September is Pain Awareness Month and a fitting end to our chronic pain series. We began the series with the notion that pain does not equal injury and injury does not equal pain. We then discussed our pain alarm system and how it protects us from perceived threat but can sometimes become extra sensitive. And, finally, last month we discussed how pain is ultimately an output from the brain. Which brings us to the question, “what can I do about it?”. There is a ton of information out there about how to manage chronic pain. The reason there is so much out there is because there is no single answer. It is different for everyone. I have done my best to consolidate the basics into a straight forward chronic pain management strategy.
As in all things, knowledge is power. In this case, the power to manage your pain. Learning more about pain neuroscience education (PNE), coping skills, cognitive behavioral therapy (CBT), pharmaceutical interventions, movement interventions and complementary and alternative medicines (CAM) that are based in evidence can give you that power. You have already dipped your toe into PNE by reading the past few newsletter but there is much more to learn if you are interested. I have provided links here and on my Resources page for more information regarding PNE as well as for the other therapies and treatments that I reference in the remainder of the newsletter. Don’t let your education stop here.
Pain is our protector. It is there to keep us from harm or further injury. It has no ill will, only good intentions. It is a unique part of us that is made up of all our memories, emotions, beliefs, knowledge and so much more. We tend to think of pain as our enemy instead of taking a moment to recognize all the things it has protected us from. The things you have protected yourself from. Accepting pain as a part of yourself that you have some control over is an important part of pain management. Maintaining a negative, pessimistic view of pain known as catastrophizing has been shown to be the strongest psychological predictor of poor pain outcomes. Treatments such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) can help those with chronic pain work through the psychosocial aspects of pain that are unique to them.
Stress, anxiety, depression. All of these are known to increase pain levels. The reverse is also true. Chronic pain can lead to increased stress, anxiety and depression. As someone who reacts completely opposite when someone tells me to “calm down”, I realize that it’s not always easy to calm yourself. I also understand that calming activities are not a cure all for these problems, but they certainly help. There is evidence that mindfulness based activities can help to reduce pain levels and assist in treating anxiety, stress and depression. Incorporating mindfulness can increase quality of life as well as physical functioning. Mindfulness can take many forms. It’s all about being in the moment with complete focus on the task at hand, letting everything else just float away. You don’t have to turn yourself into a pretzel or stare at a candle for hours on end to practice mindfulness. You can simply take a walk, color, crochet, knit…there are options for every personality and fitness level. So, just calm down.
Now that we’re calm, let’s talk about pacing. With either acute or chronic pain, you want to find a balance between doing enough to progress and not doing so much that you regress. It can be tricky to find that sweet spot but that’s where tools like pacing can help. Pacing is the idea of balancing rest and activity then slowly progressing your exercise or activity. If I sprain my ankle on Wednesday, I don’t expect to run a mile on Friday. And, if I did try to run a mile on Friday, I probably wouldn’t be able to do much of anything Saturday and Sunday. The road to recovery may have ups and downs and a twist or two but it’s important to avoid the roller coaster of “overdoing”.
Just as every pain experience is unique, every pain management plan is unique. Do not expect that what worked for Uncle Joe or the nice lady in the grocery store will work for you. You are unique as is your pain. Take the time to find ways to educate yourself, accept yourself, calm yourself and pace yourself. The benefit will be more time and energy to just be yourself.