Taking Control of Your Pain: Part 2 The Pain Management Toolbox
Mara Towne, PT, DPT
Does your pain define you? When you have been in chronic pain for several years, it can feel like it does! Additionally, chronic pain management occurs best with a team approach. But, what happens when you start to feel better? How can you take what you have learned from your healthcare providers and apply it to your life to continue practicing self care as you decrease your treatments?
This blog is part 2 of a series in which we will unravel what patients can do to manage their pain at home with help and support from their physical therapist. The materials and information in this blog are from an excellent continuing education course called, Transforming Your Clinical Practice: Integrating Cognitive, Behavioral and Motivational Skills into Physical Therapy presented by Kristin R. Archer PhD, DPT and Stephen T. Wegener PhD, ABPP of Vanderbilt University. The handouts attached are reproduced and distributed with their expressed permission.
One of the most important things to realize is stressors will occur in your life and these can flare your pain! The goal is for the pain flare to be minimal and able to be contained with tools you have learned through physical therapy or other treatments. Sometimes you may need to come back in for a few treatments as well which is part of managing chronic pain and not deemed as going backwards. But, in the midst of a pain flare, it can be difficult to know what to do. This is why it is beneficial to fill out the Managing Setbacks Worksheet (see attached) when your pain is at a reasonable level. Going through this worksheet helps you to identify stressful situations you will encounter in your day to day life. This is different for everyone but examples include: travel, overdoing activities, and work stressors. After you have identified your personal stressors, you will note signs and symptoms that tell you you need to address the problem now such as increased pain or decreased ability to walk, sit or stand. Then, the most important piece is to find strategies you will use to prevent and cope with these setbacks. It is helpful to discuss this with your physical therapist, if you have one, since he or she will have insight into practices that have helped you decrease your pain during treatment.
Pain recovery is not a linear path. There will be twists and turns throughout the process. That is why it helps to have a plan. The Recovery Plan (see attached) is a comprehensive tool to incorporate all the aspects of pain relief. There are 7 aspects of the Recovery Plan: Activity, Walking, Relaxation, Distraction, Positive Thoughts, Pacing and Setbacks.
Activity is the first piece. Again, your physical therapist is a great resource for helping you decide which activity goals are most important for you. Walking goals are also added to this. It can be especially helpful to walk outside if you are able. Studies have shown that walking outdoors can reduce negative thinking (check out this link for more information: https://www.theatlantic.com/health/archive/2015/06/how-walking-in-nature-prevents-depression/397172/)
After activity is relaxation. As I noted in part 1, we all live in a high paced world and with the increase in technological advances, we do not have as many opportunities to unplug. So, we have to create those opportunities. Guided mindfulness meditation can be a great way to relax. There are several free apps (one of the many benefits of technology J). Here are some options but this is by no means a complete list: https://www.healthline.com/health/mental-health/top-meditation-iphone-android-apps.
Distraction is important. It helps us to reset our focus. Some ideas for distraction include: a free daily quote app (I’m a fan of this myself), gratitude practices (I personally like The Five Minute Journal: https://www.intelligentchange.com/products/the-five-minute-journal but there are many options out there-see our Gratitude blog for more ideas) and deep breathing. Moreover, we are social beings! Getting out and seeing a good friend or family member can be incredibly helpful as well!
Positive thoughts also help us to decrease pain. Donald Hebb, a neuropsychologist, first said “neurons that fire together, wire together”. This was in 1949! Since that time we have learned a lot of about neuroplasticity which is the brain’s ability to change itself. The more we practice a habit or the more we think a certain way about ourselves, the more we strengthen that connection in our brain. Check out this You Tube video for a great explanation of this phenomenon: https://www.youtube.com/watch?v=ELpfYCZa87g. Daily affirmations or positive thoughts really do help us to think more positively over time!
The last two pieces of the Recovery Plan are pacing and managing setbacks. These are unique to all of us as individuals. However, as you may recall from Part 1, if you haven’t walked 2 miles in several years, it would be hard for anyone to just go out and walk 2 miles. Pacing is breaking down this goal into more manageable pieces. Additionally, The Managing Setbacks Worksheet noted earlier in this blog will help you create a plan for setbacks that is customized to your situation. If you are struggling with any aspects of your Recovery Plan, we are happy to help you! Please reach out to me at: firstname.lastname@example.org.
“Acceptance doesn’t mean resignation: it means understanding that something is what it is and that there’s got to be a way through it.” Michael J. Fox