Understanding pain and setting goals
Chronic Pain and Physiotherapy
To understand pain, you must keep the following points in mind:
What does this mean? Second by second, the brain filters a huge variety of information to judge whether pain is appropriate and helpful. Messages from nerve cells, hormone and immune responses, emotions, thoughts, beliefs, past experiences and environmental cues are all involved.
With chronic pain conditions, the body's tissues and nerves begin to respond in a different way. It is as if the body and brain become extra-sensitive to signals that suggest danger. The brain's cautious, concerned response increases and spreads pain, and often fatigue as well.
Self-management strategies address this complex interaction. Understanding how pain works within the body can help in developing skills that regulate the system. Generally, self-management incorporates five major skills.
With self-monitoring, you learn to track and monitor patterns in your experience. This includes using graphs to track pain level and activity level. When and what you eat, when and how you sleep and your mood all play a role. It is easy to underestimate the variety of body and brain experiences that are interpreted as challenges. For instance, hours of food deprivation challenge your body, yet many people with pain will skip breakfast if they do not feel hungry.
Self-monitoring is especially useful when making changes to your pain management plan. Be a 'curious scientist.' Measure your experience to judge whether the change has been effective.
Pacing can be thought of in many ways. Often people say they try it and fail. To work well, pacing must be properly targeted and specific. Effective forms of pacing include adapting, alternating and shaping activities.
Adapting activities means using the best tool aids (such as a reacher) and postures to make tasks as easy as possible. The more you reduce the demand of a task on your body, the more you can tolerate without increasing pain.
Alternating activities is the most commonly used approach to pacing. You can alternate either:
As with all self-management strategies, a proactive approach works best. Look at the demands of the task. Next, break it up into reasonable chunks or periods of time. Explore how long you need to pause, and how to make your rest effective.
Understand that good pain management (and good pacing) is not more productive. Without pacing, you might be highly productive but then suffer days of pain and down time. The idea is to stay adequately productive without making pain worse.
Shaping behaviours or activities is the third pacing strategy. With chronic pain, the brain quickly reacts to increasing demands or changes in activity level. As a result, you may feel pain increasing when you try to do more or different things. The problem is that those with chronic pain often double an activity without thinking about it. With weight training, the maximum recommended increase of weight or repetitions is 10 to 25 per cent. Many people try increasing by 100 to 200 per cent, spiking pain levels.
To use the shaping concept, increase the activity you want to do very gradually. This approach can be challenging because the increases are so gradual. It seems minimal and ineffective. Remember that you are building from a starting point. Over time, likely months, change will happen. Slowly and surely, you can dramatically improve your quality of life.
Relaxation strategies offer a variety of benefits. Using them, you can consciously choose to alternate between other activities to help with pacing. Relaxation techniques directly affect arousal of the sympathetic nervous system (stress system) and general nervous system wind up.
A number of relaxation strategies are effective in managing pain. They range from breath focus to muscle tension reduction to imagery. Accept that your mind will wander as you try to relax. Once you notice that you are drifting, bring your focus back to the breath, muscle or image, over and over.
These strategies are skills that take time and practice to develop. They are also portable, free and highly individualized. Be creative in how and when you use these strategies. Even one or two slow diaphragmatic breaths can immediately affect your heart rate and blood pressure.
We know that the brain's evaluation of the need for pain is guided by thoughts, feelings and beliefs. Cognitive behavioural (self-talk) strategies explore these connections. To use this idea, monitor how you think about your pain and experiences. Note that certain thoughts and beliefs inevitably lead to sadness, fear or anger. Consider how you might think about the situation differently.
Essentially, these strategies explore how changing the view of a situation affects the experience. Someone who believes pain is a sign of damage sees any strategy that might risk more pain as frightening.
Two negative styles of thinking are common to people with pain. Catastrophic thinking always expects the worse. The other style of thinking involves 'shoulds' – " I should feel better or be able to push through the pain."
To challenge such thoughts, ask questions. If you feel unhappy, what thoughts about your experience or situation lead you there? Thoughts such as, "My life is over," "I'm helpless," or 'Nothing I do makes a difference," can take you to sadness.
Chronic pain does not just affect the person experiencing it. It also has an impact on those who interact with, live with and love that person. Changing your approach and reactions to pain will directly affect those around you. You may need skills to share the experience, ask for help or say no. Many relationships are challenged by changes to identity and personality linked to the pain experience. Exploring communication strategies, and how pain can encourage passive or aggressive behaviour, can help you to feel more in control and capable of responding as you wish.
Consistently using these five skills can dramatically improve quality of life and sense of control over pain. Most people experience a real and clinically significant decrease in pain levels, especially the risk of flare-up.
Many resources are available to help with these self-management strategies. If you are interested in trying them, talk with your health care team.