As I’ve posted on many occasions before, for those of us living with chronic pain or illness, the word tired doesn’t quite cover it. It goes beyond the tired experience that able-bodied people get from the odd night of poor sleep. The tiredness I feel goes so much deeper and it’s hard to explain just how tiring it is if you haven’t experienced full blown fatigue to that level. For me, it's a profound, bone-deep weariness that a good night's sleep cannot cure. That multiple good night’s sleep cannot cure. When you are a Pain Warrior, you aren't just managing physical symptoms, you are managing your mental health too and it’s like a full-time, high-stakes job that never offers a day off. This job requires constant micro-calculations about energy, medication, and activity, leading to intense decision fatigue.
Like most people, I used to think of burnout as something that happens at the office. A condition caused by long hours, high-pressure deadlines, and difficult management. But for someone with chronic pain, the burnout felt is a much deeper, more fundamental crisis. It’s a physiological and emotional bankruptcy that attacks the core of well-being.
Unlike typical workplace burnout, this exhaustion is rooted in a constant, hidden war waged inside our bodies that never stops for us to have lunch or take any coffee breaks. And you are working 24 hour shifts. Chronic pain keeps our nervous systems in a perpetual fight or flight stress response, that is constantly flooding our bodies with cortisol and adrenaline. Over time, these alarm states wear out our adrenal systems, leading to a state often described as tired but wired, where deep rest is impossible. This is compounded by the invisible cognitive load and the endless cycle of micro-calculations necessary just to get through a day. Things like determining how much energy (or spoons) a simple task or chore will cost, or navigating medication timing to minimize side effects. This constant mental effort results in intense decision fatigue.
Furthermore, living with chronic pain forces a person through a recurring and seemingly endless grief cycle (I wrote a blog post on the 7 Stages of Grief For Chronic Pain, which you can read here:
It involves processing the loss of a former, healthy self, the loss of hobbies and activities, a career, or a predictable future. Trying to maintain a facade of a normal life while processing this profound, continuous grief is an emotionally draining process that strips away reserves, culminating in true physiological and emotional bankruptcy.
Chronic pain keeps your body in a state of fight or flight. Your nervous system is constantly stuck on high alert, flooding your body with stress hormones like cortisol and adrenaline. This is your body's survival mechanism, interpreting the constant pain signals as a physical emergency that requires immediate, high-energy readiness. Over time, this alarm state is never turned off, and your adrenal system wears out. This prolonged exposure to stress hormones deregulates the body's natural rest-and-digest functions, leaving you feeling chronically exhausted yet simultaneously restless—a state often described as tired but wired. This perpetual high-alert mode prevents the deep, restorative rest your body needs to heal, creating a vicious cycle where chronic stress exacerbates the pain, and the pain fuels the stress.
Something I’ve learned to live with is grief. Intense grief. Living with chronic pain involves a recurring sense of loss and this loss is felt over and over and over. Loss of your former, healthy self, the loss of hobbies or activities, a career, playing sports, or even just a predictable future. This grief is not like other grief, in that it is not a one-time event, but a continuous and ongoing cycle of grief. Every setback, every flare-up, and every milestone missed reintroduces the pain of what has been lost and the grieving process starts all over again. You can also be in multiple stages of grief at the same time. This kind of grief is a constant reminder because once you’ve processed one loss, another loss occurs and you are thrown right back into the grieving process again without having completed grieving for the previous loss. Processing this profound, continuous grief while simultaneously trying to maintain a façade of a normal life for the outside world is an emotionally draining process that strips away reserves. We all want to be normal and this emotional labor of constantly masking your internal struggle and mourning your old life contributes significantly to the overall emotional bankruptcy that culminates in burnout.
This is not laziness, it is a real and very valid clinical symptom. The over-activation of the stress response diverts blood flow and resources away from the prefrontal cortex, the brain's executive functioning center, to the areas needed for fight or flight. Sustained high cortisol levels impair memory and concentration, turning simple acts like forming a coherent sentence, following instructions, or remembering an appointment into monumental challenges. It is so hard to live with a brain that is like this, because there is almost no fixing it, just finding things that will help you adapt to and manage your brain fog a little better. This cognitive struggle adds another layer of profound frustration, hindering your ability to manage your medical care and daily life effectively. It’s why I need so much help with certain thinking tasks and to stay organized. Especially doctors appointments, and organizing my medication refills. Thank you mom!
This pattern is incredibly seductive: You wake up and feel okay, maybe even good, so you decide to make up for lost time. You do everything: laundry, errands, exercise, catching up with friends. You push through your body's subtle signals until you hit a wall. Then, you spend the next three days bedridden, recovering from the flare-up you unknowingly caused. This cycle is fundamentally unsustainable, creating a debt of energy that your body can never repay and rapidly leading to burnout. Even though I know all of this, I still get caught in this cycle, because there’s so much I’m behind on, I feel like I need to do as much as I can on the good days because when else will it get done.
Pacing is the practice of stopping before you need to. It’s an act of radical self-trust that requires you to actively choose rest and moderation even when you feel capable of more. Instead of waiting for a flare-up to force you to stop, pacing involves pre-emptively rationing your energy throughout the day and week. This approach stabilizes your nervous system, reduces the intensity and frequency of pain flares, and protects your precious energy reserves from being catastrophically depleted.
To make pacing work, you must adopt the mindset of long-term sustainability over short-term achievement. This can be really hard to do, especially when so many of us feel like burdens to our loved ones already, so we try and do as much as we can, often ignoring our body’s warning bells. This is encapsulated in The Golden Rule of Pacing: If you think you can do 100% today, aim for 60%. Save the other 40% for your body’s internal healing and maintenance. This reserved energy is your buffer and it’s what allows your nervous system to calm down, your immune system to function, and your body to recover from the baseline stress of chronic illness, rather than being constantly overdrawn.
By actively tracking your energy by assigning a spoon cost to tasks like showering, grocery shopping, or attending a meeting, you gain concrete data on where your energy is truly going. You’d be surprised at how many spoons you need for a day, so doing this exercise can put things in perspective so you can manage your spoons as best as you can without taking too much from the next day. Use this audit to identify your energy vampires, tasks that drain you disproportionately, and see if they can be delegated, minimized, or deleted entirely from your schedule. The goal is to move from unconscious depletion to conscious conservation.
The first and most critical step is Radical Acceptance. We need to stop fighting the fact that our body and mind are completely overwhelmed. Resisting our exhaustion only creates more tension and keeps our nervous systems on high alert, trapping us in something called the stress response loop. The stress response loop is a vicious cycle that occurs when chronic pain keeps our bodies in a constant state of fight or flight. It is much better to acknowledge our current state without judgment or guilt: "My body and mind are overwhelmed, and they deserve rest." This conscious surrender is the radical shift in perspective required as it is giving ourselves permission to stop struggling against the reality of our illness. Once you stop struggling and fighting against this, you’ll notice a huge shift in your stress levels.
Because burnout is fundamentally an overload of the nervous system, it’s important to know that when your body has been stuck in fight or flight due to chronic pain, your five senses become hyper-reactive, turning everyday input into sources of stress. To recharge, you must actively counteract this by leaning into low-input activities that soothe the physiological alarm bells. This is about consciously reducing the data stream coming into your brain. Here are a few things I have found helpful in reducing this overwhelm in myself:
Think of very gentle stretching, restorative yoga, or simply focused diaphragmatic breathing. I like to do Mindful Cooldown’s in Apple Fitness+, which are stretching videos that conclude with a meditation. I try to do these a few times a week, in addition to my fitness routine with my mother-in-law. Mindful Cooldown’s work because they are not exercises of strength or endurance, they are practices of presence and de-escalation. I also just got a little treadmill that’s more like a walking pad, and I go for “walks” using the treadmill section in Apple Fitness+. I don’t pressure myself to finish a video in one go. Instead I do about 10 minutes of walking and then pause. I’ll then continue that video the next time I’m using it. It’s also important to note that gentle stretching, for instance, should focus on releasing held tension in the shoulders, neck, and hips, not on achieving a deep, aggressive stretch. Something like restorative yoga involves passive poses held for a long time, often supported by pillows or blankets, which uses gravity to encourage deep rest and allow the body to sink out of its hyper-vigilant state.
Most importantly, diaphragmatic breathing is perhaps the most powerful tool. By practicing slow, deep breaths that expand your belly, you physically engage the vagus nerve and activate the parasympathetic nervous system. This results in a direct, physiological override of the stress hormones that have been flooding your system. A few minutes of focused, gentle breathing is a potent way to calm the physiological chaos of burnout, proving that sometimes the smallest, least strenuous movement can create the biggest shift toward healing. I use an app called Mind Llama, by the creators of Water Llama, which has you focus on deep breathing with an image that moves in and out as if it’s breathing. It’s actually very calming.
The goal is to find one small thing that reminds you who you are outside of your pain. This isn't about ignoring your illness; it's about feeding the parts of your personality that have been starved of attention. This might mean listening to a favorite podcast that has nothing to do with health, drawing for the simple joy of creation, or chatting with a friend about anything except doctors and symptoms. These acts of re-engagement with your non-pain self serve as a psychological anchor, grounding you in your true identity and providing emotional energy that the illness cannot touch.
By consciously dedicating time and energy to these activities, you are creating a crucial, protected space for personal identity to breathe. It helps to break the cycle of emotional flatlining and detachment by stimulating joy and interest that isn't dependent on physical ability. This process is vital for mental resilience, confirming that while chronic pain is a part of your life, it is not the whole of who you are.
The most important thing you can do now is rewrite the internal script that tells you to push harder. Recharging isn't a luxury. It is a clinical necessity for anyone living with chronic pain. It is the most effective form of preventative medicine you have. Give yourself the radical permission to rest, to slow down, and to prioritize your healing above all else. This process is a marathon, not a sprint, and your only job right now is to step off the track and allow your system to finally stand down.
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