12 ms·

Decisions can be tough when you have chronic pain

85 points by laurex 9y ago

specialist 8y ago
I'm open minded towards these kinds of explanations. If (mostly) true, it compliments the notions that we have a cognitive budget. Pain, chemo, aging, poverty, (bad) stress, and so forth can reduce that budget. Nutrition, exercising can increase it.
- __blockcipher__ 8y ago
  Isn’t that pretty generally accepted (at least in this community)?
- sp332 8y ago
  https://en.m.wikipedia.org/wiki/Spoon_theory https://en.m.wikipedia.org/wiki/Spoon_theory
harlanji 8y ago
After quitting my 2nd crap job in Nov I prepared to give everything I have and build a new box, but first recorded 50+ lectures in a couple months knowing that I’d be impaired by my coming poverty (now 5mo in) and look forward to again thinking how I used to think. Poverty is extreme mental anguish, and I’m not even homeless until the end of the month (never been). And yet my decision making ability is already getting weak, I can barely think beyond whatever is in working memory or beyond tomorrow, forget big parts of days despite coding and live streaming it. (Eg. I know that I’ll never perform on a coding interview now, gotta attract opportunity). It’s my 3rd time being in poverty; tangental to pain but far from orthogonal so it feels like a decent anecdote. Variety is the spice of life, without resourses to eat or travel and with social connections rejecting the majority of the time, there’s both no point to turning on that circuitry and negative reinforcement for doing so... so the fact of mental handicap in subpar circumstances feels like common sense by now. Energy conservation, homeostasis.
- deleted 8y ago
  [deleted]
- smm2000 8y ago
  Why would you do it? Why not find new job before quitting? I understand that some people can thrive when poor but it clearly does not work (based on this comment) for you.
  - xab9 8y ago
    Not op. Sometimes the environment makes it nearly impossible to do a job hunt with an active job, also one time I was "convinced" that I'm not feeling good in the team so "probably" I should quit, like, right now (they did let me close the laptop though). I managed to find an okayish job in week, but I consider that an extreme luck. Fear of poverty is a mindset, for some it's stronger, for others it's less troublesome, to me it's strongly connected to childhood memories and not trusting my abilities.
- code_duck 8y ago
  Next, imagine that you have lost your job because you are so ill that you can’t work enough, and you also don’t have any insurance or savings. Since financial success usually requires hard work, which is mutually exclusive with poor health, the anguish and hardship of poverty very commonly comes in combination with serious illness.
epx 8y ago
I did a pretty simple teeth whitening treatment. The chemicals penetrate some micropores in the tooth and "explode" there, causing pain on very small disturbances like breathing cold air trough the mouth. It was gone after one day but it was enough to make all aspects of life miserable well before I had to endure the next session. Just kept thinking "what about people that have chronic pain for months or years?!"
- jacquesm 8y ago
  That can make the top layer of your teeth brittle.
- notatoad 8y ago
  I had the same awakening when I flew off my bike into a tree a couple years back. Just ever-present pain, not debilitating but enough that it couldn't be ignored, for about a month and a half. Until then I'd never even come close to understanding the hell that chronic pain sufferers must go through. It changes everything. There isn't a choice you make that isn't in some way impacted by the pain.
curiousDog 8y ago
I've experienced this in terms of general problem solving abilities as well. A car accident has me suffering from TOS (Thoracic Outlet Syndrome) which triggers severe pain down my left arm after sitting at a desk for 20minutes. Once the pain starts, i find that my productivity and thinking ability takes a nose dive despite my attempts to look past it. Chronic pain is truly debilitating.
- __blockcipher__ 8y ago
  I’ve noticed that long hours hunched over a desk coding without good breaks/posture triggers TOS-like symptoms for me. Every few days I’ll foam roll the shit out of my thoracic spine and it helps a good bit.
- code_duck 8y ago
  Nerve damage is terrible. Are used to have a problem with my arm related to celiac, gluten ataxia. It would start going numb starting at the fingertips while I was typing, blowing glass, and then at its worst, anytime I laid her down. I would wake up with my arm completely numb. I thought it was carpal tunnel, and vitamin D seemed to help. Now I know that it was an autoimmune reaction, which was not expected. We rely on our bodies to work, and that’s that. It’s amazing how pain in one little part of the body which you otherwise never even think of can suddenly make life almost impossible.
maxxxxx 8y ago
I sometimes get migraines and am barely functioning during those times. I can't even imagine how it would be if you had something like a never ending migraine. It would be pretty much impossible to have a normal life.
- ridgeguy 8y ago
  This is my wife's lot. Chronic refractory migraines. We're looking into the recently FDA-approved monoclonal antibody (CGRP target) migraine drug. It would change her life if it even cut out 10% of her headaches. To the topic, yes, I've seen how chronic pain changes decision outcome probabilities, most often for the worse. It shortens perspective and priorities to the very near term. Pain is a useful informant. Chronic pain is a disabling phenomenon. I hope you can find relief from your migraines. Have you tried the triptan family (Sumitriptan, Frovatriptan, etc)? These are symptomatic treatments that work well for a significant portion of migraineurs.
- xab9 8y ago
  My current lap record is tension headaches for 25 days out of a full month. I just crawl home from the office :)
- stordoff 8y ago
  That's roughly where I am - constant headaches going on for a couple of years at this point, never completely going away. Incidentally, I've found the constant pain is easier to deal with - when they normalise to a constant intensity for a few days, you can tune them out to some degree. When they are fluctuating, even though you get periods of relief and the intensity is lower most of the time, it's harder to ignore when it suddenly feels like someone is driving a nail through the top of your eye. The only thing I've found that truly helps is lying completely flat - as soon as I stand back up, the pain worsens again and I start to feel nauseated.
- code_duck 8y ago
  I had a serious reaction to food almost every day, sometimes twice a day, for years from celiac. Now I know that what I was often experiencing is called an abdominal migraine, which I didn’t even know existed. Essentially, I would just put my life on hold for hours until I would crawl out of bed, blinking, shaking my head, trying to figure out what happened, and resume my day. Very true that when you spend half the day laying around in bed feeling like you’re dying, every day, it’s difficult to have a normal life.
nemo1618 8y ago
If you have chronic pain, especially back pain or RSI, please read up on TMS. I probably would have written it off as new-age garbage if not for this excellent post by Y Combinator's very own Aaron Iba: http://aaroniba.net/how-i-cured-my-rsi-pain http://aaroniba.net/how-i-cured-my-rsi-pain Actually I did write it off the first time, but after a year of wrist pain I was ready to give it a try. Within a week my pain was 90% gone, and a month after that it was just a bad memory. I consider myself very lucky; not everyone's condition can be cured this way. But there's very little downside to trying. (Sorry to be "that guy," but I figure that if even one person finds relief because of my post, it's worth the social cost.)
- graeme 8y ago
  As a counter anecdote: I tried this, gave it a willing shot, saw no improvement. Also tried a large amount of physio, ergonomic things, etc. In the end, there were four specific things that made a difference: * Trigger point massage * A specific physio who used MAT * A sit/stand desk that let me get my desk low enough, as well as standing. * The handshoe mouse (mice and trackpads had been a big cause of my rsi) Those are out of a long list that didn't work. So, if you're reading this, have rsi, and nothing has improved it: there might still be something that does. It can be a very difficult problem to assess accurately. But in my own case, when something worked, it worked near instantly. Writing this to point out that failure to resolve the problem with physical methods doesn't necessarily mean others won't work. Took me eight months to find the first two, and eight years before the problem worsened again and forced me to seek out the final two.
- code_duck 8y ago
  But what if the pain is truly warning you of a dangerous physical condition, or something that could cause irreversible damage?
  - nemo1618 8y ago
    That is a risk, I admit. You should do your best to rule out any clear structural causes for your pain. The tricky thing is that doctors will often provide structural explanations for your pain that are believable when you actually have TMS. In Aaron's story, four different hand surgeons gave him four different interpretations of an imaging scan. My advice is to only consider the TMS diagnosis after you've had consistent pain for many months. Our bodies are strong and can heal from most structural injuries in this time. A sprained wrist should not be causing you pain a year later. Lastly, you can reintroduce movement gradually. Dr. Sarno advised not resuming physical activity until the pain had already improved a bit. He also said that, of his many patients, none ever reported that resuming physical activity permanently worsened their condition.
code_duck 8y ago
I’ve dealt with chronic pain of various sorts from celiac and an esophagus condition, and this is interesting. This has held me back from growing professionally in a direct, simple to understand way. 1/3 of the waking hours that I was otherwise able and intending to work have been wasted by having fatigue and illness after eating breakfast or lunch, then I have felt sub-par for another 1/3 of my work hours. It’s hard to learn new things when you are in a daze. It seems that every time I start a project, my momentum will soon be derailed by a 1-7 day long sick spell where my body stops working and my mind suddenly feels like it is another planet. I spend days trying to recover and get back to where I was, and often just go in a new direction since it’s weeks later. This makes my output sporadic and inconsistent. I end up doing safe, comfortable work tasks with assured success, since missing so much work makes me out of practice and behind financially. Overall (and I am referring to glassblowing) I have not kept up with my peers, and mainly do styles that were popular 5-10 years ago, which is in line with the article.
- kuro68k 8y ago
  I have the same experience working in an office job. The best thing I have found is to carefully manage my energy to avoid the boom/bust cycle, but it's only partially effective. The best thing would be to simply work less hours. Say 28/week, but they would all be good high productivity ones. Unfortunately it would be a massive pay cut too, because employers don't think that way.
  - code_duck 8y ago
    The only way I’ve been able to handle this is by being self-employed. That way, when I needed to sleep for 5 hours after lunch it was up to me. Now that I know I have celiac and can manage it by avoiding gluten, I just have chronic pain and inability to eat without not all of the autoimmune madness. This is a lot less uncomfortable but I am surprisingly almost as unable to work fully.
    - xab9 8y ago
      My crohn days are over (at least for the diagnosis), but I'm with you on this one. I follow a strict schedule with eating and then just sit around (this usually means breakfast at 7am and then waiting an hour and a half, similar thing for lunch), but whenever an empoyer comes up with "team breakfast" or "early standups" I'm in a difficult situation.
cimmanom 8y ago
Given that depression is known to activate the same brain centers as physical pain, its unsurprising that some of the resulting symptoms should be similar (difficulty with decision making and learning/adaptability). Perhaps we should further investigate crossover treatments between depression and chronic pain.

85 points by laurex 9y ago

I'm open minded towards these kinds of explanations. If (mostly) true, it compliments the notions that we have a cognitive budget. Pain, chemo, aging, poverty, (bad) stress, and so forth can reduce that budget. Nutrition, exercising can increase it.

__blockcipher__ 8y ago
Isn’t that pretty generally accepted (at least in this community)?
sp332 8y ago
https://en.m.wikipedia.org/wiki/Spoon_theory https://en.m.wikipedia.org/wiki/Spoon_theory

harlanji 8y ago

After quitting my 2nd crap job in Nov I prepared to give everything I have and build a new box, but first recorded 50+ lectures in a couple months knowing that I’d be impaired by my coming poverty (now 5mo in) and look forward to again thinking how I used to think. Poverty is extreme mental anguish, and I’m not even homeless until the end of the month (never been). And yet my decision making ability is already getting weak, I can barely think beyond whatever is in working memory or beyond tomorrow, forget big parts of days despite coding and live streaming it. (Eg. I know that I’ll never perform on a coding interview now, gotta attract opportunity). It’s my 3rd time being in poverty; tangental to pain but far from orthogonal so it feels like a decent anecdote. Variety is the spice of life, without resourses to eat or travel and with social connections rejecting the majority of the time, there’s both no point to turning on that circuitry and negative reinforcement for doing so... so the fact of mental handicap in subpar circumstances feels like common sense by now. Energy conservation, homeostasis.

deleted 8y ago
[deleted]
smm2000 8y ago
Why would you do it? Why not find new job before quitting? I understand that some people can thrive when poor but it clearly does not work (based on this comment) for you.
- xab9 8y ago
  Not op. Sometimes the environment makes it nearly impossible to do a job hunt with an active job, also one time I was "convinced" that I'm not feeling good in the team so "probably" I should quit, like, right now (they did let me close the laptop though). I managed to find an okayish job in week, but I consider that an extreme luck. Fear of poverty is a mindset, for some it's stronger, for others it's less troublesome, to me it's strongly connected to childhood memories and not trusting my abilities.
code_duck 8y ago
Next, imagine that you have lost your job because you are so ill that you can’t work enough, and you also don’t have any insurance or savings. Since financial success usually requires hard work, which is mutually exclusive with poor health, the anguish and hardship of poverty very commonly comes in combination with serious illness.

epx 8y ago

I did a pretty simple teeth whitening treatment. The chemicals penetrate some micropores in the tooth and "explode" there, causing pain on very small disturbances like breathing cold air trough the mouth. It was gone after one day but it was enough to make all aspects of life miserable well before I had to endure the next session. Just kept thinking "what about people that have chronic pain for months or years?!"

jacquesm 8y ago
That can make the top layer of your teeth brittle.
notatoad 8y ago
I had the same awakening when I flew off my bike into a tree a couple years back. Just ever-present pain, not debilitating but enough that it couldn't be ignored, for about a month and a half. Until then I'd never even come close to understanding the hell that chronic pain sufferers must go through. It changes everything. There isn't a choice you make that isn't in some way impacted by the pain.

curiousDog 8y ago

I've experienced this in terms of general problem solving abilities as well. A car accident has me suffering from TOS (Thoracic Outlet Syndrome) which triggers severe pain down my left arm after sitting at a desk for 20minutes. Once the pain starts, i find that my productivity and thinking ability takes a nose dive despite my attempts to look past it. Chronic pain is truly debilitating.

__blockcipher__ 8y ago
I’ve noticed that long hours hunched over a desk coding without good breaks/posture triggers TOS-like symptoms for me. Every few days I’ll foam roll the shit out of my thoracic spine and it helps a good bit.
code_duck 8y ago
Nerve damage is terrible. Are used to have a problem with my arm related to celiac, gluten ataxia. It would start going numb starting at the fingertips while I was typing, blowing glass, and then at its worst, anytime I laid her down. I would wake up with my arm completely numb. I thought it was carpal tunnel, and vitamin D seemed to help. Now I know that it was an autoimmune reaction, which was not expected. We rely on our bodies to work, and that’s that. It’s amazing how pain in one little part of the body which you otherwise never even think of can suddenly make life almost impossible.

maxxxxx 8y ago

I sometimes get migraines and am barely functioning during those times. I can't even imagine how it would be if you had something like a never ending migraine. It would be pretty much impossible to have a normal life.

ridgeguy 8y ago
This is my wife's lot. Chronic refractory migraines. We're looking into the recently FDA-approved monoclonal antibody (CGRP target) migraine drug. It would change her life if it even cut out 10% of her headaches. To the topic, yes, I've seen how chronic pain changes decision outcome probabilities, most often for the worse. It shortens perspective and priorities to the very near term. Pain is a useful informant. Chronic pain is a disabling phenomenon. I hope you can find relief from your migraines. Have you tried the triptan family (Sumitriptan, Frovatriptan, etc)? These are symptomatic treatments that work well for a significant portion of migraineurs.
xab9 8y ago
My current lap record is tension headaches for 25 days out of a full month. I just crawl home from the office :)
stordoff 8y ago
That's roughly where I am - constant headaches going on for a couple of years at this point, never completely going away. Incidentally, I've found the constant pain is easier to deal with - when they normalise to a constant intensity for a few days, you can tune them out to some degree. When they are fluctuating, even though you get periods of relief and the intensity is lower most of the time, it's harder to ignore when it suddenly feels like someone is driving a nail through the top of your eye. The only thing I've found that truly helps is lying completely flat - as soon as I stand back up, the pain worsens again and I start to feel nauseated.
code_duck 8y ago
I had a serious reaction to food almost every day, sometimes twice a day, for years from celiac. Now I know that what I was often experiencing is called an abdominal migraine, which I didn’t even know existed. Essentially, I would just put my life on hold for hours until I would crawl out of bed, blinking, shaking my head, trying to figure out what happened, and resume my day. Very true that when you spend half the day laying around in bed feeling like you’re dying, every day, it’s difficult to have a normal life.

nemo1618 8y ago

If you have chronic pain, especially back pain or RSI, please read up on TMS. I probably would have written it off as new-age garbage if not for this excellent post by Y Combinator's very own Aaron Iba: http://aaroniba.net/how-i-cured-my-rsi-pain http://aaroniba.net/how-i-cured-my-rsi-pain Actually I did write it off the first time, but after a year of wrist pain I was ready to give it a try. Within a week my pain was 90% gone, and a month after that it was just a bad memory. I consider myself very lucky; not everyone's condition can be cured this way. But there's very little downside to trying. (Sorry to be "that guy," but I figure that if even one person finds relief because of my post, it's worth the social cost.)

graeme 8y ago
As a counter anecdote: I tried this, gave it a willing shot, saw no improvement. Also tried a large amount of physio, ergonomic things, etc. In the end, there were four specific things that made a difference: * Trigger point massage * A specific physio who used MAT * A sit/stand desk that let me get my desk low enough, as well as standing. * The handshoe mouse (mice and trackpads had been a big cause of my rsi) Those are out of a long list that didn't work. So, if you're reading this, have rsi, and nothing has improved it: there might still be something that does. It can be a very difficult problem to assess accurately. But in my own case, when something worked, it worked near instantly. Writing this to point out that failure to resolve the problem with physical methods doesn't necessarily mean others won't work. Took me eight months to find the first two, and eight years before the problem worsened again and forced me to seek out the final two.
code_duck 8y ago
But what if the pain is truly warning you of a dangerous physical condition, or something that could cause irreversible damage?
- nemo1618 8y ago
  That is a risk, I admit. You should do your best to rule out any clear structural causes for your pain. The tricky thing is that doctors will often provide structural explanations for your pain that are believable when you actually have TMS. In Aaron's story, four different hand surgeons gave him four different interpretations of an imaging scan. My advice is to only consider the TMS diagnosis after you've had consistent pain for many months. Our bodies are strong and can heal from most structural injuries in this time. A sprained wrist should not be causing you pain a year later. Lastly, you can reintroduce movement gradually. Dr. Sarno advised not resuming physical activity until the pain had already improved a bit. He also said that, of his many patients, none ever reported that resuming physical activity permanently worsened their condition.

code_duck 8y ago

I’ve dealt with chronic pain of various sorts from celiac and an esophagus condition, and this is interesting. This has held me back from growing professionally in a direct, simple to understand way. 1/3 of the waking hours that I was otherwise able and intending to work have been wasted by having fatigue and illness after eating breakfast or lunch, then I have felt sub-par for another 1/3 of my work hours. It’s hard to learn new things when you are in a daze. It seems that every time I start a project, my momentum will soon be derailed by a 1-7 day long sick spell where my body stops working and my mind suddenly feels like it is another planet. I spend days trying to recover and get back to where I was, and often just go in a new direction since it’s weeks later. This makes my output sporadic and inconsistent. I end up doing safe, comfortable work tasks with assured success, since missing so much work makes me out of practice and behind financially. Overall (and I am referring to glassblowing) I have not kept up with my peers, and mainly do styles that were popular 5-10 years ago, which is in line with the article.

kuro68k 8y ago
I have the same experience working in an office job. The best thing I have found is to carefully manage my energy to avoid the boom/bust cycle, but it's only partially effective. The best thing would be to simply work less hours. Say 28/week, but they would all be good high productivity ones. Unfortunately it would be a massive pay cut too, because employers don't think that way.
- code_duck 8y ago
  The only way I’ve been able to handle this is by being self-employed. That way, when I needed to sleep for 5 hours after lunch it was up to me. Now that I know I have celiac and can manage it by avoiding gluten, I just have chronic pain and inability to eat without not all of the autoimmune madness. This is a lot less uncomfortable but I am surprisingly almost as unable to work fully.
  - xab9 8y ago
    My crohn days are over (at least for the diagnosis), but I'm with you on this one. I follow a strict schedule with eating and then just sit around (this usually means breakfast at 7am and then waiting an hour and a half, similar thing for lunch), but whenever an empoyer comes up with "team breakfast" or "early standups" I'm in a difficult situation.

cimmanom 8y ago

Given that depression is known to activate the same brain centers as physical pain, its unsurprising that some of the resulting symptoms should be similar (difficulty with decision making and learning/adaptability). Perhaps we should further investigate crossover treatments between depression and chronic pain.