Secondary Gain: A Hidden Barrier to Pain Recovery

Secondary gain refers to any perceived benefit you receive from having pain. If not identified, secondary gain gives you unconscious reasons for holding onto your pain. This does not mean you are pretending to hurt for the benefits you get, just that the perceived benefits make the pain rewarding in some ways and thus more complicated to treat. Some examples of secondary gain that might result from having chronic pain include:

• • Receiving more attention.
  • Not having to work.
  • Being excused from responsibilities.
  • Being on disability—essentially, being paid to be in pain.
  • Getting out of activities.
  • Having an excuse to take medication.

You may view secondary gain as deserved compensation for the pain you experience. These thought processes may be conscious or totally unconscious. Either way, if these beliefs remain unexamined, they may interfere with your ability to improve your condition. Taking inventory of secondary gain you may be experiencing and examining your attitudes about this is an important step in moving toward balance. In the preface of A Day Without Pain, Mel Pohl, MD, recounts the role of secondary gain in his personal story of chronic pain: As much as I hate to admit it, in some odd way, the pain I was experiencing and the consequences of having that pain served a function in my life. Actually, the pain had some surprising advantages for me. I didn’t realize it at the time, but because of my pain I didn’t have to exercise. I had a great excuse to sit around and watch TV, and, of course I had to eat while I was watching TV, which gave me an acceptable excuse for gaining weight. After all, I was in pain. In most of my conversations with friends and family, the opening line usually was “How’s your back?” A well-timed groan or moan, more often than not, elicited the sought-after sympathetic “poor Melly…” Now at the time, if you told me that any of this served me, I would have slugged you. After all, I was hurting, frustrated, furious, and miserable a good part of the time. I felt helpless, powerless, and hopeless. How could anyone suggest I was benefiting from my pain? Thankfully, not a soul dared to make such a suggestion. Without question this would have been a good reason to bite some heads off. I needed an excuse to yell and scream. As long as I stayed angry, my muscles stayed tight. The harder I tried to be powerful and overcome the pain, the more powerless and in pain I was. The more I resisted, the worse I hurt. Today my pain is still there, but it is much less. What changed? My attitude. I experience my pain in an entirely different way. I got tired of the pain, of complaining, and of being miserable. I realized that my identity was my back pain, and I had become locked in the cycle of the futile search for freedom from suffering. By my resisting, paradoxically, the hurt got worse. I learned to stop fighting and judging the pain. And, lo and behold, it disappeared—often for days at a time. One of the insights I gained was that I was experiencing something known as secondary gain. In other words, I was gaining something (attention, sympathy, support, an excuse for my inactivity) from my negative or maladaptive behaviors. Furthermore, as I gave up my resistance, I found freedom. The following is a list of categories that many of the real and perceived benefits one can receive from having chronic pain. Be sure to include the things you get, as well as things you were or are able to avoid along with one hypothetical example of each.

• • • • physical {example: I don’t have to help around the house.}
      • social {example: If I don’t show up or cancel at the last minute, everyone understands.}
      • emotional {example: If I get frustrated or angry, I can blame it on my pain.}
      • Relational {example: My family and friends pays more attention to me when my pain is bad.}
      • Professional {example: If I call in sick, I can always say it’s because of my pain.}
      • Financial {example: I receive workers’ compensation payments. It’s less money than I made when I worked, but enough to live on. I can’t do the same job, so why should I take a job that pays less?}
      • Sexual {example: My partner no longer expects me to work as hard at providing him or her with sexual pleasure.}

It’s important to look closely at secondary gain, as the perceived benefits might not be as attractive as you believe. Most of the time secondary gain is not gain at all, but loss. Chronic pain sufferers often inadvertently buy into secondary gain without looking at primary loss. Most people find they are just stuck and afraid to move forward. Once you walk through this fear, you will find you gain much more by a return to normalcy in your life. This blog post is an excerpt from Pain Recovery – How to Find Balance and Reduce Suffering from Chronic Pain by Mel Pohl, MD, FASAM, Frank Szabo, LADC, Daniel Shiode, PhD, Robert Hunter, PhD; Published by Central Recovery Press (CRP). photo credit: Jacob Barss-Bailey via photopin cc