
Decisions can be tough when you have chronic pain - laurex
https://www.futurity.org/chronic-pain-decision-making-brains-1761342-2/
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harlanji
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.

~~~
smm2000
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
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.

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nemo1618
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.)

~~~
code_duck
But what if the pain is truly warning you of a dangerous physical condition,
or something that could cause irreversible damage?

~~~
nemo1618
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
It seems that this is fairly specific to certain types of chronic pain. In my
case, I did my best to overlook, work around and ignore discomfort and pain
for years, and that was a grave mistake. I was very good at it and suffered
for a long time, over twice the average time that people go undiagnosed. The
medical system also failed to accurately diagnose me several times when they
had the chance. This delay in treatment may have created permanent nerve and
digestive system damage that could have been avoided.

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code_duck
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
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
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
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.

~~~
code_duck
My schedule in the undiagnosed celiac days was to get up, and only drink
coffee instead of breakfast since food made me intensely exhausted. Then I had
good productivity until lunch. After lunch it was a tossup whether I’d be
basically okay, a little slowed down, feeling like a nap, or incredibly
exhausted and feeling like I was dying. At some point I found that drinking
only alcohol for lunch left me feeling less horrible than food, on average,
and that was puzzling, somewhat convenient and not helpful.

Work gatherings based around food are a huge problem, now and then, in several
ways. For various reasons, I always got felt sick after eating at restaurants.

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epx
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?!"

~~~
notatoad
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.

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curiousDog
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.

~~~
code_duck
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.

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maxxxxx
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
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.

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cimmanom
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.

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specialist
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.

~~~
sp332
[https://en.m.wikipedia.org/wiki/Spoon_theory](https://en.m.wikipedia.org/wiki/Spoon_theory)

