Chronic Pain, Work, Purpose, Meaning and Connection

Wellbeing

The World Health Organisation defined Wellbeing in 1948 as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”.  Wellbeing can be split into two different types:

• Subjective wellbeing:  this looks at how people think and feel about their own wellbeing, for example, satisfaction with their life, positive emotions, and whether their life has meaning, direction and purpose (link).
• Objective wellbeing:  this looks at whether a person has their basic human needs and rights met, for example, enough food, clean water, physical health, education, safety and protection (link).

Subjective wellbeing is generally what is effected most when living with chronic pain, and is one of the largest sources of suffering, flowing into every aspect of a person’s life.  Subjective wellbeing is made up of a deeper kind of wellbeing which includes living in a way that is good for you and good for those around you, it includes:

• Social wellbeing:  a sense of belonging to a community and making a contribution to society (link)
• Emotional wellbeing:  feeling goo, being happy, experiencing positive emotions like love, joy and compassion, and generally feeling satisfied with life (link)
• Spiritual wellbeing:  feeling connected to a higher power, a sense of meaning, purpose or feelings of peace or transcendence (link)
• Physical wellbeing:  feeling “well”, which includes exercise, nutrition, sleep, health (link)

Work and Wellbeing

One area of life that is impacted by chronic pain is work, and work has been shown to be strongly intertwined with all parts of our wellbeing.  Whether it is paid or unpaid, what we do with our days is a fundamental part of who we are.  It defines part of our identity, this includes how we see ourselves, how we are seen by others, our social interactions, our financial security and how we spend our time.  Whether we realise it or not, what a person does, tells us a lot about who they are, what their interests are, and the type of life they may have led.  Work has a flow on effect on our engagement and satisfaction in life; our identity, confidence and pride in ourselves; our quality of life, meaning and purpose; our community, connection and social interaction; and our success, achievement and accomplishments.

There are many positive aspects to paid work which include:

• Our culture values paid work in adulthood, a principle founded in self-sufficiency for survival.
• Wages provide financial security.
• Work can be intellectually challenging, and/or an outlet for creativity and free expression.
• Work promotes social interaction, with the opportunity to mix with like-minded colleagues, some become friends.
• Work provides purpose and meaning, and doing a job well provides personal satisfaction in achievement.

Transitioning from work

Often people living with chronic pain, may not be able to return to their previous roles and this can leave an enormous hole in their days and weeks.  It can also leave a hole in their sense of meaning, purpose and identity.  It is important that when we transition from work, that we find a way to create structure to our day, utilise our strengths, skills and interests and continue to engage in a community.  It can be helpful to think about what was gained from our workplace, and how we can find others ways to introduce this into our life now, for example:

• Routine and structure to our day
• Social interaction with like-minded people
• A sense of meaning and purpose
• A sense of achievement and accomplishment
• A chance to use our skills and strengths
• A chance to learn and grow
• Financial security

Transitions and our strengths

One of the principle doctrines in Buddhism is that all existence in impermanent (link).  This has never been more true than living in a world with COVID-19, on a day to day basis we are struck with how little control we have over this invisible force that is dictating our lives.  We have lost the structure and order to our days, something people living with chronic pain know all too well.  When we are faced with loss, we are also faced with grief for the future we thought we would have.  We find ourselves experiencing a number of emotions – sadness, irritation, anger, uncertainty, exhaustion, overwhelm – and we find ourselves struggling to recharge our batteries.  In this moment, we find ourselves forced to find a way forward, despite our suffering.

We are not alone in this struggle through suffering.  It is a pathway many have trodden before us, for example Viktor Frankl a survivor of Auschwitz and psychologist who focused his work on meaning and purpose, as a means of moving through suffering (link).  It is our ability, in times of suffering, grief and adversity, to use those qualities which bring out our best, strength and resilience, that allow us to find a calm in the storm.  These strengths are constant and always with us, they are our “super powers” in times when we feel overwhelmed and challenged by life.  They allow us to forge a path forward using the best of us as our tools.

Finding and using our strengths

In the early 2000s, researchers discovered the 24 signature strengths that make up the best of each of our personalities.  Every single one of us has these strengths to varying degrees – they are part of what makes us “one of a kind”.  In wellbeing theory, there are 24 strengths that underpin PERMAH (link).  Positive Psychology looks at how PERMAH is the skeleton or “building blocks” of each of our personal wellbeing – mental, physical and emotional health.  PERMAH stands for:

• Positive emotion: feeling good
• Engagement: being absorbed in our passions and the activities we do
• Relationships: being meaningfully connected with others
• Meaning: having a purposeful existence
• Accomplishment: feeling a sense of achievement
• Health: taking care of our bodies:  sleep, diet and exercise

Research by positive psychologists has identified that some of the happiest people in the world are those who find and use their unique strengths and talents (link).  The purpose of identifying strengths is to help people look to what is right with them, instead of what is lacking.  These can then be used to guide them in living a more fulfilling life.  Dr Martin Seligman identified 24 signature strengths which can be categorised under 6 virtues (link).

#1 Wisdom:  tend to have thinking strengths that lead to acquire knowledge and use it in creative and useful ways. The strengths that fall under wisdom include:

• Creativity: finding new ways to do things
• Curiosity: being interested in a wide array of topics
• Open-Mindedness: seeing things from all perspectives; thinking through things
• Love of Learning: learning new things, skills, and research
• Perspective: Being able to provide wise counsel to others; looking at the world in a way that makes sense

#2 Courage:  tend to have emotional strengths which enable them to pursue goals and overcome challenges.  The strengths which fall under courage are:

• Honesty: being authentic, genuine, and honest
• Bravery: embracing and overcoming challenges and difficulties
• Persistence: finishing what they start
• Zest: approaching life with energy and excitement

#3 Humanity:  tend to have strong interpersonal strengths, including caring for and connecting with others.  The strengths which fall under humanity include:

• Kindness: good deeds and lending a helping hand
• Love: valuing close relations
• Social Intelligence: being intuitive and aware of other people’s motives and feelings

#4 Justice:  tend to possess civic strengths which promote a healthy community.  The strengths which fall under justice include:

• Fairness: treating people the same
• Leadership: organising group activities; taking ownership and being accountable
• Teamwork: being a team player

#5 Temperance:  tend to have strengths which protect against excesses in life.  The strengths which fall under temperance include:

• Forgiveness: practising forgiveness to those who have wronged them
• Modesty: allowing their accomplishments and success to stand on its own
• Prudence: avoiding doing things they might regret; making good choices
• Self-Regulation: being disciplined; controlling emotions and behaviours

#6 Transcendence:  tends to forge a connection with a greater power, providing meaning, purpose and understanding.  The strengths which fall under transcendence include:

• Appreciation of Beauty: appreciating beauty and excellence in life
• Gratitude: taking time to express thanks and find the good in life
• Hope: expecting the best and working towards making it happen
• Humor: finding the funny side of life and making other people smile or laugh
• Religiousness: having a belief in a higher purpose and meaning of life

As we discuss in our article on Identity and Changing Roles (link), finding ways to utilise our strengths in a different role can be a helpful way of transitioning forward.  Using our strengths in a different capacity can help us to retain a sense of confidence, purpose, drive and meaning, which we had in our previous working role.  Some examples include:

• Creativity:  learning a new hobby e.g. taking a class at a community college or online, joining a community group
• Love of Learning:  attending an online class or University of the Third Age, TAFE or community classes
• Kindness: volunteering at a local school, over the phone, over the internet, through a community centre, local hospital or church

It can be helpful to work out your signature strength (link) and then use a map like below to identify different ways you can use it each day.

Transitions and values

Many things may change as a result of our pain, including what we value most in your life.  Often when we experience a “life quake” that changes every aspect of our life, we can find ourselves questioning what really matters in life.  Pain can alter our capacity each day.  Finding a way to align what we do have capacity for, with what really matters to us, can help improve our quality of life  To adjust to our new life, it can be helpful to think about what our values are and how we see ourself and what matters to us.  Our values help us to see what is important in your life, they add meaning to our life.

Our values guide the way we live our life and help us to make small and big decisions.  Sometimes when there are big changes in our life, it can be easy to forget what our values are and this stops us from using them to guide and direct our life and decisions (link).  Maybe our values have stayed the same and this might bring about a sense of familiarity and comfort.  But maybe our values have changed e.g., perhaps the loss of a role, has enhanced the value of family or friends in our life.  Either way, working out what we value can help us align our daily activities with what matters most in our life.  Spending your valuable time doing what you love and what brings you happiness, can help reclaim aspects of your life away from pain.  Learn more about values here and here

Understanding our values can also help us shape how we spend our time, some examples include:

• If we value relationships, then scheduling time each day or week to connect with loved ones will be a meaningful activity
• If we value nature, then scheduling time in the garden, joining a community group or creating space to get out into nature will be a meaningful activity
• If we value routine and structure, then spending time planning your day and goal setting will be a meaningful activity

Identifying our values can help us to plan our day in meaningful ways, and what we want to introduce or reintroduce.  It can help us to schedule our precious time and energy in directions that bring about greater happiness, purpose and fulfilment.  Overtime, the introduction of these pleasant activities can reduce suffering, distress, stress and suffering (link).  Our values can also help to shape our goal and create the momentum for change.

It can be helpful to work out your values and then use a map like below to identify different ways you can use it each day.

Purpose and Meaningful Activity

When we identify our strengths and values, it will help us to work out ho we want to spend our time, who we want to spend our time with and what we want to spend our time doing.  It will help you to shape our goals and plans for the future, as well as provide a sense of purpose and direction in our days (link).  Meaningful activity is what makes us get out of bed in the morning.  It holds significance or importance to us and aligns with our strengths and values.  It is not just a job or paid employment, it includes our hobbies, social activities with friends and family, volunteering, exercise, sports, community engagement and education.  It brings a sense of purpose, connection and meaning to our days, and enhancing our quality of life and overall satisfaction and wellbeing.  It forms part of our identity and helps us gain a greater sense of who we are and where we fit int the world.

Meaningful activity is important because it forms parts of the social aspect of wellbeing and health.  It can build social connections through activities we engage in such as sports, arts, cooking, religious, walking, gardening or volunteering, to name a few.  Evidence shows that engaging in meaningful activity can lead to heightened self-esteem and self-confidence; improved sense of control and empowerment; improved physical, emotional and mental wellbeing; and decreased levels of anxiety and depression (link).

Meaningful activity also allows us to cultivate connection and purpose, through cultivating meaningful relationships; using our strengths, skill and talents; finding ways to contribute to something outside of ourselves; finding pleasure in losing ourselves in things that are challenging, achievable and enjoyable – Flow -; building a growth mindset through overcoming challenges whilst learning and growing; and learning resilience, self-efficacy and skills for coping.  All of these flow on effects have been shown to slow the pain cycle and reduce suffering (link).

Some different types of meaningful activity that can be worth exploring include:

1. Hobbies and interests
2. Volunteering
3. Community Groups
4. Support Groups

Hobbies and Interests

Hobbies and interests are a great way to unwind and spend our time.  They may involve learning a new skill, doing something we have always wanted to, reading or doing something musical or artistic.  They can improve our mental health and wellbeing, particularly stress, low mood and depression.  They can get us out and about, connecting with others.  They can provide routine and structure to our day and week, and they can be relaxing, meaningful and enjoyable.

When we are completely absorbed in a meaningful activity we can experience “Flow”. Hungarian psychologist, Milhaly Csikszentmihalyi describes this state as  “Being completely involved in an activity for its own sake. The ego falls away. Time flies. Every action, movement, and thought follows inevitably from the previous one, like playing jazz. Your whole being is involved, and you’re using your skills to the utmost” (link).

The benefits of “flow” include feeling:

• Strong and confident in ourselves
• Focused, alert and effortlessly in control
• A loss of self-consciousness (forget yourself and all your worries)
• An expression of creative abilities and an emotional outlet
• A sense of awareness of the present, being in-tune, deeply absorbed
• There is no space for negative thinking or emotions

Hobby and Activity Based Groups

• HeadtoHealth:  Purposeful activity (link)
• HeadtoHealth:  Purposeful activity – getting involved (link)
• HeadtoHealth: Purposeful activity – hobbies (link)
• 60+ Club:  Social Groups (link)
• Heart Foundation:  Walking Groups.  Find a group near you
• MeetUp:  Social Groups in Sydney (link)
• Networks, Groups and Communities in Sydney (link)
• Trailblazers Community Groups Sydney (link)
• PCYC:  Find a Group (link)
• My Community Directory:  Interest Groups (link)
• Men’s Shed:  Find a Shed (link)
• City of Sydney:  Find a community garden (link)
• Stitch Community.  Social group for over 50’s (link)
• Country Women’s Association (link)
• HeadtoHealth:  Purposeful activity – learning and education (link)
• University of the 3rd Age (link)
• Sydney Community College (link)

Volunteering

Volunteering is a great way to make new friends, learn new skills and improves our confidence, increase our ability to re-join the workforce or test out new career paths, find a sense of gratitude and fulfilment for giving to others in need, enhance our mental and physical health, provide a sense of purpose and meaning, improve our social and relationship skills and links us with like-minded people, reduces depression, stress and anxiety levels, and improve mobility and function (link).  Volunteering has also been shown to foster a feeling of gratitude.  It can assist us to live more mindfully and present, but also cultivate emotions such as love, compassion, joy, respect and appreciation.  Gratitude spreads positivity, strengthens relationships, improves health and wellbeing, and connects us with other people (link).  Functional magnetic resonance imaging (fMRI) of the brain has shown increased brain activity in areas of the brain associated with reward are increased when we volunteer and this can last for months after the event.  It changes the neuroplasticity of the brain; strengthening the positive pathways, changing our brain from its negative bias.  It also helps us to feel greater satisfaction with our life and what we have, which promotes positive feelings such as happiness (link).

Community Groups

Being a part of our local community can have many benefits, including:

• Being a part of something: attending local events, joining hobby or interest groups, or doing group physical exercise.
• Opening ourself to new experiences: which can even enrich our life, either through meeting new people, learning new skills or exploring new environments.
• Building new relationships: where we can feel safe, accepted, and connected with like-minded people.
• Creating a sense of belonging and purpose

Community Groups in NSW

• HeadtoHealth:  Connecting with community (link)
• Factsheet:  NPC: Community Groups (link)
• City of Sydney: Community Groups (link)
• Orange:  Community Groups (link)
• Roberson:  Community Groups (link)
• South Eastern NSW:  Community Groups (link)
• Berry:  Community Groups (link)
• LGBTQI Community Groups (link)
• Kangaroo Valley:  Community Groups (link)
• Hawskebury Australia:  Community Groups (link)

Online Community Groups

• Facebook:  Glenwood:  Community Groups (link)
• Facebook:  Eastern Suburbs of Sydney Community Group (link)

Mental Health Support Groups

• Online:  GROW Mental Wellness Program:  Find a group (link)
• Blue Knot:  Trauma Support Groups (link)
• Online: BeyondBlue:  Online Forum (link)
• Carers Gateway:  Support for carers (link)
• Men’s Shed:  Find a Shed (link)
• NSW Government:  Mental Health Programs.  Find a program (link)

Support Groups

Support groups offer:

• Friendships amongst empathetic, supportive people
• Information, tools and strategies for managing pain
• An opportunity to share experiences and stories
• An ability to learn new skills and techniques
• A safe and empathetic environment surrounded by people who truly understand what living with chronic pain is like

Support groups can be found in every city and town around Australia and can be in-person; online or via phone.

Chronic Pain Support Groups in NSW

• Factsheet:  NPC:  Government Support Directory (link)
• Australian Government:  Chronic pain Resources.  A summary of online and accessible initiatives and resources (link)
• MeetUp:  Chronic Pain Groups in Sydney (link)
• Factsheet:  Chronic Pain Australia:  Support Group Directory (link)
• Arthritis Australia:  Find a group (link)
• Factsheet:  APMA:  Pain Management Support Groups Directory (link)
• Connect:  Chronic Pain Support Groups Directory (link)
• GAIN: Pelvic Pain Support Group (link)
• Endometriosis Australia Support Group (link)
• Pelvic Pain Foundation.  Find a group (link)
• Pain Link Telephone Line (link)
• Australian RSD/CRPS Support Group (link)
• ConnectGroups:  Chronic Illness Directory (link)
• Arthritis and Osteoporosis Support Group (link)
• Musculoskeletal Support Groups (link)
• Humankind Chronic Illness Support Group (link)
• CRPS Network Australia (link)
• Purple Bucket Support Group (CRPS) (link)
• Rare Voices (Chronic Illness Support Groups) (link)

Online Chronic Pain Support Groups

• Online:  Chronic Pain Australia:  Online Forum (link)
• Online:  Hills Chronic Pain:  Online Forum (link)
• Online:  Dragon Claw (Rheumatoid Arthritis) (link)
• Facebook:  Diamond Facts (link)
• Facebook:  Fibromyalgia Support Group (link)
• Facebook:  Chronic Pain Support Group (link)
• Facebook:  Chronic Pain Sufferers Support Group (link)
• Facebook:  Chronic Pain – we are in this together (link)

Putting it all together

Finding ways to reshape our life, when living with chronic pain is essential for living with meaning and purpose.  Creating a plan and goals for promoting our wellbeing can help reclaim portions of our life from pain.  This shift can build more positive emotions and relationships, give us back a sense of meaning, purpose and engagement and build better health and wellbeing.

One strategy you could try is to create your own wellbeing blueprint (an example of this is here):

• Thinking about what you have learnt about values, strengths and the role work has played in your identity, how can you start to build a path forward that can harness the essence of your life before pain, whilst acknowledging the new journey that faces you?
• Creating a blueprint or map for your future can be a helpful way to set tasks or activities for your days, weeks and months.  These can include activities that are meaningful to you e.g. volunteering, support groups, hobbies and interests, self-care, pleasant activities, relaxation activities, community groups.

Additional References:

• Journal Article: Loneliness Impairs Daytime Functioning But Not Sleep Duration (link here)
• Article: The 2-Way Street Between Loneliness And Sleep That’s A Very Big Deal For Your Health (link here)
• Article: Feeling lonely? Why a good night’s sleep might be the ultimate cure (link here)
• Journal Article: Sleep loss causes social withdrawal and loneliness (link here)
• Journal Article: Overweight and Lonely? A Representative Study on Loneliness in Obese People and Its Determinants (link here)
• Article: Loneliness – Antecedent and Sequel of Obesity. Health Implications of Loneliness and Obesity (link here)
• Article: Overeating and Loneliness (link here)
• Article: The Invisible Link Between Overeating and Loneliness (link here)
• Journal Article: Social isolation, loneliness, and all-cause mortality in older men and women (link here)
• Journal Article: Social isolation, loneliness and their relationships with depressive symptoms: A population-based study (link here)
• Journal Article: Loneliness predicts pain, depression, and fatigue: Understanding the role of immune dysregulation (link here)
• Journal Article: “On their own”: social isolation, loneliness and chronic musculoskeletal pain in older adults (link here)
• Journal Article: Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis (link here)
• Journal Article: An experimental study of shared sensitivity to physical pain and social rejection (link here)
• Journal Article: Social modulation of stress responses (link here)
• Journal Article: The Impact of Social Isolation on Pain Interference: A Longitudinal Study (link here)
• Journal Article: Social isolation (link here)
• Journal Article: Chronic pain, social withdrawal, and depression (link here)
• Journal Article: Health and well-being impacts of both social connection and loneliness amongst older people (link here)
• Journal Article: Self-Esteem, Self-Efficacy, and Social Connectedness as Mediators of the Relationship Between Volunteering and Well-Being (link here)
• Journal Article: Mobility, social exclusion and well-being: Exploring the links (link here)
• Journal Article: Disembodiment in Online Social Interaction: Impact of Online Chat on Social Support and Psychosocial Well-Being (link here)
• Journal Article: Loving-kindness meditation increases social connectedness (link here)
• Journal Article: Reading into Wellbeing: Bibliotherapy, Libraries, Health and Social Connection (link here)
• Journal Article: The power of social connection and support in improving health: lessons from social support interventions with childbearing women (link here)
• Journal Article: The social context of well–being (link here)
• Journal Article: Social Isolation in America: Changes in Core Discussion Networks over Two Decades (link here)
• Journal Article: Social relationships and health (link here)
• Journal Article: People and Companion Animals: It Takes Two to Tango (link here)
• Journal Article: Pet Ownership and Human Health: A Brief Review of Evidence and Issues (link here)
• Journal Article: The Clinical Significance of Loneliness: A Literature Review (link here)
• Article: Social isolation and loneliness (link here)
• Article: Grattan Institute: Social Cities (link here)
• Book: Ageing and the Digital Life Course.  Chapter 5: Designing technologies for social connection with older people (link here)
• Article: Loneliness and Chronic Illness: The Inspiring Ways 8 Patients Cope With It (link here)
• Article:  The best life possible.  Living with chronic illness is hard. But there are psychological techniques that make it possible to thrive even when ill (link)
• Article:  Finding joy in poor health: The leisure-scapes of chronic illness (link)
• Article:  Opportunities for social connection.  A determinant of mental health and wellbeing:  Summary of learnings and implications (link)
• Article:  Midnight Friends: How Wired Patients Are Transforming Chronic Illness (link)
• Article:  What is meaningful activity and why is it so important? (link)
• Article:  Finding JOY: Strategies for Meaningful Activity (link)
• NICE Quality Statement:  Mental wellbeing of older people in care homes.  Quality statement 1: Participation in meaningful activity (link)
• Article:  Research Scoping Review: The impact and effectiveness of meaningful activity for people with mental health problems (link)
• Article:  Meaningful Activity: What’s The Point? (link)
• Article:  The importance of purposeful and meaningful activities for people with dementia (link)
• Journal Article:  Self-Efficacy and Chronic Pain Outcomes: A Meta-Analytic Review (link)
• Journal Article:  Self-Efficacy for Managing Pain Is Associated With Disability, Depression, and Pain Coping Among Retirement Community Residents With Chronic Pain (link)
• Journal Article:  Development and initial validation of a scale to measure self-efficacy beliefs in patients with chronic pain (link)
• Journal Article:  Self-efficacy and outcome expectancies: relationship to chronic pain coping strategies and adjustment (link)
• Journal Article:  Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients (link)
• Journal Article:  Targeting Acceptance, Mindfulness, and Values-Based Action in Chronic Pain: Findings of Two Preliminary Trials of an Outpatient Group-Based Intervention (link)
• Journal Article:  Acceptance and change in the context of chronic pain (link)
• Doctorate Paper:  Meaningful Daily Activity and Chronic Pain (link)
• Article:  Activity versus Exercise: How to Cope with Pain Series (link)
• Article:  Adopting an Attitude that You’re Healthy despite having Chronic Pain: Coping with Pain Series (link)
• Article:  Reducing Pain Talk: Coping with Pain Series (link)
• Article:  Reducing Pain Behaviors: Coping with Pain Series (link)
• Article:  Developing an Observational Self: How to Cope with Pain Series (link)
• Article: Coping with Pain: How People Who Cope Really Well Do It (link)
• Journal Article:  Activity pacing: moving beyond taking breaks and slowing down (link)
• Journal Article:  Experiences and attitudes about physical activity and exercise in patients with chronic pain: A qualitative interview study (link)
• Article:  Successful living: redefining living with chronic pain (link)
• Booklet:  NHS:  Living Well With. Chronic or Persistent Pain.  A Guide for Patients and Relatives (link)
• Article:  Developing Meaningful Activities and Routines with Chronic Pain (link)
• Article:  Time alone (chosen or not) can be a chance to hit the reset button (link)

Images courtesy of Canva and UnSplashed

Written by Aimee Carter