"It's easy to get discouraged and pessimistic when you're in pain for a long time, but it doesn't help me. Are the apt words of someone I spoke yesterday and have been struggling with pain for years. 

It's not fair to be in pain all the time. Maybe others don't see anything in you. That others don't understand why one time you seem full of energy, and another time you perish from the pain. Maybe you can't do your job anymore. That the care for other conditions seems to be much better arranged (and reimbursed) than for you. 

Pain and depression

Partly because of these experiences we see a strong connection between pain and gloom, or even depression. Pain is depressing, and depressing feelings can give the pain more space. 

A logical consequence is that many people with prolonged pain complaints get a strong feeling that life is not going as well as it should be. The feeling that the environment makes the problem bigger and that you yourself have little influence on your pain, let alone that there can be improvement. Maybe you are getting more and more limited, because you can do less and less. Which means that you have less pleasure in life. 

In the end it's not about whether this is justified or not. It is very difficult to find out how pain occurs and which circumstances have contributed to this and to what extent. And if you do discover it - it probably doesn't change your pain that much. In short: it doesn't help to think much about that.

Exercise: Making progress

Then what helps? A focus on progress, from the point of view of your current situation. So don't compare yourself with the past, or with others, but with the present. The following exercise can help with that.

Make a list of the things you are most opposed to. These may be activities that you can no longer perform, or perhaps the way in which others deal with you. Or correct behaviour or thoughts that you recognize of yourself. A few examples:

What bothers me most is that...

I can't cycle anymore.

Nobody understands me.

I never get help from someone else, while I am ready for everyone.

That way you can make a list of the biggest opponents in your life. About ten items is more then enough at first.

Now ask yourself the question: 'How can I make progress?'. Give a number of suggestions for each section. For example:

That I can't cycle anymore.

Progress:

- Building up a physical therapist's condition 

- Practicing on an exercise bike

- Slowly build up bicycles 

Or, if you really can't manage to ride a bike right now:

- Setting up alternatives for cycling

- Build up these activities

- Working towards acceptance that cycling is now unsuccessful

See if you can find out how to make progress on the most important parts of the list. Sometimes you will be able to work towards a goal, but you may also have to let go or accept something. Or that you are looking for new contacts, who may understand how you feel. 

And the most important part of course is: execute! You can go from part to part. Try not to change too much at the same time, but to see if you can really find a good way to make progress in one of the problem areas before you start working on another problem.