Are you coping with making and breaking commitments? It's always tough and often necessary.

I am writing this after not being able to sleep for the third night of a familiar cycle. My body hurts all over and my mind dwells on how afraid I am of feeling worse tomorrow. I think about how many things I have to do. This soon turns into a self-fulfilling prophecy: My body hurts; I worry about getting things done; my body hurts; I can't sleep; I worry I'll feel worse because I can't sleep; I still can't sleep and, guess what? I do feel worse! Sound familiar? My way of coping was to get up and write.

For me, this cycle comes into play when I have too many things to do, new responsibilities, commitments to keep, fun things planned, work to go to, all on top of the constant and often intense chronic pain that tries to take over my body. The key word for me is commitments; "easy" to make and so painful to break, thus, adding pressure to an already stressed situation. I've gotten to the point, although I am working hard on changing my attitude, where at times I'm afraid to make plans and commitments because I never know when a severe headache is coming. The pain of not making plans is almost as painful and lonely as getting the headaches and breaking the plans. I've always been an active person, with some physical limitations, but in the last four years my physical condition has worsened, causing other limitations.

I've had chronic pain since 1975, when I was 25 years old. Prior to that, I had surgery for scoliosis in 1961 and recovered nicely. After a fall in 1975, I have not had a pain free day, despite "corrective" surgery in 1981. Even with steady treatment from a variety of excellent health care professionals, I still have daily pain in my low, middle and upper back, as well as neck pain and severe headaches which began in 1982. Until four years ago, despite the pain, I was building a nice career as a vocational and personal counselor. I did volunteer work, led an active social life and enjoyed otherwise good health. I made and kept a lot of commitments; probably too many. To both the outside world and to myself, it appeared that I was fully functioning and coping.

However, I was not pacing my activities. In 1987 I "crashed and burned" from years of overdoing and failing to pace myself. With the assistance of one of my employees, I limped out of my office for good. I was even unable to attend an all-expenses paid awards ceremony in Arizona where I was to be honored for my accomplishments at work. They mailed me my plaque. Very sad. Then I was on long-term disability until last year, when I returned to a new job on a very part-time basis. I am finding that it is tough going. I am struggling to learn and implement the "pace, not race" and "cope, not mope" philosophies in all areas of my life.

Two months ago I had to temporarily stop my part time vocational counseling job due toa worsening of my condition. My boss was and is incredibly understanding. He granted me the time off and told me he wanted me to come back. I'm in a rare situation, I admit: most other jobs wouldn't or couldn't support these leave-of-absence phases. My anxiety increased to some degree when I stopped working: fear of losing the job permanently, fear of disappointing my boss and my clients, fear of not knowing how long each cycle of "work - not work" will last. Now I've decided to go back to work once again, very part-time. I've spoken honestly with my boss and we have worked out what looks like a fair and manageable schedule of responsibilities. I'll see. It helps to have the type of job I have and a boss with flexibility. I feel it is important to work, whether it is four or 40 hours. I'm learning to stop judging how much I can and cannot work and look at the work that I do as being valuable in and of itself (even if it is different than how lots of other people do it!) Any activity that you name "work" has value if there is pride, dedication, and you do your best at it.

With friends and family, making and breaking commitments is no less difficult. So many times I've made plans - a lunch or dinner out, a movie, a walk in the park, or a favor promised. Then, BINGO! A headache! Time to cancel (again), and the cycle begins: depression, disappointment, self-loathing, anger, withdrawal, eating too much. I'm not sure who feels worse, them or me. This is a painful dilemma. I don't want to make plans when there's always the possibility that I'll have to cancel. Then again, I don't want to be lonely and a hermit. Luckily, I have figured out how to talk to my good friends and explain (not complain), in a heartfelt and honest manner, what life for me is like with chronic pain. I've also charted and studied my pain patterns and know that it is safer for me to have earlier day plans than late afternoon or evening arrangements.

With my friends who work full-time, which is almost everyone, I have an agreement that the only time I'm sure to cancel is if I have a bad headache and that I will do my best to give them warning by early or mid-afternoon if I'm getting a headache so that they can either make other plans or keep in touch for a further update. Then they have a choice in the matter. It has worked out pretty nicely so far. I have loving and compassionate friends but this doesn't stop me from feeling anguish about the situation. I don't like my situation to be a constant focus and I hate feeling "unreliable," "damaged," or "different."

I'm actively working on honing some additional coping skills. I've taken a good look at all the activities I used to do. It would make anyone's head spin. I'm working on accepting, by understanding, that the past is the past. What I did for so many years was to overcompensate and deny that I do have limitations due to a structural problem. I did this so I could "fit in" and feel like everyone else. I have paid a very dear price. Though I loved a lot of the activities and all my adventures, I know that I cannot live that way anymore. Today I am learning to accept that I must go a lot slower and I am learning to be more in touch with my body and read its signals. I am learning to stop or slow down before I start to experience problems. There are lots of books and psychologists who can help with a "pacing program." I am also practicing prioritizing my choices of things to do and learning to say "no" when necessary.

Not judging myself and my current life is a challenge. I did not ask for or cause my condition. The way I choose to live my life, though, certainly can contribute either to its worsening or its stability. It is a rude awakening when you finally integrate that as part of your belief system. I've been focusing on making what I can do more enjoyable, whether I can do it for two minutes of two hours..I work on focusing on the moment, not on the memories of what I used to do or the uncertainty of my immediate future.

An example is that on days I feel pretty bad, I have movies and books to occupy myself, letters to write, friends to talk to, artwork to do. On days when I'm in the worst shape, I have daydreams to create, soft music to listen to, or a nap to take the edge off the pain. On good days, I can work at my paid job, do volunteer work, take a walk, go to a movie, do housework. It is a wonder how much easier things are when I don't judge myself on how much I am able to do or how much I'm unable to do. I'm learning to make whatever I can do be okay. To a large degree it is my attitude that makes the difference. I tell myself: "Don't deny the pain but rather work with it." As they say, "one day at a time."