10 Tips for Chronic Pain

Pain can be exhausting and intense.

When we are in pain everyday tasks become not only physically effortful, but also cognitively effortful. It can be a challenge to ‘push through’ when we feel like we cannot do something. Often there are consequences which can either be:

• the need to take a (few) day(s) of rest afterwards, 
• seriously limiting further activities after we have pushed through, 
• needing to take additional pain medication, and/or
• loss of sleep, which further affects our ability to do things because we become physically exhausted.  

Pain can be very difficult to quantify – how do we objectively measure if what we are doing is making any difference to our pain and emotional well-being? We know that doing things is often a useful way to distract ourselves from pain (of course, this means doing activities that are tolerable and enjoyable and are meaningful, even if only for a short space of time), but they can also cause pain if we overdo it. 

When we are hurting we may adopt protective behaviours, postures and implement avoidance - these can serve us well, but can also make things worse as we restrict our engagement and movement over long periods of time.

Sometimes we also need to re-educate our brains about what is ok, safe, and tolerable. We also need to build our own confidence and battle our fear of trying something that we know has caused pain in the past.

Having personally dealt with my own chronic health condition (chronic allergies) and pain for a few years, thankfully now much better, I know that no-one can make you act differently if you are not ready and confident that you can do this, therefore you must find your own path with people you can really trust to support you.

Furthermore, there are links between chronic pain and depression, with both potentially affecting the other (Romano & Turner, 1985; Fishbain et al., 1997; Miller, & Cano, 2009; Sheng et al., 2017). Holistic management of pain and chronic pain (pain extending beyond 3 months) requires considering both physical and psychological factors and assessment.

We need our personal cheerleaders who are happy to meet you where you are at and can just ‘be’ without expecting you to be ‘more’ or ‘better', yet also encourage - these can be particularly hard to find, but are there to replenish your emotional reserves when you undertake steps to manage pain and achieve the life you want.

This blog shares tips that I have applied and found useful, as well as coping strategies observed and reported by the people I serve as an Occupational Therapist.

1. Try to find a 'thinking' space away from the pain. 

Meditation, relaxation and breathing techniques or mindfulness practice can all help create a protected thinking space where you are aware of pain, but not consumed by it. It can help to create some headspace for you and offer respite and ways to think about pain or deal with pain differently.

This can provide some objectivity to the experience of pain and requires practice. This can include mindful activities where you pay particular attention to other senses such as when preparing a meal, bathing, sitting in the garden, etc. Pain will still be present, but it is no longer the chosen focus for that brief moment in time.

2. Try to find a way to measure progress.

It really is all about the 'little things' when everyday feels like survival.

Maybe today you managed to stand for one minute longer. Maybe tomorrow you were able to be outdoors for 15 minutes. Maybe next month you manage a picnic. Maybe you are managing to sleep a little better each week, by not waking up as much, or not waking up with the same level of pain as you usually do.

Clinicians often use pain rating scales to measure pain, but these can be quite tricky as my 5 (1 being no pain and 10 being the worst pain) may be very different to your 5. I have found some useful visual analogue scales that help to quantify and add some humour – believe me they have both been needed to help individuals dealing with chronic pain. Personalised pain scales are also helpful and an example of this, along with other scales, can be found here.

3. Practice regular pain management, including exercise.

Things take time and developing daily habits to help with management is vital. If we are always adopting a protective posture we can soon stiffen up and potentially create even more pain and anxiety on moving.

Exercise -  yes, exercise!  This is also critical to help manage pain. Consider exercises that are enjoyable and will not overly strain you. I knew one person who would go swimming regularly, but this was more bobbing around, floating and doing short easy strokes, rather than doing as many lengths as possible in the time at the pool. Manage expectations and perhaps concentrate on mindful participation rather than competitive participation. Have fun!

Walking, yoga, light gardening Tai Chi or even baking can be useful pain management practices. The key thing is to find solutions that you can enjoy that help you to move without overdoing things.

Make sure you choose exercises that are also appropriate to your specific health condition. Not all exercise is equally good for different people.

4. Pace yourself. 

When we feel well, we go hell-bent for success, but this can be disastrous if it results in severe consequences. This can mean we might never attempt the activity again because of how awful it made us feel. Instead start small and build up tolerance.

I personally love a good coffee. The reward is that good coffee, not the 20-minute journey to the coffee shop and/or the wait in line to order and the travel back. When that 20 minute journey was not tolerable just because being outdoors brought on severe symptoms and another bout of sinusitis and severe pain, I purchased my favourite coffee brand and a coffee machine to froth the milk 'just right', and set about having a good coffee with friends over a short visit at home. I built it up from there.

There are some things we must do and some things we want to do. There may be a compromise between which activity you choose and that is ok. Remember that there needs to be good times amidst the hard times, right? Remember that it begins with a first step, not a sprint.

On this note, do not discard the idea of assistive technology. It can be pure gold when it helps to reduce effort, time and energy so that you can rather expend this on things you want to do. Dressing aids, food processors and kitchen gadgets,  transfer and mobility equipment, ergonomic environmental equipment and environmental adaptations can be vital to building confidence and engagement. 

5. Have a dream.

Okay this one might be tricky. I do not necessarily mean a climbing-Kilimanjaro-dream, but it is important to think of something that is important, meaningful, and rewarding for you. Just for you. It is great if others can benefit, but doing something for someone else, can be quite difficult when your heart is not in it or it might not make you feel emotionally good. Have you experienced those days where the idea is there, but the will is weak because it's just too much effort? 

Your dream (goal) can be as small or as big as you want it to be. It might be just getting to the garden gate in 3 months’ time. It might be preparing a romantic dinner that you have served without any help (and with as many or as little cheats as you want to incorporate such as pre-chopped vegetables, a take-away, whatever). It might be reading a chapter in book or going swimming. Your dream, your goal.

6. Plan for success.

Some planning is probably done without any conscious thought. When people are dealing with pain, they often know how far they have walk, what the terrain is like, what ‘escape routes’ there might be, what excuses can end an activity quicker, and what recovery time is needed afterwards. This is probably more linked to problem-solving, but it does incorporate planning elements. Planning should include how you need to set up to achieve, and how will feel when you achieve, each step of it and not just the entirety of it. Appreciate the little things, the small steps of progress and the small wins if pain is all-consuming. 

Any activity consists of many steps and each one counts. Do not ignore or undermine the value of the smaller steps. Know what steps are the most valuable and find out if there are ways you can simplify how you get there. Occupational Therapists can help with this 😉.

7. Recognise that the brain is complex and challenging when it comes to chronic pain.

Pain is personal and subjective. The pain wiring in the brain can become problematic when the pathways are constantly firing. This means that we might perceive pain that may not actually be as severe as it is. Instead of fight-or-flight, we can work on training the brain to respond differently. Desensitisation training can be helpful for some when there might be changes in the perception of pain (e.g. when light touch is perceived as painful following a stroke).

Pain can also contribute to low mood and anxiety – pain management requires an integrated approach to deal with all factors as they can influence each other. Cognitive behaviour therapy can be useful.

Investigate alternative ways to deal with pain and speak to your clinical team to learn more about pain management tools. This does not mean giving up your pain medication without discussing it with your pain team. On this note, if pain is severe and you do not have a pain team involved, request one from your physician. Simply put, medication alone may not be adequate in isolation to deal with chronic pain. And some pain medication may not be ideal in managing your own pain presentation and clinical condition.

8. Treat yourself.

Just because you cannot do everything you could do or that others want you to do, does not mean you do not deserve self-care and self-love. You are important, you are valuable, you are worth it.

I like a good coffee - it brings back good memories, it is mindful, it is quick and easy to do. When it's hot I like an iced coffee and I have all the gadgets to make it just how I would like. A bubble bath, an audio book on the go whilst lounging on a deck chair, a massage, a haircut, a movie - think of something you enjoy and try to incorporate something that makes you feel good. 

9. Be kind to yourself.

We are our own worst critic and judge. Before you beat yourself up with negative self-statements and ridicule, try this: talk to yourself as if it were your best friend in the same situation. Would you berate, criticise, and make your best friend feel worthless for trying? Would you get angry if your best friend simply could not do what was planned because he/she felt so unwell that the idea of doing the activity filled them with dread? No, of course you would not. So do not be mean to yourself.

Mindfulness self compassion, acceptance and commitment therapy - there are some approaches that can help if you find it hard to be kind yourself or feel unable to progress past the difficult emotions you might be feeling. Don't be afraid to ask for help.

You can only try and keep trying. The secret is never to give-up.

10. Find your cheerleaders.

This, for me, was the most important, and the most difficult.

These are the friends/family who stick through it with you. Who encourage, yet understand and, perhaps, even have some empathy because they've experienced pain, too. 

Cheerleaders can share the little pleasures and celebrate your success without constantly reminding you that things are different or not the same or how they would like them to be. I keep thinking of sports cheerleaders who keep the energy going regardless of how the team is doing and congratulate the team afterwards for just participating and trying.

While you are finding your path, do not be scared to set boundaries for those who cannot be cheerleaders and take away more of your energy. It is hard trying to get through a day, so find the cheerleaders who reenergise your soul and help you smile in the hard times. Yes, this is difficult. It might require education, some difficult discussions, some vulnerability, some mediation, but find your cheerleaders who will meet you where you are at in your journey.

I remember friends who would seldom change their habits to support my recovery - they were not helpful. I remember others who were just happy to catch up over the phone or pop in for a short visit - they were lifesavers.

Remember, pain is personal and subjective. It is in response to trauma and can also persist because the brain's pathways become hardwired to 'feel' it after the initial stimulus has passed or the subsequent stimulus is less severe. It is a protective sensation, but can also contribute to depression lead to us withdrawing from activities.

We are born to thrive, not just survive, so find your cheerleaders and supporters to help you manage your pain and your pain management journey.

Thank you for reading! 

References: