Pain, Blame, Guilt and Shame

Its not your fault you experience pain. Why you shouldn't blame yourself, and why to run if your health professional blames you.
Ashleigh Flanagan
October 9, 2021

Pain, Blame, Guilt and Shame

Pain is a subjective, multifactorial experience that never has a single cause, even in the case of acute tissue damage. While there are risk factors that make a person more likely to experience pain (such as mood, connective tissue and autoimmune disorders) and factors that contribute to a pain experience (such as illness, injury, stress, poor sleep or changes in training load), all pain is context-dependent. Most importantly, pain is never anyone's fault, no one deserves to be in pain, and we shouldn't blame the experience on any single cause, event or person. 

Pain and emotions

Your thoughts, beliefs and emotions heavily mediate your experience of pain. For example, consider how differently a concert pianist and a runner preparing for the Olympics will experience pain on rolling an ankle. The pianist is more likely to think, 'wow, that's annoying'. In contrast, the runner may think, 'I will miss the Olympics, 'my career is over, or 'ill never achieve my goal', even if they hold a similar belief that pain is an indication of damage. In this hypothetical case, the runner may feel anger, disappointment, guilt, shame or sadness. These uncomfortable emotions can lead a person to focus on their pain and give unhelpful thoughts associated with their pain more attention. While these emotions might be normal and appropriate in the context, they can result in unhelpful coping strategies (such as ignoring healthy healing advice, socially isolating, bingeing and misuse of drugs and alcohol) that increase pain sensitivity. Guilt and shame can be particularly problematic when it comes to pain.

Guilt and Pain

While guilt feels uncomfortable, it's an important human emotion that motivates us to act in ways that support our relationships and act in accordance with our values. For example, if you feel guilty you weren't able to help your parents move house because of pain, but this helps you recognise that you weren't taking care of yourself as well as you could be and drives you to prioritise your health (e.g. go to bed on time, eat well and exercise regularly), then this is helpful.  If you feel guilty that pain stops you from playing soccer with your kids and it motivates you to set up a craft activity that you can all participate in, that's also helpful. Guilt can be a sign of self-reflection, indicating what's important to you and reminding you of your ability to influence an outcome. Guilt becomes problematic when you blame yourself for your pain, resulting in unhelpful action (or inaction) or maladaptive coping.

Pain and shame

Very simplistically, you feel guilty if you blame yourself and shame if you believe others blame you. Shame is a more general negative perception of aspects of yourself as a person, related to the expectations of others. For example, you may feel guilty if you skip your exercise program, but shame if you believe this makes you lazy, or if your physio tells you this is why you are still in pain.  Shame is a terrible motivator. Ultimately shame is disempowering and is more likely to reinforce unhelpful beliefs and result in unhelpful coping strategies than positive action.  Carrots (positive reinforcement) almost always trump sticks (negative reinforcement). Feeling shame may be helpful if it serves as a red flag that you need more support managing your pain or that some part of your support system reinforces the unhelpful belief that you are to blame for your pain.

If you feel guilt or shame is a significant contributing factor to your pain experience:

-Recognise that it's not your fault you are in pain. Acknowledge that you don't want to be in pain and are doing the best you can to manage your pain with the resources and knowledge you have. Understand that there is no way to avoid pain altogether, even if it was possible to do everything to reduce the risk of pain perfectly.

-Acknowledge that you feel guilt / shame and that these emotions may be heightening your pain experience.

-Reflect on if your feelings of guilt / shame reinforce positive, helpful behaviours or maladaptive coping strategies.

-Look at your actions and how they match your values. It may be time to change priorities if there is a disconnect. 

-Don't blame yourself, but accept responsibility for the aspects of managing your pain that you have some influence over.

-Get support from a relevant qualified professional who can guide you through your concerns.

-Consider replacing anyone involved in the management of your pain that:

     *Suggests there is one thing to blame for your pain (e.g. your work, posture, genetics, or weight)

     *Tells you there is one thing that will fix your pain (e.g. a specific exercise, meditation, weight loss, or manual therapy)

     *Blames you if you don't get better, even if you don't do everything they suggest.

     *Uses shame to try to motivate you. 

For more information and resoucres:

Pain Australia

Australian Pain Management Association

Beyond blue

Chronic Pain Australia

Learn why a specific exercise wont fix your pain. Read the blog

Learn why your sitting posture isnt the problem. Read the blog

Learn why pain doesnt mean you are stretching incorrectly. Read the blog

Book a physio appointment: Book now

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