When pain persists - managing my chronic pain
Learning how to manage your pain will help you minimise the impact pain has on your life. Although this can sometimes be challenging, it is possible to manage your pain better by learning new skills.
Anger and frustration are associated with growing disruption of your lifestyle due to unmanaged pain. As you gradually do less of your "usual" activities, it is easy to lose a sense of just who you are. Fear is a common emotional response. It is normal to be fearful when you do not understand what is happening to you.
Living with chronic pain may require you to make some changes to your lifestyle. Learning "how" to make these changes will be important as it will improve your quality of life and enable you to be involved in many activities again.
As the first step in taking charge of pain management it is important to learn as much as you can about your condition. See the "Explaining how the nervous system contributes to chronic pain" page for more information and direction.
Working with your pain instead of fighting against it
Once you understand as much as possible about what may be happening inside your body, and once you have decided that there is little that medicine or therapy can do to "cure" you, then you have an opportunity to learn how to live with what has happened and try to minimise the impact of pain on your life. Accepting that you cannot change what has happened in the past can allow you to move forward and it may allow you to become engaged in the healing process.
Does pain mean further injury or damage?
There are several important things to understand about this.
If you have not undertaken any exercise or physical activity for a long time, you should not start a program without professional guidance from a health care practitioner, usually a physiotherapist who is specialised in understanding the role of the nervous system in chronic pain. Please see the "Exercising with pain" page for more detail. As pain continues for an extended period of time, other body systems become involved, especially the immune system which is responsible for inflammation amongst other things.
When the immune system starts to become active it is possible that you can develop problems in your stomach or elsewhere. In this situation it can be helpful to learn how to stay calm and de-stress your life as much as possible. Please go to "How does the IMMUNE system affect my pain and what can I do about it?" for more information. Medical science has not really developed adequate techniques to help many people living with pain, and you may not feel satisfied when you attend your doctor for an explanation. (See section on choosing your health care team and preparing yourself to become an active member of your Health Care Team.
If your pain is due to arthritis and you have started to do more exercise, more pain may mean that you are causing more problems. It is important that you consult your doctor if you have arthritis before you embark on an exercise program. There are safe and tested ways of improving your fitness and general health through exercise when you have arthritis, but you need expert help to guide you initially.
Once you have considered these points, it is then important to understand that usually pain does not mean further injury or damage. If you think that every time you feel an increase in pain you are damaging yourself, then you will be afraid to move. Engaging a physiotherapist who really knows about pain is helpful when you are starting out with exercise programs. See our page on Choosing Your Health Care Team for more on this. However, once you feel confident that you understand what is happening in your body, remember that doing what you can and enjoying what you choose to do is one of the keys to managing your pain.
To gain confidence in making management decisions about your pain, you will probably need some help. Many successful pain managers talk about having a "toolbox" and a "multidisciplinary care team".
The "toolbox" is to help you live a better lifestyle and might consist of a number of strategies including medicine, relaxation techniques, exercise, sleep management strategies, choosing enjoyable activities, pacing and distraction. Many people report that as a result of using their tools they are able to choose enjoyable and meaningful activities that are paced well, and being able to organise their lives so that there is less stress and worry.
A "multidisciplinary" approach simply means that you can work with health professionals from a variety of different backgrounds.
Your "team" always starts with yourself as the leader, and may include your partner, your GP, friends, physiotherapist, pharmacist, rehabilitation counsellor, rheumatologist or pain specialist, psychologist to name a few possibilities. It is all about finding the team that works for you. Some people try out a few possibilities before they find the right team. Working with a multidisciplinary team can give you more options and choices when it comes to managing your pain.
Whilst your healthcare professional's advice is important, you must also be knowledgeable about your own pain so that you can make more informed decisions about choosing treatment options that are right for you.
Decide what is important to you
When you decide to get involved in your own "healing", it is time to work out what is important to you. Set priorities. Think about what it is that you love and enjoy. What are your important values in life? Then you can start to set meaningful goals. Don't get overwhelmed by this process. Small steps are essential to achieve larger goals. For instance, if you enjoy walking or swimming, but flare up if you walk 20 minutes, how about walking for 5 minutes, but enjoying every step (slow down, you don't have to be superman/ superwoman!!)??A word about trying to be superwoman, or superman... remember that we are all human. It is OK to say NO, it is OK to ask for HELP, and NOT FEEL GUILTY or second rate for having done so.
While it is important to relax, it is also important to learn relaxation techniques, which is different to just relaxing. Relaxation techniques operate on the principle of learning how to calm the mind and the body, which in turn calms the pain. Finding a technique that suits you and using it regularly can make a very real difference to pain intensity. Pain increases in times of stress. Muscles tighten up when you are stressed and this process can increase your pain.
Part of enjoyment is relaxation. When you react to a situation or event, watch yourself. Have you changed the way you would breathe when you are relaxed? There are plenty of resources available to help you breathe in a way that leads to less tension. You have probably noticed that when you are feeling tense you experience more pain. Of course, there are explanations for this [click here to go to Explaining how the nervous system contributes to chronic pain].
"How different our lives are when we really know what is deeply important to us, and keeping that picture in mind, we manage ourselves each day to be and to do what really matters most"
Recognising your emotions
The way you feel physically can be directly influenced by your emotions. Pain may bring about feelings of anger, sadness, frustration and grief, and that is understandable. However, if these negative emotions go on for long periods, they tend to make pain worse. By acknowledging and dealing with your feelings, you can reduce stress and decrease the pain you feel.
You might have already noticed that when you have a very stressful time your pain is worse. This is because there are chemicals inside your body and your brain that are produced to excess and released during times of stress and these can actually make pain worse.
On the other hand, there are natural chemicals you produce in your body which relieve pain. These are released when you do things you enjoy such as talking with friends, laughing, feeling loved and loving, watching a good movie, listening to your favourite music or just going for a walk and enjoying your neighbourhood.
People in pain sometimes forget how important the simple things in life are to their wellbeing. Has this happened to you?
Living with pain can make you moody and depressed. Be aware of any mood swings or changes and discuss these with your healthcare team or visit www.beyondblue.org.au for assistance.
Before starting any exercise program it is best to discuss with your health professional (e.g. physiotherapist or GP) what exercise is appropriate for your condition. If you have been managing your exercise program for a while and you haven't seen your health professional for a long time, it may also be useful to make an appointment for a review, as there may be new strategies that you can use, or things may have changed with your condition and you haven't realised it.
For more detail on using exercise strategies to manage pain please go the "Exercising with Pain" page.
If you have not started your exercise program yet, it may be helpful to engage a physiotherapist who is up to date with the latest research in pain science.
Although health authorities recommend you undertake 30 minutes of moderately active exercise each day, it is important to realise that each person is different and will need an individual exercise program that is right for them. If you live with chronic pain and you haven't exercised for a while, it will probably be a good idea to work with a health professional who will help you to start your exercise program at a very low level. Many who successfully manage their pain start at levels of 5 minutes or less, and then gradually build up over time. Examples of moderate exercise activity could include a brisk walk or cycling or hydrotherapy (exercise in warm water usually under supervision).
Over time, it will be important for you to love your body again. Be kind to yourself. Start with a very small demand on yourself and your body, knowing that it will be possible to increase the level over time. Remember you are the boss, you are the one that lives with the pain, so you are the one who needs to decide on an upgrading schedule. Again, try to find a way of increasing the load on your body gradually, but in a way that is enjoyable to you. If you decide to go to a class, give yourself permission to do 5 minutes only, this will ensure that you go back the next time. Nobody else has to deal with the consequences inside your body, just you. So take control of the schedule.
Deciding on the level of exercise for you is important. Work out what you can do on a bad day. This might be 5 minutes only, 2 times per day. The general rule is that you take 80% of that level and stick to that level, so you would choose 4 minutes of activity 2 times a day to start with. This means that even on a bad day you will be able to do it. Then create a plan, that after a period of time, perhaps a week, you will increase this by a small amount. Over time, you are increasing your exercise duration.
Some people with persistent pain may fear exercise because it has caused them pain in the past or because they fear that they may be causing further injury. With reassurance and support from your doctor and a healthcare professional (e.g. physiotherapist) you can develop an individual exercise program that is more suitable for you. As you build strength, your pain can decrease.
It is important not to overdo your activities, especially on the days you feel ‘good' as this may make the pain worse the following day. If you do experience a flare up after exercise it might mean that you have increased too quickly or there may be a particular exercise that isn't right for you just yet.
An important point with exercise is that if you haven't been doing any exercise for a while, you may well experience the soreness that goes with starting an exercise program as muscles that haven't been used suddenly get a "work out". This is OK. Learning to discriminate between a "flare-up" and normal muscle soreness is important. For more detail please go to the "Exercising With Pain" page.