Everyone with a chronic issue has identified stressors (biological, psychological and social) that act as triggers. Previously, in a post about headaches, I wrote about how triggers were cumulative but there’s another aspect to them that deserves to be looked at.
In regards to migraine I wrote“sometimes what will trigger a migraine on one day may not trigger it on another”. That seemed to cause some confusion so I'll explain. Let’s broaden out a bit beyond migraines though. The same idea holds true for anyone with a chronic pain, anxiety, CRPS, headache, depression, arthritis, cardiac conditions etc. This is how it works:
You get up on a Sunday, the sun is shining, you’re going for a picnic with your family and you’re in a good mood. You have a shower, go back into the bedroom to put on clothes and stub your toe on the wardrobe. “Oh F#!@” you yell, grab your toe and check your nail. You move on quickly though “Where did I put the corkscrew and I suppose we’ll need a blanket………
Alternatively, you get up on Monday, it’s grey and raining. A full week of work ahead and you’ve got to spend the first part of the morning with your boss in a meeting. Mood - not so great. You have a shower, go back into the bedroom and stub your toe on the wardrobe again. “Oh F#!@” you yell, grab your toe, check your nail, just like you did yesterday but you don’t move on this time. Instead you begin talking to yourself “jeez that was stupid, what a way to start my week” or “I can’t believe I did that, that bloody hurts, I probably won’t be able to walk properly for the rest of the day”.
It’s all a bit harsh and you’d never say that stuff to a friend (you might slag them off a bit but you’d be sympathetic, I hope). You’re quite happy saying it to yourself though.
What’s important to realise is that not only does the pain feel seem to feel worse on Monday; it is, you’ve actually changed the way your body processes the sensation. The chemicals and the pathways that you use to transmit the pain signals have been altered because your mood is different, not to mention the negativity around telling yourself that you’re “stupid”.
So in addition to the triggers being cumulative (see the last post) you have a situation where the same trigger at two different times can have a completely different impact because of the mood you’re in.
We’ve only talked about a situation where you can easily see the trigger i.e. in this case it’s immediately painful but the same holds true for any trigger whether you are conscious of it or not. Let’s take a food additive that has routinely caused trouble before:
You’re out to dinner with your nearest and dearest and the chef has put ‘that’ additive in your dish but it doesn’t trigger anything (you’re relaxed and the future looks good). Now the following evening you’re at home cooking after a tough day at work. You accidently include ‘that’ additive but because you’re tired and cranky this time, it acts as a trigger. The sum of it and all the other potential triggers you have encountered that day and …ouch!
Or here’s another:
You’ve got to give a presentation at work that afternoon. Normally that’s enough to cause you to have a panic attack/anxiety episode (you don’t like public speaking) but you are going out with friends later that evening. Because you are looking forward to going out, you’re feeling a bit more upbeat than usual and the anxiety doesn’t trigger the panic (this time).
You get the idea, it’s not just the stressor it’s how you perceive the stressor or in this case, the mood you’re in when you perceive the trigger.