process the loss of his mother and the pain of his divorce? Perhaps not: his severe physical pain at these times took over. If Jim had understood the link between physical pain and emotions, he may have been able to recognise the onset of pain as a response to grief, loss and complex relationships.
4. And what about the present?
I would help Jim to unpick the relationship between his pain and the work tasks that he hates. Once he can see that his back pain has specific triggers and isn’t inevitable, I would introduce him to simple approaches which can enable him to turn off the pain, focusing on .As part of this, I would help Jim to consider a way forward with his work situation. It might be that he can shape the conversation with his line manager, to get the support and recognition that he needs. Perhaps he needs to consider a move to another team whose values are more aligned with his. Or, it might be that a job with the local authority, with the associated requirements around paperwork, is not the best fit for him in the longer term. The most important thing is that he feels empowered to make the decision that’s right for him.
So, what can you do if you have chronic pain and Jim’s story rings true for you?
Speak to your GP
It goes without saying that you need to check out whether there’s anything causing your pain that needs treatment. But if your doctor has said your pain simply needs to be ‘managed’ (for example, with painkillers and/or lifestyle changes), you can safely use a method like SIRPA (the approach I use at ACACIA Freedom from Pain).
Listen to your pain
Start to recognise when the pain kicks in and when it’s absent. Does it correlate with any stresses in your life, past or present? What might the pain be trying to tell you?
Find out more about how chronic pain works
The Resources page on my website is a good place to start as it lists a number of helpful books, websites and similar.
Consider past trauma and stress
Even if you feel that your past experiences are ‘normal’, unresolved buried emotions can still find their way to the surface in the form of physical pain (and other stress symptoms). It’s not selfish to get help for yourself. You may want to seek out counselling/ISTDP.If you’re in a strong place mentally, you can use a pen and paper to journal about how you feel about difficult experiences. Allow yourself regular time to write about your emotions and process how those experiences have made you feel.
Address current stress
The 5 Pillars of Protection are a great place to start. Make sure to put into practice the Self Care Psychology principles. Journalling is also a really helpful way of handling current stress. And make regular time for reflection on case work, especially considering the emotional component.
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Finally, if you feel that you would benefit from 1:1 help to deal with your pain, ACACIA Freedom from Pain offers free 30 minute consultation over the phone, with absolutely no obligation!
About Emma Kemp
Emma is a social worker and practice educator. She works in local authority Adult Care and Support services for part of the week, and also runs ACACIA Freedom from Pain, which is dedicated to helping people understand and get relief from chronic pain using professional social work skills. She is trained in and uses the SIRPA approach for chronic pain.