One of the most common feelings associated with persisting pain is fatigue and this fatigue can become overwhelming. People with chronic pain can report being drained of energy and motivation to engage with others or the world around them.

In fact, a study from the United Kingdom on people with long-term health conditions found pain and fatigue are the two biggest barriers to an active and meaningful life.

But why is long-term pain so exhausting? One clue is the nature of pain and its powerful effect on our thoughts and behaviours.

Short-term pain can protect you

Modern ways of thinking about pain emphasise its protective effect – the way it grabs your attention and compels you to change your behaviour to keep a body part safe.

Try this. Slowly pinch your skin. As you increase the pressure, you’ll notice the feeling changes until, at some point, it becomes painful. It is the pain that stops you squeezing harder, right? In this way, pain protects us.

When we are injured, tissue damage or inflammation makes our pain system become more sensitive. This pain stops us from mechanically loading the damaged tissue while it heals. For instance, the pain of a broken leg or a cut under our foot means we avoid walking on it.

The concept that “pain protects us and promotes healing” is one of the most important things people who were in chronic pain tell us they learned that helped them recover.

But long-term pain can overprotect you

In the short term, pain does a terrific job of protecting us and the longer our pain system is active, the more protective it becomes.

But persistent pain can overprotect us and prevent recovery. People in pain have called this “pain system hypersensitivity”. Think of this as your pain system being on red alert. And this is where exhaustion comes in.

When pain becomes a daily experience, triggered or amplified by a widening range of activities, contexts and cues, it becomes a constant drain on one’s resources. Going about life with pain requires substantial and constant effort, and this makes us fatigued.

About 80% of us are lucky enough to not know what it is like to have pain, day in day out, for months or years. But take a moment to imagine what it would be like.

Imagine having to concentrate hard, to muster energy and use distraction techniques, just to go about your everyday tasks, let alone to complete work, caring or other duties.

Whenever you are in pain, you are faced with a choice of whether, and how, to act on it. Constantly making this choice requires thought, effort and strategy.

Mentioning your pain, or explaining its impact on each moment, task or activity, is also tiring and difficult to get across when no-one else can see or feel your pain. For those who do listen, it can become tedious, draining or worrying.

No wonder pain is exhausting

In chronic pain, it’s not just the pain system on red alert. Increased inflammation throughout the body (the immune system on red alert), disrupted output of the hormone cortisol (the endocrine system on red alert), and stiff and guarded movements (the motor system on red alert) also go hand in hand with chronic pain.

Each of these adds to fatigue and exhaustion. So learning how to manage and resolve chronic pain often includes learning how to best manage the over-activation of these systems.

Loss of sleep is also a factor in both fatigue and pain. Pain causes disruptions to sleep, and loss of sleep contributes to pain.

In other words, chronic pain is seldom “just” pain. No wonder being in long-term pain can become all-consuming and exhausting.

What actually works?

People with chronic pain are stigmatised, dismissed and misunderstood, which can lead to them not getting the care they need. Ongoing pain may prevent people working, limit their socialising and impact their relationships. This can lead to a descending spiral of social, personal and economic disadvantage.

So we need better access to evidence-based care, with high-quality education for people with chronic pain.

There is good news here though. Modern care for chronic pain, which is grounded in first gaining a modern understanding of the underlying biology of chronic pain, helps.

The key seems to be recognising, and accepting, that a hypersensitive pain system is a key player in chronic pain. This makes a quick fix highly unlikely but a program of gradual change – perhaps over months or even years – promising.

Understanding how pain works, how persisting pain becomes overprotective, how our brains and bodies adapt to training, and then learning new skills and strategies to gradually retrain both brain and body, offers scientifically based hope; there’s strong supportive evidence from clinical trials.

Every bit of support helps

The best treatments we have for chronic pain take effort, patience, persistence, courage and often a good coach. All that is a pretty overwhelming proposition for someone already exhausted.

So, if you are in the 80% of the population without chronic pain, spare a thought for what’s required and support your colleague, friend, partner, child or parent as they take on the journey.

More information about chronic pain is available from Pain Revolution.

Michael Henry, Physiotherapist and PhD candidate, Body in Mind Research Group, University of South Australia and Lorimer Moseley, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The holiday season is meant to be filled with joy, connection and celebration of rituals. Many people, however, are starkly reminded of their grief this time of year and of whom – or what – they have lost.

The added stress of the holiday season doesn’t help. Studies show that the holidays negatively affect many people’s mental health.

While COVID-19-related stressors may have lessened, the grief from change and loss that so many endured during the pandemic persists. This can cause difficult emotions to resurface when they are least expected.

I am a licensed therapist and trauma-sensitive yoga instructor. For the last 12 years, I’ve helped clients and families manage grief, depression, anxiety and complex trauma. This includes many health care workers and first responders who have recounted endless stories to me about how the pandemic increased burnout and affected their mental health and quality of life.

I developed an online program that research shows has improved their well-being. And I’ve observed firsthand how much grief and sadness can intensify during the holidays.

Post-pandemic holidays and prolonged grief

During the pandemic, family dynamics, close relationships and social connections were strained, mental health problems increased or worsened, and most people’s holiday traditions and routines were upended.

Those who lost a loved one during the pandemic may not have been able to practice rituals such as holding a memorial service, further delaying the grieving process. As a result, holiday traditions may feel more painful now for some. Time off from school or work can also trigger more intense feelings of grief and contribute to feelings of loneliness, isolation or depression.

Sometimes feelings of grief are so persistent and severe that they interfere with daily life. For the past several decades, researchers and clinicians have been grappling with how to clearly define and treat complicated grief that does not abate over time.

In March 2022, a new entry to describe complicated grief was added to the Diagnostic and Statistical Manual of Mental Disorders, or DSM, which classifies a spectrum of mental health disorders and problems to better understand people’s symptoms and experiences in order to treat them.

This newly defined condition is called prolonged grief disorder. About 10% of bereaved adults are at risk, and those rates appear to have increased in the aftermath of the pandemic.

People with prolonged grief disorder experience intense emotions, longing for the deceased, or troublesome preoccupation with memories of their loved one. Some also find it difficult to reengage socially and may feel emotionally numb. They commonly avoid reminders of their loved one and may experience a loss of identity and feel bleak about their future. These symptoms persist nearly every day for at least a month. Prolonged grief disorder can be diagnosed at least one year after a significant loss for adults and at least six months after a loss for children.

I am no stranger to complicated grief: A close friend of mine died by suicide when I was in college, and I was one of the last people he spoke to before he ended his life. This upended my sense of predictability and control in my life and left me untangling the many existential themes that suicide loss survivors often face.

How grieving alters brain chemistry

Research suggests that grief not only has negative consequences for a person’s physical health, but for brain chemistry too.

The feeling of grief and intense yearning may disrupt the neural reward systems in the brain. When bereaved individuals seek connection to their lost loved one, they are craving the chemical reward they felt before their loss when they connected with that person. These reward-seeking behaviors tend to operate on a feedback loop, functioning similar to substance addiction, and could be why some people get stuck in the despair of their grief.

One study showed an increased activation of the amygdala when showing death-related images to people who are dealing with complicated grief, compared to adults who are not grieving a loss. The amygdala, which initiates our fight or flight response for survival, is also associated with managing distress when separated from a loved one. These changes in the brain might explain the great impact prolonged grief has on someone’s life and their ability to function.

Recognizing prolonged grief disorder

Experts have developed scales to help measure symptoms of prolonged grief disorder. If you identify with some of these signs for at least one year, it may be time to reach out to a mental health professional.

Grief is not linear and doesn’t follow a timeline. It is a dynamic, evolving process that is different for everyone. There is no wrong way to grieve, so be compassionate to yourself and don’t make judgments on what you should or shouldn’t be doing.

Increasing your social supports and engaging in meaningful activities are important first steps. It is critical to address any preexisting or co-occurring mental health concerns such as anxiety, depression or post-traumatic stress.

It can be easy to confuse grief with depression, as some symptoms do overlap, but there are critical differences.

If you are experiencing symptoms of depression for longer than a few weeks and it is affecting your everyday life, work and relationships, it may be time to talk with your primary care doctor or therapist.

A sixth stage of grief

I have found that naming the stage of grief that someone is experiencing helps diminish the power it might have over them, allowing them to mourn their loss.

For decades, most clinicians and researchers have recognized five stages of grief: denial/shock, anger, depression, bargaining and acceptance.

But “accepting” your grief doesn’t sit well for many. That is why a sixth stage of grief, called “finding meaning,” adds another perspective. Honoring a loss by reflecting on its meaning and the weight of its impact can help people discover ways to move forward. Recognizing how one’s life and identity are different while making space for your grief during the holidays might be one way to soften the despair.

When my friend died by suicide, I found a deeper appreciation for what he brought into my life, soaking up the moments he would have enjoyed, in honor of him. After many years, I was able to find meaning by spreading mental health awareness. I spoke as an expert presenter for suicide prevention organizations, wrote about suicide loss and became certified to teach my local community how to respond to someone experiencing signs of mental health distress or crisis through Mental Health First Aid courses. Finding meaning is different for everyone, though.

Sometimes, adding a routine or holiday tradition can ease the pain and allow a new version of life, while still remembering your loved one. Take out that old recipe or visit your favorite restaurant you enjoyed together. You can choose to stay open to what life has to offer, while grieving and honoring your loss. This may offer new meaning to what – and who – is around you.

If you need emotional support or are in a mental health crisis, dial 988 or chat online with a crisis counselor.

Mandy Doria, Assistant Professor of Psychiatry, University of Colorado Anschutz Medical Campus

This article is republished from The Conversation under a Creative Commons license. Read the original article.