When I reflect on having fibromyalgia, chronic migraine disease and Major Depressive Disorder I see this as a Perfect Storm of stress and unmanaged pain. You cannot cope because your pain isn’t managed and you are not able to cope emotionally or mentally to that level of pain which then worsens your mental illness. And then you burnout.

I have written some posts on this before

Chronic illness: Work burnout
Chronic stress and the body
Thinking about depression and fibromyalgia
Survival mode is not meant to be lived in

Mental health and chronic pain: pain tangled with depression

Reflecting on survival mode

Survival mode is when you have too much unmananaged pain and are still trying to function with it… such as working full-time, yet completely unable to do so. You are running on fumes every day and every aspect of your life gets cut out so you can do this One Thing. But even that One Thing is impossible to do with that level of pain, yet you push through and push through.

Maybe you push through the chronic pain because:

  • You have no choices and need to have an income
  • Because your insurance company fails to see you as disabled
  • Because you personally feel obligated to pull your own financial weight
  • Because you want to hold onto your career
  • Because you Hope that treatment will come some indefinite time in the future and you just need to hold on until then… but it never happens
  • And other various reasons

This is a high stress situation. High stress on the body. High stress mentally and emotionally. It is not meant to be lived in long. I did for quite some time and the only reason I managed it for so long is because I had sporadic short-term leaves in there for various medical reasons, which I must say your employer will not like.

So I survived but every day- every inch of every day was a struggle. So my productivity began to falter. I began to miss a lot of work. When I was there it was more presenteeism- there but not There- trying to think through the pain and haze and just not doing well at all.

Chronic pain can then be tangled with mental illness like depression

I was told my depression was basically triggered and caused by my chronic pain but because I was under such immense stress and living with such unmanaged pain for such a long time the depression because so much deeper and darker- and its own massive beast.

You add this to the severe high level of pain you are enduring and not coping with well under survival mode and depression decreases your capacity to cope further. It sucks all hope from you. Motivation to work in that much pain begins to seriously lag. It becomes a real struggle to just get out of bed in the morning. And do basic things. Let alone force yourself to work when you know how painful that will be. How much pain you will have to endure.

Suicidal ideation becomes like this fantasy of the pain ending. Like maybe I will just have a fatal stroke or heart attack and not have to go to work one more day. Or maybe I will go into a coma and have a long break from work and pain and everything. You do not want to end your life. You want to end the pain. And there is no options presented to you to do that. No hope given to you to even help you with the pain. You see No end to the pain and suffering and struggle. And it is torture.

Then comes suicidal intent. Thinking about plans. How to do it. When to do it. How much relief it will be to finally end the pain. If thoughts are the RED FLAG then Intent is the BLARING ALARM for immediate help needed. We need to see our psychologist. Call 911. Go to the hospital. Make ourselves SAFE. I didn’t for my first attempt but I did for the second… because I was beginning to figure things out.

Suicide Hotlines

Sadness and pain

When chronic pain becomes tangled with depression

I think burnout is inevitable when we have unmanaged chronic pain and severe depression. I think we cannot cope with that level of stress on our bodies, mentally and emotionally on our minds. No matter the coping skills we have, we cannot get ourselves out of this tangled mess because the situation is far too much to handle. Far beyond anyone’s capacity to cope with. And the stress inevitably gets to that burnout state fast. And maybe you get a short term leave that helps you relax for a moment in time. But as soon as you are back you get to the cusp of burnout fast again because this cannot be coped with.

What the hell is a person supposed to even do?

The main problem is we have to be aware a) we are in survival mode b) our mental health is suffering due to it c) we are on the cusp of burnout d) we cannot handle it and something must change.

When you realize all this and that some states of affairs must change then you have to reflect carefully on What must change in your life to make you capable of living without this constant unlivable level of stress on you.

This may mean very difficult compromises

  • You may realize that your job is inherently too stressful and you have to change jobs altogether.
  • You may realize you are incapable of working full-time and go down to part-time
  • You may realize you need flexibility in your work in order to work With your chronic pain and illness such as flexible hours or work from home options
  • You may come to the conclusion you can no longer be in the workforce at all

And once you decide on a compromise you still have to deal with the tangle of chronic pain and depression that have developed from years of pushing through the pain and the abundance of stress you endured for so very long.

This may require:

  • Seeing a psychologist for your mental health and pain management strategies
  • Getting medication for your mental illness issues
  • Getting pain management or going to a pain clinic and learning new pain coping strategies.
  • Learning stress reduction strategies
  • Going on a medication to help manage the pain
  • During this treatment you may not be able to work as it can take some time to adjust to treatment and new coping strategies

Your stress threshold

Upon reflection I think migraine disease and fibromyagia make me very, very sensitive to my environment. Too MUCH muchness. Too loud. Too Bright. Too sensitive to all stimulus. It is easy for my body to respond to environments like that by amping up my pain. And getting more frequent migraine attacks. And more intense migraine attacks. And more fibromyalgia flares. I do not believe my body handles physical enviromental stressors well and I cannot control my environment to the extend I Need to in order to help with this issue. Unless I work from home.

Also this heightened nervous system seems to make me have a low stress threshold. Now, I have always functioned well with positive stress. It helps with deadlines and gets things done. But negative stress, on the other hand, can rapidly make me feel overwhelmed due to the pain levels I am in which leads to an emotional response of frustration and depression and like I am getting nowhere no matter what I do. And like I am a failure no matter what I do. This trigger point for being Overwhelmed seems to be lower and lower the higher the pain levels I endure. And lower and lower the worse my depression gets. And then I am well on my way to burning out.

If we understand our bodies and know our bodies and our minds have this low stress threshold then we can make choices that work with our bodies. We can engage in specific stress reduction techniques that work for us. We can work jobs that fit specific criteria that works for us physically and mentally.

This is clearly difficult. I couldn’t figure it out. I kept bashing my head against the same impossible wall and burning out. I did eventually do down to part time when I had no choice (at the point when my doctor, my psychologist, and my family all said I should Not be working at All) And this change modestly helped. Not as much as you would think. The job change was into one I found actually more stressful to my brain. I made more errors. My migraine brain in high pain got confused a Lot. I forgot a lot of things. I couldn’t focus. This was not the job for me but the hours were good for me. So I thought it a decent compromise. However, I then got significantly worse physically in a Different and unexpected way with a vestibular condition and had to become disabled because I literally had no choice.


Being disabled is a bit of a boon to coping and stress reduction. One can control one’s environment. You can focus on your well-being and stress reduction. You can work on pain management and rest and recover when needed. You do not feel that raw desperation of having to function under extreme pain levels. You just rest when you need to rest.

The fact I am not very functional tells me how hard I was pushing over my limits all the time. I have a lot of pain that lays me out-often. And to know I worked through that it doesn’t surprise me I was way too stressed, depressed, overwhelmed, and unable to cope. Being able to rest when pain is high and do the things that help with it helps immensely with pain management. And stress management. And mood management. One is never financially stable ever again though so that is a new stress. But you can manage things better. You can finally have acceptable and cope better. Even though my functionality with the vertigo on top of the chronic pain makes functionality very low… I am still in a better mental head-space and have better acceptance. I am capable of less but coping better. Because I am not forced to exceed my limits every single day over and over until I just-break.

However, that is not to say we are not capable of working with chronic pain. I just think we have to be rather choosy of where we work and the environment and atmosphere that place has. Does it work with us? Or against us? We have to have stress management that works for us Down. We have to have some sort of effective pain management in place. We have to have any mental illness being managed or treated with medication. Any factor out of place leads to imbalance which leads to stress getting out of control and… then things can get bad from there.

It makes it very hard to find that perfect balance of work life and chronic illness life. That balance is hard to find. If we can’t find it we falter. We become less reliable and dependable because we cannot manage the pain and work at the same time. We blame ourselves for that. But we are not to blame. Chronic pain is one of those things that is aggravated by doing things for long periods of time, and stress due to trying to think through the pain and trying to function through the pain, and dealing with the immense fatigue- the cost is massive and work just makes the cost so much more. In a way that employers cannot seem to comprehend such that sometimes they contribute to the stress by making the situation so much worse.

In my work-life, I know what bad looks like. I know working with pain. I know what horrible looks like; working with severe pain in a bad work atmosphere where I burned out and became severely depressed. I have no clue what good looks like. Work always increased pain, and then stress. It was a necessary evil. I may have liked it mentally- the work itself- but it always harmed my capacity to cope. If I am ever capable of working again, which I do hope is one day possible, I will be exceptionally careful one who and where I work and what I do. Well-being will be far more important a factor than it might be for others. A necessary factor. And I will dip my toe in and test the waters to see if my capacity to cope with pain and the stress of pain is sufficient to balance with work.

See more on related topics

Chronic pain: fake it till you make it
The worst lesson pain ever taught me
Chronic pain and mental health

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