Living with chronic pain is one of those battles you have to fight on multiple fronts. Beyond the physical agony, there's a silent, insidious struggle that often takes root: the cycle of procrastination and avoidance. It’s a natural, almost instinctual response to a body in constant distress, yet it can quietly magnify the very suffering it seeks to prevent. This post will explore the complex relationship between chronic pain, procrastination, and avoidance, exploring why it happens, its profound impact, and most importantly, how to break free.
Why Procrastination and Avoidance are Unwanted Companions to Chronic Pain
For those who haven't experienced it, procrastination might seem like simple laziness. But for individuals with chronic pain, it's a far more nuanced and challenging issue. Several powerful factors contribute to this pattern:
- Fear of a Pain Flare-Up: This is perhaps the most significant driver. The memory of past activities triggering excruciating pain creates a powerful deterrent. The fear of re-injury or simply making the existing pain worse can be paralyzing. Especially when just breathing or walking often cause influxes of sharp, and heart-stopping pain spikes. You begin to fear even moving or having anyone touch you. So the activities that cause the most pain are not always on the top of my list, even if they are necessary for basic survival.
- Example: A person with chronic back pain might continuously put off cleaning their house. The thought of bending, lifting, and stretching conjures vivid memories of past pain flares, making the "safer" option to do nothing at all. I struggle with this. Because the pain is in both legs, as well as my neck and back, basic movements cause incredible amounts of pain, so doing things that require lots of bending over, crouching, standing on my feet and arm movements, all cause me a lot of pain. Pain that I then have to recover from. It makes doing anything harder and some days I just can’t handle any more pain.
- Coping Strategy: Graded Exposure. Start with a tiny, almost ridiculously easy version of the feared activity. If cleaning the whole house is overwhelming, start by wiping down one counter. The next day, perhaps unload the dishwasher. By gradually and gently reintroducing activities without causing a major flare-up, you can slowly retrain your brain to disassociate movement with pain. What also works well for me is scheduling that exposure. I make a commitment to myself to do the task or chore at a certain time of the day, and when that time comes up, I count backwards from 5 (thank you Mel Robbins for your 5 Second Rule!) and then start the task or chore.
- Pain-Related Fatigue and Brain Fog: Chronic pain is exhausting. The constant barrage of pain signals drains both physical and mental energy. This often leads to "brain fog," a state of cognitive impairment that affects focus, memory, and executive function—the very skills needed to initiate and complete tasks. This is something I really struggle with. My brain is impacted significantly because of the high amount of pain I’m always in, as well as the medication I’m on. It all causes my brain to have to work extra hard to do simple things. Your brain actually creates new pathways that go around the areas of the brain that are impacted by chronic pain, meaning it takes longer for your brain to process and complete simple tasks.
- Example: Someone with fibromyalgia might struggle to pay their bills on time. The mental effort required to organize paperwork, log into online accounts, and track finances can feel insurmountable when grappling with widespread pain and cognitive difficulties. Doing anything challenging with a deadline is usually where I get caught with time blindness, and then end up rushing to finish. Recently I had a custom graphics job I was doing for a local club here, and I made sure I was super organized so I could get the job finished long before the deadline. It felt good to be organized for a change and not rushing at the last minute.
- Coping Strategy: The "Two-Minute Rule." If a task takes less than two minutes, do it immediately. This bypasses the executive dysfunction that can make even small tasks feel monumental. For larger tasks, break them down into two-minute chunks throughout the day. This is where the new to me concept of Mel Robbins’ The 5 Second Rule comes in. They say it takes your brain 5 seconds before it starts to talk you out of doing something you need or want to do but that might make you nervous or anxious. By counting backwards from 5, then starting the task, you trigger the prefrontal cortex in your brain, and you make the decision to start doing the task before your brain has time to talk yourself out of it, saying to yourself you’ll do it later, or talk yourself into an anxiety attack about it.
- The "Good Day/Bad Day" Cycle: Living with chronic pain often means unpredictable fluctuations in symptoms. This can lead to a boom-or-bust cycle of activity. On a "good day," there's a frantic rush to get everything done, often leading to overexertion and a subsequent "bad day" (or several) where even basic tasks are impossible. This reinforces the idea that activity leads to pain. This is really hard to manage because on the days you feel good, you often need to catch up on things that you didn’t do during a pain flare or bad day. Things still need doing despite how your pain is impacting you at that moment, so it can be hard to not overdo it on your good days.
- Example: A person with rheumatoid arthritis might feel relatively good one morning and decide to do a week's worth of grocery shopping, laundry, and gardening. The next day, they are in so much pain and so fatigued that they can barely get out of bed, reinforcing the connection between activity and suffering. This is something all pain warriors get caught in. We feel badly that we can’t do these things every day, so on the days we can, we want to do as much as we can, but then it takes time to recover. I feel like I’m always playing catch up.
- Coping Strategy: Activity Pacing. Instead of doing as much as possible on good days, aim for a consistent level of activity every day, regardless of pain levels. This involves breaking tasks into manageable chunks and taking scheduled breaks, even if you feel you could do more. This helps to even out activity levels and prevent the boom-and-bust cycle. I have an app that helps me with this, and I look at it in the morning, to see what needs done, and then I chip away at it over the day. I like to try and get these things done in the morning so that I have the afternoon to do as I like.
- Fear of a Foggy Mind: The Anxiety of Making Mistakes: The "brain fog" that so often accompanies chronic pain isn't just about feeling tired or unfocused; it can trigger a profound and specific type of anxiety. It's the fear of cognitive failure. When your mind feels unreliable, tasks that require mental clarity become terrifying hurdles. This fear is multi-layered: it's the fear of making a critical mistake, of forgetting crucial information, of becoming confused during an important conversation, and the deep-seated fear of the embarrassment and judgment that might follow. The anxiety itself can then intensify the brain fog, creating a vicious feedback loop where the fear of getting confused makes you even more likely to get confused. I suffer severely from this fear of cognitive failure, specifically when using the phone, and it’s something that I actively work at every day. I worry about embarrassing myself, or looking incompetent or like I’ve lost my mind, and it causes me a lot of distress.
- Example: An individual with chronic Lyme disease might need to call their pharmacy to sort out a complex medication issue. They put it off for days, not because of the physical pain of holding the phone, but because they are terrified of forgetting the doctor's instructions, mixing up medication names, or not understanding the pharmacist's questions. They dread the potential of sounding incoherent or making a mistake that could impact their health, and the sheer anxiety of the possibility feels paralyzing. I am on the phone with the pharmacy at least once a week, sorting out my meds, and it’s taken me a long time to get to a place where I can call them without stressing out. A longtime friend of mine is also calling me once a week so that I can practice talking on the phone.
- Coping Strategy: Pre-Task Preparation and Scripting. Before engaging in a mentally demanding task, take the pressure off your brain by putting all the information onto paper. Write down a simple script, a list of key questions you need to ask, important numbers or names, and the main goal of the conversation. This external "hard drive" reduces the fear of forgetting and provides a concrete anchor to return to if you feel confused or anxious. It allows you to enter the situation with confidence, knowing you have a safety net. My mom helps me with this when I need to make phone calls. She makes sure I have all my questions written, and points I want to make, and then I follow that in the call.
The Vicious Cycle: How Procrastination and Avoidance Take Hold
Procrastination and avoidance in chronic pain are not isolated events; they are part of a self-perpetuating cycle that can be incredibly difficult to escape. It often looks like this:
- Anticipation of Pain: A task needs to be done, and immediately, the brain anticipates the pain it might cause.
- Anxiety and Fear: This anticipation triggers anxiety and fear, flooding the body with stress hormones.
- Avoidance/Procrastination: To escape these negative feelings, the task is put off. This provides immediate, short-term relief.
- Increased Pain and Stiffness: The lack of movement from avoidance can lead to muscle deconditioning, stiffness, and ironically, more pain.
- Guilt and Low Mood: The undone task lingers, creating feelings of guilt, frustration, and helplessness. This can contribute to depression and anxiety, which are known to amplify pain perception.
- The Task Becomes More Daunting: The combination of increased physical discomfort and negative emotions makes the original task seem even more overwhelming, reinforcing the desire to avoid it.
Example of the Cycle in Action: A person with chronic migraines needs to go to the grocery store. They anticipate that the bright lights, loud noises, and physical exertion will trigger a migraine (Anticipation of Pain). This thought causes their heart to race and a sense of dread to set in (Anxiety and Fear). They decide to wait until they "feel better" (Avoidance). Because they haven't left the house, they miss out on gentle movement and fresh air, and their neck muscles become tighter from stress (Increased Pain and Stiffness). They feel guilty about not having food in the house and frustrated with their limitations (Guilt and Low Mood). Now, the thought of the grocery store is coupled with both the initial fear and the added emotional weight, making it an even more formidable task (Task Becomes More Daunting). I am certainly guilty of this. Guilty of not wanting to do a task or activity because I know what the fallout is going to be and my brain wants to avoid it. But that’s not sustainable.
Breaking the Cycle - Coping Strategy: Cognitive Behavioral Therapy (CBT) Techniques. CBT helps individuals identify and challenge the unhelpful thought patterns that fuel this cycle. A key technique is cognitive restructuring. This involves recognizing the thought ("Going to the store will give me a migraine"), examining the evidence for and against it, and replacing it with a more balanced thought ("Going to the store might be challenging, but I can take breaks, wear sunglasses and earplugs, and go at a less busy time. I have managed it before.").
The Ripple Effect: How Procrastination and Avoidance Impact You and Others
The consequences of this cycle extend far beyond the individual, creating a ripple effect that touches every aspect of life.
Impact on You:
- Physical Decline: A sedentary lifestyle resulting from avoidance leads to muscle atrophy, decreased flexibility, and weight gain, all of which can exacerbate chronic pain conditions. It’s why it’s so important to keep moving. Last week I expanded my exercise routine from doing 2 days a week with my mother-in-law over the last couple of years, to doing 7 days a week. On the days I don’t exercise with Paul’s mom, I exercise by myself. It’s really helped me in so many ways, both mentally and physically, and is something I enjoy doing. It took me 15 years for me to believe in myself enough to start a small exercise routine. I had definitely talked it up in my head as being something that I couldn’t do. Boy am I ever glad I stopped listening to myself, because exercising has helped with my balance, my endurance, and my pain.
- Worsening Mental Health: The constant stress, guilt, and sense of powerlessness can lead to or worsen anxiety, depression, and social isolation. You may even feel embarrassed about this so you don’t reach out. Embarrassment fuels my avoidance and procrastination and is something I worry a lot about. My brain works differently than it used to, and I’m very self conscious about that.
- Loss of Independence and Identity: Relying on others for tasks you once did for yourself can lead to a loss of self-esteem and a feeling that your identity has been stolen by your pain. You also don’t want to feel like a burden to your family and friends. The guilt and shame felt when you are limited physically and mentally, can be overwhelming and contribute to procrastination and avoidance. When you have to rely on others to do many of the things you used to be able to do with no second thought, it can make you feel embarrassed, useless, impact your self esteem, and may mean you withdraw into yourself or fall back on older, unhealthy habits. This is something I have to be very careful of. When I’m not doing well, I typically retreat into myself, but the past couple of years I have been working on that and have made vast improvements.
Impact on Others:
- Strained Relationships: Family and friends may initially be understanding, but over time, resentment can build as they take on more responsibilities. They may struggle to understand the invisible nature of chronic pain and misinterpret avoidance as laziness or a lack of care. Even the most understanding of family and friends may feel this way.
- Example: A spouse who consistently has to do all the yard work and home repairs because their partner with chronic pain avoids these tasks may start to feel like a caretaker rather than a partner, leading to emotional distance.
- Social Isolation: Regularly canceling plans or avoiding social gatherings due to fear of pain can lead to friends and family eventually stopping to extend invitations. This deepens the individual's isolation and can create feelings of being a burden.
- Example: A person with chronic pelvic pain might repeatedly turn down invitations to go out for dinner with friends because sitting for long periods is painful. Eventually, the invitations may become less frequent, not out of malice, but because friends assume the answer will be no.
Coping Strategies for Mitigating the Impact:
- Open and Honest Communication: Have frank conversations with your loved ones about your limitations and the reasons for your avoidance. Explain that it's not about a lack of desire, but a legitimate fear of pain. Use "I" statements, such as "I feel scared to go for a long walk because I'm worried it will cause a pain flare that will last for days." Communicating is SO important because we are not mind readers, and oftentimes feeling overwhelmed and stuck in procrastination and avoidance, looks like laziness or a lack of wanting to help. So it’s important to communicate all of that.
- Involve Others in Your Coping Strategies: Share your activity pacing plan with your family. Let them know that you are breaking down tasks and that their support in respecting your scheduled breaks is crucial. This can help them feel like part of the solution rather than just picking up the slack.
- Focus on What You Can Do: Instead of dwelling on the activities you're avoiding, find alternative ways to connect with loved ones that are within your current capabilities. If a long hike is out of the question, suggest a short, gentle walk in a park or watching a movie together at home.
A Path Forward: Embracing Compassion and Action
Living with chronic pain is an immense challenge, and the added layer of procrastination and avoidance can feel like an insurmountable obstacle. The key to breaking free lies not in forcing yourself to "just do it," but in approaching yourself with compassion and taking small, intentional steps. Small steps, repeated over time, become habits, that become a natural part of your day, that for me, I look forward to.
Start by acknowledging that your tendency to procrastinate is a protective mechanism, not a character flaw. From there, you can begin to gently challenge your fears with manageable actions. Celebrate the small victories—washing a single dish, walking to the mailbox, making that phone call. Each small step forward is a testament to your resilience.
Breaking this cycle is an ongoing journey, and one that pain warriors have to constantly work at. There will be good days and bad days, but by arming yourself with knowledge, practicing self-compassion, and implementing these coping strategies, you can reclaim a sense of control and begin to build a life that is not defined by what you avoid, but by what you choose to embrace.
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