Managing Chronic Pain with Expressive Writing

  Tuesday, July 6, 2021
Contributed by Dr. Carrie Jackson

When you are trapped in another day of excruciating pain, you feel stuck within your own body with no escape. Most people don’t understand the impact that chronic pain has on your day-to-day life. It makes everything more challenging from getting ready in the morning, to relationships, to working, to sleeping. Chronic pain impacts almost every facet of life in one way or another, and it’s been linked to greater rates of anxiety, depression, disability, and lower overall quality of life. For the estimated 50 million Americans who are living with chronic pain, it leads to great suffering.

Yet many people are often surprised by the number of people who are experiencing chronic pain, because of the amount of stigma attached to this diagnosis. Unlike other conditions, chronic pain is often an invisible disability. It’s not always something that is apparent to they eye. Because of this, many people living with chronic pain are given invalidating advice about their condition and ways to feel better. What’s worse is that in many cases of chronic pain, doctors are unable to find a known cause for the suffering. Even if doctors are unable to find the known cause, this doesn’t mean that the person with chronic pain is making it up. Their suffering is very much real and causing significant disruptions to their life.

Further adding to the challenges of chronic pain is that experiencing chronic pain results in changes in the brain such as decreases in gray and white matter integrity and neurotransmitters. These brain changes play a role in the development of chronic pain, such that some people are more susceptible to dealing with chronic pain. And neuroplasticity also plays a role in the maintenance of chronic pain symptoms, such that the brain begins to feel pain more intensely after experiencing pain. Over time, frequently experiencing pain leads to a hypersensitive nervous system which may lead individuals to feel pain during daily activities in which they would not typically experience pain. Essentially, the brain has begun to misinterpret various signals as potentially dangerous or painful, therefore leading to actual experiences of pain. Given that chronic pain leads to changes in brain structure, it can leave many people feeling hopeless about their abilities to recover from or manage chronic pain.

One of the most challenging things about chronic pain is it differs a lot from acute pain. With acute pain, there is often an identifiable cause for the pain and once that cause is treated, the pain can be improved upon or go away. With chronic pain, there usually isn’t any magic pill, treatment, or surgery that will make the pain disappear. More often, people find some relief from learning skills with how to manage their pain. Typically, it takes several coping skills to be able to find some relief from chronic pain. 

Given that many people with chronic pain are at an elevated risk of anxiety or depressive symptoms, it’s important to know that therapy is something worth considering if you don’t already have a therapist. In order to find a therapist, check out this post on finding a therapist near you. Even if you aren’t able to find a therapist near you that has openings, online therapy is an option that can be particularly helpful. If you have a therapist that isn’t the best fit for you, this post also includes good information on how to get rid of the therapist that you currently have. When looking for a therapist, it’s important to consider if they have prior experience in working with chronic pain. If so, they likely have helped plenty of people in similar situations as you find some relief. 

Therapy may not be accessible for everyone, so it’s important to consider other more affordable and common options for coping skills. A less talked about coping skill for chronic pain is writing or journaling. The benefits of journaling have been found for individuals struggling with a variety of difficulties (e.g., weight loss) as well as for those who are looking to improve their overall positive experiences and gratitude. Similar to meditation and yoga, journaling is a mindfulness exercise that leads to increased awareness and acceptance of experiences. Within this guide, I’ll discuss the ways in which journaling may be helpful for you if you’re struggling with chronic pain as well as some ideas on how to develop a journal when you have chronic pain.

Benefits of Journaling When You Have Chronic Pain

Mental health professionals have argued that journaling can be helpful for many people for a variety of reasons. It can be helpful to people who are struggling with sleep difficulties, depression, anxiety, and stress. Additionally, it can be helpful for people who are looking at building greater awareness around certain parts of their life. For chronic pain, there are lots of important benefits to regular journaling that are detailed below.

1. Effective for Various Pain

Aside from the general health benefits of journaling, it can be helpful for people who are specifically dealing with chronic pain. Writing for chronic pain has been found to be helpful for people with a variety of conditions that cause pain, such as arthritis, cancer, and for people with general chronic pain from an unknown cause. It seems that expressive writing is a coping skill that can be effective regardless of the reason for your chronic pain, and it appears to have many benefits to help individuals with chronic pain.

2. Low-Cost Alternative to Therapy

As mentioned previously, not everyone is able to access therapy. For many people who are interested in pursuing therapy, they are unfortunately unable to access them because of cost, extensive waitlists, or a lack of providers who specialize in chronic pain. Given that therapy may not always be accessible for people who have chronic pain, it’s important to identify other mechanisms for which they can seek relief. In fact, therapeutic writing has been included as part of a therapy program for individuals with chronic pain. Those who utilized therapeutic writing as part of their therapy process found that it strengthened their response to therapy and increased their awareness, understanding, and acceptance of how to manage their chronic pain.

3. Self-Efficacy

The benefits of using writing as a form of management for chronic pain have been studied to examine how it influences these outcomes. When individuals with chronic pain regularly write, they are able to improve their feelings of self-efficacy and self-compassion. Additionally, when individuals feel better about themselves and have more self-compassion, it also influences their mental and physical health. The positive outcomes of journaling for chronic pain can therefore lead to cascading effects, where they affect a person’s overall quality of life.

4. Become Active Again

With chronic pain, many people tend to change their lifestyles to become more sedentary given that it is difficult to engage in exercise. Although your body is fighting against engaging in physical exercise, exercise is also something that leads to a reduction in chronic pain. Regular journaling for six months along with physical therapy has been found to help people with chronic pain remain consistent in their exercise efforts. Possibly the act of having to document your activity levels is a significant reason for why it helps. If you have found that your chronic pain has led you to a lifestyle that is less active than what you would want, beginning journaling may help you regain some activities in your life that you previously enjoyed.

5. Helps Regulate Your Emotions

Having chronic pain can make it feel like you are on a rollercoaster of emotions. One day everything is fine and you’re feeling little pain, and the next day you are back to some of the worst pain you’ve ever experienced. Journaling makes you feel better about yourself, makes you feel happier, and helps you better regulate your emotions that you are experiencing. When people write about their emotions, they are able to understand and control their emotions more. Research has even found that when people write about their feelings, medical scans show that their brain activity looks similar to people who are consciously trying to control their emotions. In fact, men tend to show greater benefits for using journaling than women.

6. Reduces Stress

If you have chronic pain, you are at a greater risk of experiencing more anxiety or depressive symptoms. With both of these mental health concerns, individuals are at an elevated risk of having negative thoughts about themselves and others. Getting these negative thoughts down and onto paper can help you with processing and understanding the emotions that you are having. It also helps you gain a different perspective on what’s going on and to begin to see what thoughts are based on emotions and which ones are based on facts. You may then be able to identify more helpful thoughts to help you manage your chronic illness and pain.

7. Improve Sleep

Journaling helps people fall asleep faster and have better sleep quality. Sleep is something that many people with chronic pain struggle with. Sometimes the pain may make it more difficult for people with chronic pain to sleep, or they may have more trouble sleeping due to increased stress in their life. One study even found that individuals who write out lists about things they need to do just before bedtime fall asleep significantly faster. Journaling can help with sleep because it is a way to reduce stress and to get out the negative thoughts you are having onto paper. It’s also helpful to create lists of what you have upcoming to accomplish so that you aren’t spending your nights thinking of them. When these thoughts are on paper, you may find that you don’t spend your nights tossing and turning as much going over various situations in your mind.

8. Strengthens the Immune System

There is now research suggesting that journaling also offers more physical benefits in addition to its positive effects on mental health. Some studies have found that journaling has immunity benefits for those battling chronic or terminal illnesses, such as rheumatoid arthritis and cancer. Although the research is relatively new, it has been suggested that writing and processing emotions is akin to therapy and can be helpful for people to reduce their stress and improve their overall functioning. It is important that journaling should focus not only on venting, but also on fully processing and learning from experiences. 

Benefits of Journaling About Pain 

In addition to journaling about your daily life or positive experiences, some people with chronic pain have found it beneficial to write specifically about their pain experiences. One of your first thoughts is probably, “Why would I want to write about something that is a negative experience for me?” or “I don’t want to focus on something that is just going to make me feel worse.” Those are valid concerns to have about journaling with chronic pain. It’s interesting that the opposite has been found for the effectiveness of journaling for chronic pain. Although it seems counterintuitive, there are many mental and physical effects to tracking your pain that are discussed below.

Benefits of Keeping a Pain Journal

1. Reduces Pain

Although there are many types of journals you can keep that will be beneficial for chronic pain, a pain journal can be particularly helpful. The purpose of a pain journal is to increase awareness around pain experiences. Specifically, keeping track of pain experiences in the form of a pain journal has been found to be effective for individuals dealing with chronic pain. For some, journaling for as little as 15 minutes per day has been found to decrease overall experiences of pain. It is one tool that can be used to help reduce your overall pain experiences.

2. May Result in Neuroplasticity

As mentioned previously, chronic pain results in changes in the brain which unfortunately make it so that individuals are more likely to experience more severe pain. Over time, your brain has learned to experience pain and it has become even easier for it to experience pain. Luckily, there is emerging research suggesting that these maladaptive changes can be reversed, by retraining these pathways within the brain through pain management. Several treatments have been recommended for beneficial neuroplasticity of the brain, such as mirror therapy, mindfulness therapy, mediation, and yoga. If you are able to retrain your brain so that you can process your pain in a different way, your brain will gradually begin to reinterpret its experiences of pain. This is where journaling specifically about your pain can be helpful to further interpret and increase your awareness around the pain you are experiencing. 

3. Increases Acceptance

This sounds counterintuitive to many people. If I am having pain and want to decrease it, shouldn’t I attempt to reduce my awareness around the pain that I’m experiencing? Actually, it’s the opposite. In many cases in psychology, the more that you try and fight against symptoms the worse they become. Acceptance and Commitment Therapy, which has been found to be very effective for chronic pain, is based on the tenant that acceptance of symptoms and stressors leads to reduced suffering as a result of them. For chronic pain, increasing mindfulness orientation (e.g., increasing awareness) actually reduces the attention that you pay towards your pain.

4. Increases Awareness

Additionally, chronic pain and other illnesses that cause it are confusing and unique, and it’s often hard to pinpoint what is leading to increased pain. A pain journal can serve as a method for tracking symptoms and pain, which are often hard to keep track of or may seem inconsistent. This can be helpful for patients as well as their doctors who are looking to better understand and manage their chronic pain. It can also be done with very limited amounts of time throughout the day. For someone experiencing chronic pain, keeping this detailed record can often be the first step towards receiving the best pain management care that you can.

How to Get Started Journaling for Chronic Pain

To get started with journaling for chronic pain, there are a few things that will be important to think about. You will want to think about the type of journal to have, what to write about, as well as how you can understand and interpret the thoughts that you are having. One of the best places to start with is identifying a journal that will fit your needs.

Choosing a Journal

When getting started with journaling, one of the most important first steps you will have to take is what type of journal to choose. Since you will be writing about your own individual experiences as well as your experiences with chronic pain, I recommend choosing a journal that is easy to customize and individualize to your experience. There are two main types of journals to choose from that are easy to individualize. Online journals are an option as well as traditional paper journals to write in.

Online Journals

Online journals are an easily accessible option that can travel with you anywhere you want or need to go. Online journals can be helpful for people with chronic pain because they are easy to share with your doctor or to take with you to your doctors’ appointments. Being able to have your journal with you wherever you go is also optimal because you will be able to track when you are experiencing pain and what the cause of the pain was. 

If you are interested in an online journal, you can utilize an app such as the DayOne app or use GoogleDocs to journal. These options allow you to incorporate pictures and audio files into your journal easily. Additionally, these options allow you to use a talk to type option. If you are having chronic pain that is influencing your ability to function, it may be hard for you to have the energy to write, especially if the pain is in your arms or hands. Using the talk to type function helps to reduce this difficulty and can make it easier to write down your notes throughout the day. To do this, you simply pull up the app and can say what you are thinking, and it will then be added onto the app entry or Google Doc. This is a really great and quick option for people who want the accessibility and ease of having their journal with them at all times.

Paper Journals

Traditional paper journals are also an option to use when journaling about your chronic pain. Being able to physically write down your experiences can sometimes feel more cathartic than using an online journal or talk to text option. Being able to write out your thoughts and physically see them can also be helpful for organizing and making sense of everything going on in your mind.

If you do decide that using a paper journal is the best fit for you, it’s important to choose one that fits your needs. There are tons of journal options that include preset templates, prompts, and blank journals. For individuals with chronic pain, I highly recommend a blank notebook as a journal option because it will give you the ability to individualize your journal to your needs. After that, it is really a personal preference on the size and type of journal that you will need. If you are planning on carrying your journal with you throughout the day, you may benefit from a smaller journal that can fit into your purse or in your pocket. On the other hand, if you are planning on only writing at specified times throughout the day, you can consider a larger journal. If you are worried about making mistakes while writing in your journal, the FriXion pen is an erasable pen so that you don’t have to worry about making mistakes while writing in pen. Figuring out the type of journal is one of the most important pieces to getting started. Whether you decide between electronic or paper journals, the most important thing is that it fits your needs.

How Often to Journal

If you are new to journaling, it is typically best to start with incorporating small amounts of journaling into your days, weeks, or months. It doesn’t matter how often you journal, as long as it is something that you can commit to. If you can, try to set a goal of how many days per week you are realistically able to journal. Even if you are only journaling for once a week, that is still a habit that you can commit and stick to. Avoid trying to overshoot on what you may be able to accomplish knowing that there will be days where your chronic pain gets in the way of you being able to write and journal. Oftentimes, this will lead to feeling more guilt and shame about being unable to maintain a goal you set for yourself so it’s very important to stick with realistic goals.

When you journal, you do not need to spend tons of time throughout your day journaling. Journaling for as short as 5-minutes per day can be effective in writing down the main points throughout the day. For others who have been journaling for quite some time, you may find that you prefer writing sessions of around thirty minutes to one hour. Journaling practices can always be adapted and flexible. What works for you one day may not fit into your schedule the next day, depending on how you are feeling. The most important thing is that you allow yourself the flexibility to make adaptations to your journaling practice.

What to Write About

In order to receive all the benefits of journaling, it’s important that your journal capture several pieces of important information. Your journal should contain information about the pain you are experiencing, your treatment, as well as daily stressors, and positive experiences. 

What to Track About Pain in a Journal

There are specific types of information you should include within a pain journal in order to facilitate awareness of your pain experiences, which can lead to greater awareness and letting go of control of their influence on you. In a pain journal, you will want to track basic data centering around your experiences of pain. This will include dates and times when your pain is occurring, as well as additional information on where the pain is located and what the pain feels like. 

Note the location and duration of your pain to get a better understanding of how long you are experiencing pain for and if it is in the same location of your body every day. Try to also note what you were doing when you began to have chronic pain. Did you notice it when you were sleeping? Or was it something that developed during the day while you were working at your office job? These details will give you important information about how to recognize and manage your pain. 

With what the pain feels like, jot down detailed notes on how it feels (e.g., tingling, throbbing pain) as well as any other uncomfortable symptoms you’re experiencing that day such as fatigue and migraines. Try to rate your pain on a scale so you can get a better sense of how intense and severe it is in an effort to begin to identify patterns. You can use a scale of 0-10 to get a better idea of how bad the pain is, with a 10 representing the worst pain you have experienced. Quantifying your experience of pain is an important step for eventually identifying the patterns.

Chronic pain often has a significant impact on your sleep and mood, which is why it can be helpful to track these in your pain journal. To track your sleep, note down how much sleep you are getting in the night as well as what time you usually go to sleep and wake up. If you are getting up in the middle of the night, note approximately how many times you got up and what the reasons were. With your mood, try to describe how your mood is throughout the day. You can also choose to rate your mood multiple times throughout the day. You can rate your mood by describing it with words, such as anxious, happy, or relaxed. And you can also rate your mood on a scale of 0 to 10, similar to how you rated the severity of your pain. 

It’s also helpful if you can note any changes to your pain management treatment, diet, or medications. These changes can influence your pain and the severity of it. By keeping such detailed notes of when your pain changes and your treatments at the time, you and your doctors will be able to put together a more helpful plan for managing your chronic pain.

Writing about your Emotions

One of the ways to access the positive benefits of writing and journaling is to journal about your emotions. If you are newly diagnosed with chronic pain or if it is something that you have been dealing with for a while, it can wreak havoc on your emotions. In order to gain the positive benefits of managing and regulating your emotions, it’s important to write and process your emotions in your journal. Sometimes, journaling can help you to slow down and process these emotions you are experiencing. It can be a chance to understand the thoughts that you are having and to help make sense of them too. 

To journal about the emotions you are experiencing, you can start by writing about the different situations that have happened throughout your day and attach an emotion to it. How did you notice that you were feeling at each moment? If you are not used to writing about your emotions, you may notice that this is hard at first for you to recognize and identify your emotions. The more practice that you get with writing about your emotions, the easier it will be to get used to identifying and understanding them in the moment.

To further understand your emotions, try to write about the thoughts that you are experiencing. Are you feeling more down on yourself and noticing a lot of self-defeating thoughts throughout the day? For example, you may be thinking that the chronic pain you are experiencing is really affecting your life and every aspect of it. To retrain your brain to have different experiences of your pain, you will want to try to understand and reinterpret the thoughts that you are having about your pain. Over time, the more you are able to look at and understand your maladaptive thoughts about pain, the more you are able to analyze them further to understand what is happening and going on. You can come up with more adaptive thoughts with how to understand your pain. This may lead to some of the changes in your brain, in order to rewire your experiences of pain. Hopefully, over time, this will lead to better experiences and reduced pain. 

Writing for Gratitude

Noticing and cultivating a gratitude practice is a psychological intervention that has been found to have many positive effects. Cultivating gratitude has been found to enhance mental health as well as prevent mental illness and have long lasting positive effects on someone’s life. Feelings of gratitude can be hard to come by when you are experiencing chronic pain and it feels like it is hard to find the good things going on in your life. Instead, you may find yourself focusing on the negative way more often. Given that gratitude can have significant mental health benefits, it is something positive for people with chronic pain to engage in.

To begin writing for gratitude, you don’t need more than five minutes out of your day to feel the positive effects of gratitude. Sitting down and writing about something you are grateful for can be hard at first, especially when you don’t feel like there are many positive things to look forward to. Instead, you can start off by using a prompt to help with cultivating gratitude. One prompt for cultivating gratitude that was used in a research study is “We want to focus for a moment on benefits or gifts that you have received in your life. These gifts could be simple everyday pleasures, people in your life, personal strengths or talents, moments of natural beauty, or gestures of kindness from others. We might not normally think about these things as gifts, but that is how you should think about them. Take a moment to really savor or relish these gifts, think about their value, and then write them down every night before going to sleep.” Over time, you may become more comfortable with not using a prompt and simply listing things in your life that you are grateful for. You can start with the basics and then gradually add more details about what you are grateful for. For more on how to write a gratitude journal, you can read this article on how to get started with cultivating gratitude for less than five minutes per day.

Journal Prompts for Chronic Pain

If you are having trouble getting started with processing your emotions around pain, you may benefit from looking at a few prompts to get started. These can aid in your abilities to process the emotions you are experiencing around your pain. These can also serve as a way to further and deepen your journaling practice by getting out of the habit of answering the same questions repeatedly. When using journal prompts, you may use one or two a day, or reuse journal prompts in order to see how your responses have changed over time. Here are some journal prompts to try out:

  1. What experiences can you control around your chronic pain? What experiences can’t you control around your chronic pain.
  2. If you could write a letter to your body, positive or negative, what would you say?
  3. What have you endured or survived due to your chronic pain? What surprises, positive or negative, has your chronic pain brought you?
  4. When you begin to get frustrated about your body and health, what do you typically do? What support systems do you rely on?
  5. How are your mental health and physical health related? Does your chronic pain impact your mental and physical health?
  6. What would life be like for you if you showed up for yourself with compassion towards you and your body?

Using Your Journal

Once you have gotten into the habit of incorporating these details into your journal, you will want to use it. Writing itself is a way to get the benefit of using a journal. But aside from writing, you can still receive many benefits even after you have written your journal. In order to assist you in learning about your experience with pain, you can begin to identify patterns in your pain triggers as well as in your pain management. This will be essential to you and your doctors for finding the most effective ways to manage your pain. For further clarification and understanding of your emotional experiences, it may be helpful for you to revisit and process your emotions. Given that your brain has developed patterns of understanding and interacting with your pain, you will need time to process your experiences around your pain. The more repeated experiences you can have where you analyze your thoughts and emotions around your pain, the better you will be able to retrain your brain to interpret various experiences and their impact on your pain.

Getting started with journaling when you have chronic pain is no easy feat. There are difficulties, stressors, and challenges that make it tough to know how to get started and even how it will be helpful. After reading this article, I hope you are able to see the numerous benefits that expressive writing can have for someone experiencing pain. It can have positive and lasting effects on your mental and physical health, and help you set up a way to manage your pain. It won’t be too long until you start to notice the benefits, and it won’t take too much of your time. So start today with feeling better mentally and physically despite your chronic pain. 

About Dr. Carrie Jackson

Dr. Carrie Jackson is a contributor of JournalOwl. Her primary interests are to increase access to evidence-based mental health treatments for children and adolescents, providing specific information to parents and individuals with ADHD.

Carrie is a graduate of West Virginia University with a doctoral degree in Psychology, and a specialization in Clinical Child Psychology. Carrie has worked as a therapist and evaluator at several children’s hospitals, providing care and treatment to clients with ADHD, Autism Spectrum Disorder, and anxiety. She has also worked with children with chronic medical conditions, providing supportive mental health care to children with cancer and burn survivors. 

Although originally from South Carolina, Carrie has lived in two countries and four states. She enjoys hiking, traveling, and trying new recipes.

Health Disclaimer

JournalOwl is not intended to be a substitute for professional advice, diagnosis, medical treatment, medication, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptoms or conditions. JournalOwl is not authorized to make recommendations about medication or serve as a substitute for professional advice. You should never disregard professional psychological or medical advice, or delay in seeking treatment, based on anything you read on JournalOwl’s website or platform.

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