Look inward for the
power to manage your pain.
MINDSET, MEDITATION
& SOCIAL WELLBEING
Anyone who has had pain for a more than a few weeks knows it affects you in so many ways. Pain can affect how much you engage in work or leisure activities, your ability to enjoy time with family and friends, or your capacity to perform everyday activities. Pain can also affect your sleep, make you feel down and worry more often. In some cases, people may even develop depression or severe anxiety, or may use things such as alcohol to cope.
Working on these issues can go a long way to helping you manage your pain. They may not directly cure the pain, but they can help make it more manageable and improve your quality of life.
There are a number of key strategies that have been shown through research to help people with chronic pain. While not all of these strategies are relevant to everyone, experience has shown there are three components to effectively managing pain – medical interventions, physical fitness and reconditioning, and working on coping strategies. Treatment is most effective when it includes all three of these strategies deployed together in an integrated way.
CLINIC LOCATOR
Find a Pain Practice near you and learn more about treatment options for managing your chronic pain.
KNOWLEDGE AND
UNDERSTANDING
Understanding pain and why you may be experiencing it is very important. It will help you to understand how to manage it better, and how to work more effectively with your treatment team. It’s your body, and you should understand what it is happening with it. There are many good pain resources available, including The Pain Book, Explain Pain, and the ACI website.
RELAXATION AND
MEDITATION.
Pain causes muscles to tighten, as does reduced activity and exercise. Anxiety, stress, worry and poor sleep also cause muscle tension. Relaxation exercises can help reduce pain, stress and anxiety, and improve sleep.
Meditation can be very helpful in managing pain. In addition, meditation can help you deal with a range of other problems that come with pain, such as depression, negative thinking and low energy.
PACING, GOAL SETTING AND
ACTIVITY PLANNING.
Pacing, goal setting and activity planning are strategies aimed at helping you manage activities, get more accomplished, and improve your physical functioning. For example, by breaking things down into a series of manageable tasks, it is possible to reduce the build-up of pain and reduce the risk of flare-ups.
People with pain often struggle to maintain consistency of activity throughout the week. They tend to either pull back on what they do, which leads to gradual deconditioning, push themselves too hard, which leads to flare-ups, or bounce between the two, which ultimately results in the feeling that pain is controlling their life.
Pacing is an alternative that can help you take back control. This involves determining how much you can do of a particular activity, such as walking. Begin by developing a consistent pattern. Then gradually increase what you do every week or two. The goal is for you to be able to do more, more consistently, over time.
WORRY AND
ANXIETY.
Pain can influence the way we think directly, by making us more stressed, or indirectly, through problems with sleep, anxiety or depression.
Cognitive Behavioral Therapy, or CBT, involves identifying and changing unhelpful patterns of thinking. Changing our thinking can help us feel less stressed, improve depression, help us feel less anxious. CBT has also been shown to help with things such as poor sleep, excessive alcohol use, anger, irritability and frustration, and more.
SLEEP
HYGIENE.
Nearly everyone with pain experiences some level of sleep problems. Poor sleep can actually make your pain worse. Sleep hygiene is a collection of strategies that have been shown to improve sleep for people with pain.
STAYING
ACTIVE.
Persistent musculoskeletal pain is one of the most common conditions affecting Australians, with one in five adults experiencing persistent pain. A number of pain conditions, including low back pain, neck pain, arthritis and headaches are in the top ten medical conditions worldwide causing long term disability (1).
RELAPSE
PREVENTION.
People with persistent pain know that occasionally, even with the best management, they will experience flare-ups. Flare-ups can be frustrating and disappointing and can make you feel as if you are controlled by your pain.
Over time, however, it is possible to develop a good understanding of the things that cause flare-ups. By identifying your triggers you can work to reduce the likelihood of activating them and develop a plan to deal with them when they occur. People who have a relapse prevention and flare up plan tend to report feeling more in control of their pain, and report having greater confidence in dealing with flare-ups when they occur.
Research over the past two decades has significantly increased the understanding of persistent pain, and has led to a number of clinical guidelines to help guide management of patients with persistent pain (2).
Scientific understanding recommends taking an approach to management of persistent pain conditions that considers the interaction of biological, psychological and social variables. This does not mean that “pain is all in your head”, which at times has been incorrectly advised. It does mean, however, that persistent pain can be due to the following factors:
Biological
This can refer to any injury or disease process contributing to pain. It can also include the effects of chronic inflammatory states, and changes to the musculoskeletal system (such as weakness and deconditioning). Nervous system changes can also occur in persistent pain contributing to increased sensitivity.
Psychological
This can refer to normal and understandable mood changes such as stress, depression and anxiety, which can occur in relation to persistent pain. Prior problems in this area can be exacerbated by persistent pain. Furthermore, fear of further injury, or loss of confidence, can further impact pain and function.
Social
Persistent pain can have a broad impact on your life in general, including work, finances, relationships and the ability to engage in activities you enjoy. This can compound the biological and psychosocial factors outlined above.
In summary, the evidence-based guidelines suggest staying active and continuing to exercise appropriately. By following the three steps outlined below using a Cognitive Functional Therapy Approach (4, and picture 1), we can help identify all of the contributing factors to your persistent pain and implement a safe and suitable exercise or activity plan.
Making sense of your pain
The role of a good pain clinician is to help you identify all the factors contributing to your pain. Importantly, this will include a thorough examination of the biological or physical component. This allows for identification of any ongoing injury, but it also can identify safe ways to start an exercise program even in the presence of some pain. A good pain clinician can also identify when there are changes to the nervous system which can result in increased sensitivity to pain. In certain cases, pain may be experienced with movement or activity. If the pain is not an indication of risk or physical damage, exercise can then aid in reducing pain sensitivity and in turn improve physical function. Recent evidence has demonstrated that when patients have a good understanding of pain, it can help to improve confidence, function and, ultimately, aid in reducing pain (4).
Exposure with control
Once the causes of your pain are understood, we can then implement a graded exposure exercise plan. Graded exposure means starting exercise or activity at a level which is safe for your condition. And a plan you feel confident starting. With persistent pain, your first onset of pain is very likely to begin well before there is any danger to the tissues themselves, due to the sensitization of the nervous system (picture 2). It is safe to exercise at this level. While there may be some small level of pain with this exercise in the beginning, the pain should be low in intensity and settle quickly post exercise. Over time, the aim is to slowly increase the intensity and duration of the exercise, to both improve the musculoskeletal system, but also to retrain the nervous system sensitivity. The increments can be as slow and steady as needed, and there may be an occasional flare up along the way. Don’t be disheartened with this, as it is part of your body’s adaptation process. There is no particular exercise that is proven to be better. Each exercise should be determined based on what will most help you, and get you back to reaching your specific goals.
Healthy Lifestyle interventions
Rehabilitation is best performed within the context of a healthy lifestyle. Optimal sleep, management of stress and anxiety, some enjoyable general exercise, catching up with friends, and maintaining meaningful work activity. Where possible, all of these lifestyle components are associated with good outcomes. These factors also aid in the production of natural pain killers, and our feel-good chemicals. Sometimes, simply starting with simple healthy lifestyle strategies can lead to positive improvements.
Managing persistent pain is a complex process. Having a number of tools in your pain management toolkit can help you manage the ups and downs. These may include a variety of movements or activities to engage in, using relaxation or meditation techniques, allowing time for yourself to do something you enjoy, and using medications appropriately as advised by your doctor. A good pain clinician will take the approach of being a “pain coach” more so than a treatment provider. A pain coach will understand your history, assist in identifying rehabilitation goals, manage barriers to recovery, and take a problem solving approach to establishing the best management strategies. Our ultimate goal is to empower you to manage your pain effectively.
REFERENCES
1. Neuroscience Research Australia (NeuRA) 2021, NeuRA, accessed 28 May 2021. <https://www.neura.edu.au/health/chronic-pain/#:~:text=One%20in%20five%20Australians%20experience,experience%20disability%20and%20even%20depression>
2. Cho, D., Deol, Harashdeep K., & Martin, L. 2021. “Bridging the translational divide in pain research: biological, psychological and social considerations.” Frontiers in Pharmacology, vol.12, pp.603186–603186, DOI: 10.3389/fphar.2021.603186.
3. Body Logic Physiotherapy 2021, BodyLogic.Physio, accessed 28 May 2021, <https://bodylogic.physio/service/cognitive-functional/>