Should You Accept Your Pain or Keep Trying to Change It?

At what point do you stop trying to fix your pain… and start accepting it? It’s a question captured well in The Serenity Prayer:

God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

The Research

Back in the 60's, before ethics for research became more stringent, Martin Seligman and Steven Maier did some highly influential experiments on dogs (Seligman and Maier, 1967). They put the dogs in a harness where they received electric shocks through their back legs from the floor. Some could stop the shocks by pressing a lever with their nose, for others pressing the lever did nothing.

The next day the same dogs were put in a box, divided in the middle by a low barrier. After 5 minutes of free roaming in the box, a metal plate on one side started shocking the dogs. The dogs who nudged the lever and escaped the day before jumped over the low barrier. Many of the dogs who's lever did not stop the shocks the day prior did not try to escape. They lay down and took the shocks until the researchers ended the experiment. This was the first research to demonstrate the concept of 'learned helplessness' - when repeated experience tells you your actions do not influence pain, you stop trying, even when opportunities for improvement arise.

How do you know if your actions can reduce your pain?

The average person living with persistent pain has tried all sorts to reduce the pain they are experiencing. If you feel like you have tried everything, with no success, then acceptance of the pain makes sense.

This is the philosophy behind approaches that aim to encourage healthy acceptance of pain and help people live well with pain.

But, and its a big but (🙄), acceptance before fully exhausting all the treatment options means a person may be trying to accept pain levels that could be improved!

Like the dogs on the second day of the experiment above, accepting electric shocks rather than jumping the low barrier to the other side, because everything they tried the day before did nothing! Of course, for people living with persistent pain, often all the options they have tried have been ineffective for months or years. Often, they’ve tried many variations of the same type of treatment, typically focused on the body (muscles, nerves, joints, discs etc.)

This means important drivers of pain may never have been addressed.

To accept or not to accept the pain?

Acceptance has a place.

But accepting pain too early, before fully exploring what might be driving it, risks giving up on change when change is still possible. As more research is done and new treatments become available, even those who have tried every viable avenue to date to change their pain may find future treatment approaches improve their pain.

In practice, people with persistent pain I treat tend to have at least a few angles for improving their symptoms that they haven't yet considered.

As Professor Cormac Ryan puts it:

"Everything Matters When it Comes to Pain."

This means the potential list of contributors to the pain people experience are vast, which can be daunting given how complex individual humans are (the causes will be different for everyone).

However it also means the potential options for improving persistent pain are also vast. In practice, it’s rare that nothing can be changed.

The challenge is knowing where to look.

How to Help Yourself

A practical place to start is tracking your symptoms for at least a month. This often reveals patterns most people miss. You can learn more and download a free symptom tracker template at the bottom of this article -> Why the Biopsychosocial Model Matters in Persistent Pain Bringing this information to a persistent pain healthcare professional can also help them identify possible contributors to your pain and allow you to get the most out of your appointment with them.

In Summary

People living with persistent pain have usually tried many approaches and seen many healthcare professional to try to reduce their pain. It is no surprise that after doing this over and over and repeatedly getting no change in their symptoms, some stop trying to change their pain and accept it. Healthcare professionals too sometimes advocate for living well with pain, when nothing seems to shift it. Acceptance can be freeing.

But if it closes the door too early on improvement, it stops being helpful, and starts looking a lot like learned helplessness.

References

Seligman, M. E., & Maier, S. F. (1967). Failure to escape traumatic shock. Journal of Experimental Psychology, 74(1), 1–9. https://doi.org/10.1037/h0024514