The Boom and Bust Cycle of Chronic Pain

stock-exchange-680583_1920The boom and bust cycle describes a behaviour pattern people in chronic pain often follow. Unbenknownst to them – it is a powerful prolonger of chronic pain. Following this pattern can keep pain going for years.

The root cause of this pain often stretches all the way back into childhood. Here’s one common scenario:

Imagine yourself as a small child – perhaps five or six. One day, you do some small task. And you get praised by your parents or someone other person very important to you. Instead of tying this praise to your actions – as a young child you instead link doing a good job to being a good person. To put it another way – your identity and self esteem gets bound inextricably to how well you do a task.

You need to do a job absolutely perfectly – every time. It’s a point of pride & honour, and you don’t stop until the job is completed to your high standard. Another way to describe this personality trait are being a perfectionist or type A driven personality.

Your work ethic get lots of praise and credit from the people important to you. People rely on you – and their praise reinforces your identity as someone who does a job perfectly. It becomes entrenched as a foundation of your value as a person.


But over time, this behaviour comes at great cost to you. You start to believe that if you don’t do every task perfectly – you’re not a good person. You set the unachievable goal of perfection – and this bill needs to be paid by some part of you.

Unfortunately – it’s often your health that ends up footing the bill.

Having this constant striving towards perfection creates stress. You feel constantly dissatisfied and under pressure. Even though your to-do list would keep several people busy – it’s never enough even if you finish it.

In the end something has to give.

One of the commonest things is that – overwhelmed by stress and exhaustion – a chronic pain process gets turned on in your body. Think about it – you’re under constant (self inflicted) pressure. You have stress hormones like adrenaline and cortisol sloshing around in your system. You’re in a hyped up fight or flight mode – leaving no energy left for your body’s normal tasks of healing and maintenance.

Sometimes there’ll be a precipitating incident – like a fall or lifting something heavy. Sometimes there’s nothing you can trace it to – you simply start feeling pain.

The Boom & Bust Cycle Kicks In

Now you’re in pain. Maybe it’s back, or neck or shoulder pain. It could be a generalised pain that shifts around – often classified as fibromyalgia. You’re in pain and low on energy – but you still have the same beliefs relating to doing every task perfectly.

Here’s where the Boom and Bust Cycle kicks in.

Imagine you’ve been flat on your back unable to do anything for the last few days. In your mind you’ve been fretting – tormented by your huge to-do list. It weighs on you – sapping what little strength you have.

Then, on the fifth day you wake up – and you feel good. Amazing. One of your good days – at last.

The first thing you do is take a quick breakfast – already planning out your day and all the things you’re finally going to ‘get done.’ And you hoe into your list – full speed. It’s spring cleaning time and your first task is to clean all the windows.

Perhaps after lunch you feel a little twinge – like something isn’t quite right. But you’re so focused on finishing the task you ignore it. You finally sit down that evening to enjoy a brief respite from a day of frenetic activity – and then it hits you.

You’ve 100% overdone it. Every muscle aches. You can barely get yourself upstairs to bed. And you’re flat on your back recovering for the next four days. Until on the fifth day you wake up – and you’re feeling good again….

Do you see how this can become a self fulfilling prophecy?


For more insights on breaking the chronic pain cycle:

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(3) comments

Maria October 25, 2015

Wow that could not have been worded better just me 2 a tee how do I break this cycle how do I stop stress

Aga April 10, 2017

I can recognize some of this pattern, though in a slightly different form. As I learnt that my pain isn’t caused by a physical abnormality, I create self-imposed pressure to “have a normal life”, i.e. not giving myself any excuses to avoid any tasks or physical activities. With the long “to-do list”, I feel I can’t afford to just relax, because if I do I feel guilty to giving into the pain.

BTW, for someone who developed their self-esteem based on “doing good job” it is hard to imagine other alternative sources of self-esteem… Any tips on this?


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