Coping With Pain

Welcome to the second article in our series about coping with pain.

In the previous article, we looked at 6 steps to understanding your pain.

Step 1 Pain portfolio

Step 2 Illness or injury

Step 3 Impact on Identity

Step 4 Noticing thoughts

Step 5 Activities

Step 6 Review

In this article, we will use the information gathered from completing each of the above steps and turn it into a plan using a Box method. Working through each of the following 7 boxes and recording the results in your pain portfolio will enable you to tailor your plan to your individual needs, turning last week’s roadmap into a customised tool to help you start working with your pain rather than resisting it.

From step 1:

If you identified that your pain is consistently rated at a high level, consider the following:

• Could you benefit from having a medication review?
• Are there any other pain reduction options that could now be considered?
• If so, who could you consult with? Pharmacist, GP, pain clinic, acupuncturist? Massage therapist?

Often massages can be helpful during a massage session, but do not provide long term relief and so are sometimes quickly dismissed by people who have chronic pain.  However, short term relief is often better than no relief and therefore in some cases, it  may be worth considering regular massage treatment to gain short term relief if helpful and safe.

If you identified that certain activities made your pain worse, can these activities be avoided or carried out at times during the day when you have the most energy? 

Can these activities be broken down into smaller steps or can someone provide assistance?

Pacing your activities is of paramount importance when you are in pain.

Conversely, if you identified that certain activities made you feel better, how can you incorporate more of these activities into your schedule?

Exercise 1 - Write Down: 

• What practical changes can you now make to your schedule to make the most out of each day?
• What assistance can you find?

 From step 2:

Whether your pain was caused by illness or injury, what further information can you learn about it and what support can you seek from other people?

If you have identified that your pain has changed over time, what can you learn from this?

If it has become less severe, what has contributed to this improvement and how can this be leveraged?

If you have identified that it has become worse, what has contributed to this change and how can this be addressed?

e.g. Sleep

It is very common for people who experience chronic pain to have severe sleep difficulties.  This could be trouble falling asleep or difficulty staying asleep.

If your pain is constant, it can often be the case that when your medication wears off during the night, not only do you wake up but you wake up in pain.  If this is the case for you, consider speaking to your GP about adjusting your night time medication.

Sometimes this is not possible e.g. if changing medication will leave you feeling too drowsy to function well during the day and in these circumstances, other adaptations should be explored such as :

• going to bed earlier or later in order to achieve longer periods of uninterrupted deep sleep.
• Planning relaxing activities on awakening during the night to help you fall back to sleep more easily such as listening to relaxing music, visualisation, affirmations.
• Engaging in techniques to keep your thoughts calm. One way of starting this process is to ensure that your sleep environment is clutter-free, noise-free and light free.

Exercise 2 - Write Down:

• How can you adjust your activities to help reduce your pain, including your sleep routine?
• What external support have you not yet considered?
• Would you benefit from a medication review?

From step 3:

Consider what you learned about your thoughts and feelings regarding pain in general and also your thoughts and feelings about your specific pain. Was there a difference? Did any of these emotions you identified surprise you?

Emotions such as anger are common and although natural, over time can have a negative impact on both our mood and our capacity to cope well with pain.

Writing out your feelings about what has happened to you and the impact on different aspects of your life can bring relief and help you to start to process these feelings.

Exercise 3 - Write Down:

• Letter to self: Write out your emotions and the impact on:
• Work, hobbies, relationships, family, socialising, goals, sense of hope, mood, self-esteem and plans for the future.

It is also important to remember that our minds are linked to our bodies and the only way we can access and process our emotions is to engage with them and allow ourselves to feel them.

We often go to great lengths to avoid doing this because we fear it will be too overwhelming or uncomfortable but once we give ourselves permission to feel our feelings, we can experience great relief and let go of negative emotions which do not serve us.  

Allowing yourself to feel your emotions in a controlled way can also be very empowering and help us to regain a sense of control.

Exercise 4

• For one week, set aside 10 minutes per day to focus on your feelings regarding your pain, not the pain itself but the emotions that the pain brings up.
• Before starting this exercise, plan a pleasurable activity to do immediately afterwards.
• e.g. speaking to a friend, eating some food you enjoy, catching up on Netflix.
• Find a quiet space, sit down and close your eyes.
• Allow yourself to feel these emotions and notice the intensity, just observe quietly.
• Start by doing this for a few of minutes and gradually extend the time over the week up to 10 minutes.

Notice what happens to these feelings over the course of a week and write the results in your portfolio as detailed below.

This exercise can be powerful and can help you to come to a place of acceptance. 

When you give yourself permission to feel your emotions, they dissipate and bring you to a place of neutrality rather than distress.

Pain can also change our perspective about what we believe is now possible for our future. As a result of your pain, your sense of identity may have shifted but this can often be temporary once some adjustments are made to your short term goals so that they still fit with your values.

Exercise 5 - Write Down

• What were your previous goals?
• Why were these important to you?
• What emotions would achieving these goals have given you?
• What would some short term goals be that could give you these same emotions whilst reflecting what is important to you?
• How many steps can you break these new goals down into?
• What are these steps?
• Can you schedule a time to take the first step?

 From step 4:

Low mood and negative thoughts can exacerbate pain.  Therefore prioritising feeling good and having positive thoughts is paramount.  This takes practice but is worthwhile.

This change in perspective seems small but can make a huge difference to how you experience coping with your pain.

Now that you have practised noticing your thoughts, start to challenge any negative thoughts and try to see if there is a more realistic alternative.

Exercise 6 - Write Down

• Practise writing down your negative thoughts.
• Look for evidence in support of your negative thought
• Look for evidence against your negative thought
• Consider a more helpful, realistic alternative thought.
•  Record one event per day that made you smile.

From step 5:

Evidence shows that balancing your activities to ensure a good mixture of necessary, routine and pleasurable activities helps to maintain positive mood. When we are in pain, it becomes even more important to prioritise relaxing and self-care activities in order to build our resilience, lift our mood and to maintain our sense of wellbeing.

Many of us minimise the importance of relaxation because we are conditioned to believe that we do not deserve to take time for ourselves or that we are somehow doing something wrong if we choose looking after ourselves over doing the washing up. 

We also often misconstrue relaxing activities with being still.  Self-care is all about the way you feel whilst engaging in an activity. You could be walking in a park whilst feeling highly anxious or you could be watching your favourite movie whilst worrying about work. Being aware of this should help you to identify which activities may be better for you to engage in when it comes to self-care. This also speaks to the importance of noticing and learning to control our thoughts in order to be able to relax effectively.

Evidence also shows that stress makes pain worse and that people who prioritise relaxation and self-care are not only in better health but also build the resilience they need to cope better with difficult situations and stress and in doing so, are better able to help those around them.

Exercise 7 - Write Down

• Schedule your weekly activities ensuring that they include:
• - a balance of necessary, routine and pleasurable activities
• - some activities which are important to you and relate to your values
• - relaxation and self-care
• Start to re-introduce activities which you have been avoiding out of fear rather than due to pain.

Useful links:

https://www.nhs.uk/live-well/sleep-and-tiredness/how-to-get-to-sleep/

https://www.nhs.uk/live-well/healthy-body/10-ways-to-ease-pain/