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How I Use Mental Models, Beliefs, and Recipes to Manage My Chronic Pain

Roderick McMullen


You Manage Your Pain. It Doesn't Manage You. Part II

This is the first post in Rick's series on managing his own chronic pain condition.

  1. You Manage Your Pain I: How I Cultivated an Ownership Mindset to Manage My Chronic Pain
  2. You Manage Your Pain II: The Three Tools I Use to Manage My Chronic Pain (this post)
  3. How I Stay out of the Chronic Pain Cycle (coming soon)
  4. More to come!

Hi! I’m Rick, co-founder of Alleviate. This is the second post in a series where I'm sharing my own story of reclaiming my life from chronic pain.

In my previous post, I shared how I transitioned from a Victim Mindset where pain controlled my life and limited my choices, to an Ownership Mindset where I actively manage my pain to live my life to the fullest. In this post, I’m excited to share the three pillars that support my current Ownership Mindset: Mental Models, Beliefs, and Recipes.

Briefly, here are what I’ve learned to do over many years through trial and error:

  1. Embrace Mental Models
    A Mental Model is a useful simplification of a complex reality that aids in learning. Good ones drive positive action. In the context of chronic pain, a mental model simplifies your understanding of the physiology of your injury and mechanisms of interventions.

  2. Adopt Foundational Beliefs
    A Belief is a conviction or acceptance that something is true or exists, sometimes before you see proof.

  3. Practice Action Recipes
    A Recipe is a structured step-by-step guide to achieve a desired outcome or solution.

Let’s dive into each of these with an example.

Mental Models: understanding chronic pain and treatments in simple terms

Understanding complex things in a simple way is critical for me. From a scientific, physiological, and psychological perspective, chronic injury is extremely complicated. Frankly, I’m happy to leave that complexity to doctors and scientists. As a guy with a sore knee, I just need a Mental Model that makes enough sense to get me to do the right thing. And I accept that not all of my Mental Models are 100% accurate or scientifically sound, and that’s okay.

I’ll give an example of a Mental Model that’s not actually correct, but the fact that people think it’s true creates the behavior that leads to good outcomes: “Deep-tissue massage breaks up scar tissue.”

No, it doesn’t. But it doesn’t matter.

When my quads get stiff, I use a tool or my elbow to do a deep (and often pretty uncomfortable) self-massage in my quadriceps muscle, and I think to myself “I’m really getting in there and breaking up scar tissue.” When I do that, I AM doing something that is good for my body.

There is enough hard science supporting the benefits of soft tissue mobilization techniques that I don’t care that I’m not literally breaking down scar tissue. I’ve read lots of scientific literature on the topic, and I still say “breaking up scar tissue” because it’s just easier to grasp than what really happens with soft tissue mobilization, physiologically, and framing it this way leads me to use the technique to my advantage.

This is what I mean by a useful simplification. 

Beliefs: the foundation of an Ownership Mindset

Most of us already know what a Belief is. What’s relevant is how it applies to pain management. The old adage that “whether you believe you can, or believe you can’t, you’re right” has some pretty strong scientific validation. “Self-Efficacy” is the term that most scientists use as the technical term for whether or not you believe yourself capable of changing your circumstances. To be clear, I haven’t seen any science that says “you can do anything in the world.” What I HAVE seen is peer-reviewed research that shows that self-efficacy is a validated predictor of success.

For me, the most important Belief I needed was that I CAN GET BETTER, and I can get better as the result of actions I take. This did not happen overnight, but once I was able to build some belief, I started to notice results.

Many readers with chronic injuries will know that it’s not so easy to embrace this Belief at first. I was in so much pain, for so long, and had tried so many things that hadn’t worked that I had given up on the belief that I could ever be fixed. I never said as much out loud, but looking back, I didn’t believe anything could work.

Luke (my Alleviate co-founder) is purposeful and masterful at building Belief in his physical therapy patients. That is in fact where he started with me when I was his patient – he showed me that I could get better. We’ll talk more about how to build a Belief to help you actively manage chronic pain in other posts. But for now, I’ll offer this: The best way to build a Belief is to try something and receive immediate, observable feedback of an improvement. This is ideal, but not always possible. 

Recipes: specific actions that prevent and reduce pain

I say my chronic injury is “well-managed.” It’s very different from being “cured.” Being cured would be great, but that’s not my reality. This is where Recipes come in: they are specific actions I take in specific situations to manage my condition.

I don’t live pain-free every day, and I still have to take action to get and stay pain-free. Sometimes, I overdo it in the gym. Sometimes, I sit for 12 hours straight in an airplane seat designed for someone half my height and my knee gets swollen and stiff. Sometimes, my friends want to play pickup basketball and it’s worth risking a flare-up to be part of the game.

What allows me to exercise, travel, and play fearlessly is the fact that I have a trusted set of Recipes I can use to prepare for, adapt to, and respond to in those situations.

For example, I have, among others:

  • A “How to Fix a Knee Flare-up in 30 Minutes” Recipe;

  • A “How to Prepare My Knee for A Risky Situation” Recipe; and

  • A “How to Predict If What I’m about to Do Will Hurt Me” Recipe.

For me, a good Recipe meets three criteria:

  1. It’s completely prescriptive . If I have any uncertainty about what to do or how to do it properly, I won’t do it.

  2. It’s simple enough that I can memorize it. If it’s complicated or hard to remember, I won’t do it.

  3. It has a concrete feedback loop that tells me it worked, or that it’s working. If I’m not 100% sure it worked, I’ll do it exactly once. Said another way, a good Recipe builds Belief every time you use it.

When I didn’t have a good Recipe book, I felt I had two choices:

  1. Don’t take risks, ever; or

  2. Take risks and be in pain all the time.

Now that I’m in my Ownership Mindset, I reject both.

If any of this sounds interesting, stay tuned to this series for individual Mental Models, Beliefs, and Recipes that can be used to manage specific long-term injuries. I’ll share the ones that have been most beneficial for me, and we’ll talk about ones that are now a part of the Alleviate Method of active rehabilitation.

Until then, I invite you to ask yourself this:

  • To what extent do you manage your injury, and to what extent does your injury manage you?

  • Would you like the balance to be different?

  • Do you believe you can get better? Any idea why or why or not?

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Disclaimer 1: This isn’t medical advice. I’m not a doctor and I’m not telling you what to do - I’m sharing my own experience. To keep it advice-free, I write about myself, my experience, how I think and what I do. I hope that it is useful to others who, like me, want to be as self-reliant as possible. I have chronic pain; I’m highly engaged in my own care and I relentlessly educate myself about physiology, injury and rehab; but I’m definitely not a doctor.

Disclaimer 2: The techniques discussed here do NOT apply equally to all chronic pain conditions, or even all cases of the same condition. I’ll touch on this in later posts, but when self-management isn’t getting you where you need to be, lean on your doctor or physical therapist!

Okay, with the disclaimers out of the way, let’s go.