What Is the Spoon Theory Metaphor for Chronic Illness?

If you live with chronic pain, you know how debilitating it can be. Some days, you wake up with no energy at all; every little action takes an unbearable amount of effort.

“Spoon theory” is a way for people who live with chronic pain to express how health issues impact their ability to complete everyday tasks and activities. Clinical psychologist Becky Bikat Tilahun, PhD, explains spoon theory and the relationship between chronic pain and activity.

What is spoon theory?

Being in pain is exhausting, and if you live with chronic pain, you may find yourself having to carefully manage your daily activity levels to accommodate and anticipate your pain levels. That pain — and the logistics of managing it — can have an impact on your mental and physical bandwidth.

Enter spoon theory, developed in 2003 by writer Christine Miserandino. To explain how having lupus impacts her ability to perform daily tasks, Miserandino created an analogy about having a limited number of daily “spoons.”

People with chronic pain, she says, start each day with a set number of proverbial spoons, each one representing the physical and mental energy it takes to complete a daily task or activity. Smaller tasks, like showering or getting dressed, may cost only one spoon, while larger tasks, like cooking or vacuuming, may take three or four spoons. On days with increased pain, even smaller tasks may require multiple spoons.

“The spoon theory is a self-pacing strategy that emphasizes the need for chronic pain patients to work to a certain quota,” Dr. Tilahun says. “Patients have to be economical in how they spread the use of their spoons in their daily activity.”

Imagine, for example, a mother who lives with chronic pain. If she uses all of her spoons on daytime tasks, she’s left with no spoons to tend to her children at night. But she has to take care of her kids — so she pushes beyond her limits, borrowing spoons from tomorrow’s set amount to make it through today.

She’ll have to pay for it tomorrow, though, when she starts out with fewer spoons for all of that day’s activities and tasks. Today’s overexertion will result in tomorrow’s pain, fatigue and inactivity.

What is a “spoonie”?

People who live with chronic pain and subscribe to spoon theory may refer to themselves as “spoonies.” But the term isn’t limited to any one medical condition. Rather, it’s a way for anyone who lives with chronic pain to explain the way they ration their energy based on their illness.

Some chronic illnesses associated with chronic pain include:

• Back pain.
• Fibromyalgia.
• Lupus.
• Migraines.
• Rheumatoid arthritis.

And spoon theory isn’t just for people with physical ailments. It can also be a helpful way for people with mental health conditions, including anxiety and depression, to think about their daily capacity.

The science of chronic pain

Research shows that chronic pain can have wide-reaching impacts on physical and mental health.

“Chronic pain can interfere with normal brain activity, suppressing brain function such as motor coordination and learning,” Dr. Tilahun says. “Chronic pain can also disrupt the normal brain’s communication by causing sensitivity, so that even when the injury or illness that caused the initial pain ceases, the pain may endure.”

Other issues associated with chronic pain include:

• Limited energy levels.
• Difficulty with focus and concentration.
• Sleep disruption.
• Interference with sexual activity.
• Emotional distress.
• Social deprivation.

How chronic pain impacts daily life

While most people have unlimited energy to complete their daily responsibilities — including getting up in the morning, doing household chores, going to work and maintaining a social life — people with chronic pain have limited energy to perform those responsibilities without triggering a pain flare-up.

“Chronic pain patients walk a fine line between under-exertion and over-exertion when it comes to their daily engagement with activity,” Dr. Tilahun says.

Under-exertion means avoiding activities for fear of triggering pain and exhaustion. Over-exertion is when you engage in excessive activity, which can trigger a pain flare-up that impacts your capacity for the days to come.

Chronic pain = good days and bad days

“Most people with chronic pain experience good and bad days, as their pain intensity varies depending on the day,” Dr. Tilahun explains. “On a good day, they tend to overwork, which is followed by several days of ‘crashing,’ or feeling fatigued and in pain.”

To avoid these extremes, patients have to learn to balance their activity level each day, minding their limited energy and not exceeding their daily limits of activity.

How to manage your daily spoons

Even though chronic pain cannot be cured, there are strategies and treatments that can help you learn to live with it.

“Studies show that with the right interventions chronic pain patients can improve their tolerance of the pain and restore their normal function,” Dr. Tilahun says.

1. Physical therapy: Seeing a physical therapist for pain management can teach you exercises and other strategies to strengthen your body and lessen your pain.
2. Medication: Your doctor may prescribe medications to treat your chronic pain, as well as to address the depression and anxiety that often accompany it.
3. Psychotherapy: Research shows that therapy can help people with chronic pain learn to better cope with the ways their condition impacts their life.
4. Mindfulness meditation. “This kind of psychological intervention can help patients develop an accepting attitude toward their pain,” Dr. Tilahun says.
5. Complementary medicine: Combining conventional treatment with alternative therapies like acupuncture, massage and chiropractic care may alleviate some of your pain.
6. Pain management programs: These programs can help you learn coping mechanisms by incorporating many of the strategies listed above.

“Based on the cause and nature of your pain, a comprehensive interdisciplinary approach — one that combines medication, physical therapy and counseling — can help most patients to rehabilitate and restore their function,” Dr. Tilahun says. “With the right interventions and therapies, their quality of life can be restored despite the pain.”