Steve (that’s not his real name) was a fixer, the kind of person you really trust to get the job done. He was a resourceful and intelligent business coach with 20 years of experience pulling small business owners out of deep stressful-filled holes they mostly dug for themselves. He had the appearance of someone who had failed to take the necessary time to care for themselves over a long period of time. Despite having a naturally healthy and athletic disposition, the combination of occupational stress, minimal sleep, and a poor diet was making his 43 years look like an unhealthy 53. At the centre of all this was Steve’s bad back pain, which had contributed to his loss of physical well-being. And Steve mostly blamed his back for his poor physical state.

Taking a deeper dive into Steve’s pain and his attempts to resolve it revealed two common themes. The first was that he had consulted unsuccessfully with around 20 different clinicians from all disciplines, including multiple doctors, multiple surgeons, multiple physiotherapists, multiple chiropractors, and a list of many others. The second common theme was that Steve had done absolutely nothing to try and fix himself, no stretching, no pilates, no yoga, no stress management, no core exercises, no research, no cardio, and no weight loss.  

Steve had taken almost no responsibility for working on his own pain. This observation is offered without judgement; Steve’s choices weren’t based on laziness. His choices were, in fact, more rooted in a lack of education. He genuinely didn’t realize that his pain was caused to a large extent by his lifestyle, stress, and his general physical condition; if he had, he may have acted very differently. 

Steve believed his pain was among the types of medical conditions that require ‘a medical procedure’ to be performed. He genuinely thought that his back pain was like a tooth cavity that just needed the right dentist to do the right filling, and it would be permanently fixed. He didn’t realize that the bulk of the issue he was facing was far more like being unfit or having a poor diet. Thus being a life challenge that requires an unavoidable and sizable dollop of personal responsibility.

Happily, once Steve realized this truth, he was able to gradually merge better self-care with treatments that helped reduce his pain meaningfully. After a few months, he was able to gain some real momentum. This ultimately led to the resolution of his pain. After many many years of suffering.

Steve’s case is a slightly unusual one because most pain sufferers these days do take a certain amount of responsibility for their pain, in the form of exercises and tools intended to reduce their pain over time. In truth, though, most pain sufferers sit somewhere on a ‘responsibility spectrum’, inhabited at one end by those who take no responsibility and at the other by those who take too much responsibility and won’t ask for help. 

I have met literally thousands of pain sufferers and had the opportunity to have substantial conversations with them about their pain. As you might expect, there are many repeating patterns, especially among those who have suffered the most and for the longest. One such pattern is the Steve pattern, where the patient sees it as the job of healthcare providers to fix the pain. In particularly bad cases, this logic extends to those patients who start to blame their ‘doctors’ for their pain. It is no coincidence that this type of ‘blame psychology’ and the feelings of powerlessness that go with it are well-documented as significant contributing factors in many of the worst poor pain and disability outcomes.

From an early age, we are somewhat conditioned to think of our physical complaints as the job of a doctor to fix, and of course, there are times when this is true. Personally, I believe we are responsible for our own well-being. But of course, I don’t, for example, extend that to a small child who needs treatment for leukaemia, which is definitely a job for an oncologist, not a toddler. It also isn’t our job to put pins and plates in our own broken bones. you need an orthopedic surgeon for that.

Not all health issues are the same in nature, and not all of the chapters within the history of each health issue are the same. If we use tooth decay as an example, it is quite clear that it is the dentist’s job to perform the filling. But whose job is it to prevent tooth decay from happening in the first place? If you have a tumour in your lung, it is your medical team’s job to see if they can resolve it for you, but is it the consultant’s job to stop you from smoking? No, that’s your job!

So understanding that we probably have a certain amount of work to do ourselves if we want permanent resolution of our pain is a big step. But there are two other ingredients that must be added before we are able to graduate to taking full responsibility. The right tools and understandings.

The completely opposite type of pain sufferer (from Steve)  are those who work relentlessly at fixing themselves and refuse to seek any professional help. This type of approach tends to be driven partly by fundamentally positive personality traits  (like confidence, independence and tenacity) but also by disillusionment with past treatments that have not worked. Consulting with multiple practitioners and not getting anywhere can easily create the impression that help will never come, leaving the patient entirely self-managing and self-Googling their own chronic pain. 

Sadly taking too much responsibility can be as fruitless as taking no responsibility, no matter how admirable it is. Dealing with chronic pain is, on many levels, the responsibility of the individual suffering from the pain. Yet without the correct guidance, much of the effort can be wasted on ineffective or inappropriate tools that won’t get the job done.

To be able to take the right amount of responsibility for our pain, we need to be armed with the right tools. To get the right amount of help with our pain, we need practitioners who are also armed with the right tools and insights. It is our responsibility to care for our own pain and our own body. But taking personal responsibility doesn’t mean you have to figure it ALL out for yourself.

The best health outcomes tend to come when there is a healthy shared responsibility for resolving the complaint and its causes between ourselves and practitioners whom we trust. Part of their job is to perform the ‘pain-relieving procedures‘ that help us return to normal function, but it is also their job to help guide us towards which aspects of our physical well-being WE need to work on and then we fully commit to running that gauntlet on our own 2 feet.

Chronic pain needs more than ‘a procedure’ in almost every instance. Even after full joint replacement surgery, a significant percentage of patients continue to suffer from pain in the same area, and countless more continue to suffer from stubborn pain elsewhere in their bodies. This clearly demonstrates that even our most radical pain solutions seldom land like magic bullets. 

Stubborn pain is a highly complex issue, and the genuinely mature approach to it acknowledges this by not oversimplifying it. But instead, taking a broad and flexible approach. By tackling pain in a collaborative, holistic, and self-responsible way. 

Perhaps the best way to achieve this mindset is to stop asking, ‘Who can help me’ or ‘How do I fix myself’ and instead ask…  ‘Who can help me fix myself’.