Living a Healthy Life with Chronic Pain
Read Living a Healthy Life with Chronic Pain Online
Authors: Sandra M. LeFort,Lisa Webster,Kate Lorig,Halsted Holman,David Sobel,Diana Laurent,Virginia González,Marian Minor
Copyright © 2015 Bull Publishing Company and The Board of Trustees of the Leland Stanford Junior University
All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.
Published by Bull Publishing Company
P.O. Box 1377
Boulder, CO, USA 80306
www.bullpub.com
Library of Congress Cataloging-in-Publication Data
LeFort, Sandra M.
Living a healthy life with chronic pain / Sandra M. LeFort, MN, PhD, Lisa Webster, RN, Kate Lorig, DrPH, Halsted Holman, MD, David Sobel, MD, MPH, Diana Laurent, MPH, Virginia Gonzalez, MPH, Marian Minor, RPT, PhD.
pages cm
Summary: “Nobody wants chronic pain in their lives. Unfortunately, about 30 percent of people worldwide live with chronic pain conditions, many of which have no identifiable cause. We wrote this book to help these people explore healthy ways to manage and live with their chronic pain condition so they can enjoy more fulfilling, satisfying lives”-- Provided by publisher.
Includes bibliographical references and index.
ISBN 978-1-936693-88-7
1. Chronic pain--Popular works. 2. Chronic diseases--Popular works. 3. Self-care, Health. I. Webster, Lisa. II. Lorig, Kate. III. Holman, Halsted, 1925- IV. Sobel, David. V. Laurent, Diana. VI. Gonzalez, Virginia. VII. Minor, Marian A. (Marian Adams)
RB127.L384 2015
616’.0472--dc23
2015002233
Printed in U.S.A.
19 18 17 16 15 10 9 8 7 6 5 4 3 2 1
Interior design and project management: Dovetail Publishing Services
Cover design and production: Shannon Bodie, Lightbourne, Inc.
This book is dedicated to the memory of Howard Montrose Genge for his love, courage, and wisdom in the face of pain; Mary Ellen Jeans, PhD, for believing in education for people in pain; and people of all ages and their families who struggle with pain in their lives
.
M
any people helped us write this book. Among the most important are the first 110 participants of the Chronic Pain Self-Management Program study funded by the National Health Research and Development Program of Health Canada. That study paved the way for thousands of workshop participants in Canada, the United States, Denmark, and other countries. All of these people, along with our wonderful workshop leaders, told us what information they needed and helped us make adjustments along the way. All of you have informed this new North American edition of our book.
Many professionals also assisted us, including Lynn Beatie, PT, MPT, MHA, Bonnie Bruce, RD, DrPH, Norman Buckley, MD, FRCPC, Beth Darnall, PhD, John W. Doyle, BA, Steven Feinberg, MD, Chaplain Bruce Feldman, MD, Shelley Gershman, RN, Peg Harrison, MSW, Noorin Jamal, RN, MN-NP, Mary Ellen Jeans, PhD, Roman Jovey, MD, Michael McGillion, PhD, RN, Patrick McGowan, PhD, Ronald Melzack, PhD, Yvonne Mullin, MSc, RD, Sheila O’Keefe-McCarthy, PhD, RN, Catherine Regan, PhD, Ned Pratt, BFA, Kathleen Rowat, PhD, Richard Seidel, PhD, and Judith Watt-Watson, PhD, RN. A special thanks to Nicolaj Holm Faber, Chief Consultant, Danish Committee on Health Education, whose support has been invaluable. To all of you, your help has been gratefully received.
A special thanks to Jon Peck, Jon Ford, and Erin Mulligan, who helped us every step of the way. Editors are unsung heroes of good books. We wish to acknowledge their fine contributions to making this a more readable, understandable book. We would also like to thank our T-Trainers, Master Trainers, and Leaders. There are now hundreds of you, and you all have made important suggestions that helped us craft this book.
We would like to thank DRx, publisher of
The Healthy Mind, Healthy Body Handbook
(also published as
Mind & Body Health Handbook
) by David Sobel, MD, and Robert Ornstein, PhD, for permission to adapt sections of their book.
Finally, many thanks to Jim Bull, Claire Cameron, and the team at Bull Publishing. Bull Publishing has been a strong supporter of health-related books for more than 40 years. Jim’s support and encouragement have been essential to the development of this book. We couldn’t have done it without you!
If you would like to learn more about our continuing research, online programs, trainings, and materials, please visit our website:
www.patienteducation.stanford.edu
We are continually revising and improving this book. If you have any suggestions or comments, please send them to
1 Overview of Self-Management and Pain
2 Becoming an Active Self-Manager
4 Understanding and Managing Common Symptoms and Problems
5 Using Your Mind to Manage Pain Symptoms
6 Pacing: Balancing Activity and Rest
7 Exercise and Physical Activity for Every Body
8 Exercising for Flexibility, Balance, and Strength
9 Exercising for Endurance and Fitness: Moderate to Vigorous Physical Activity
10 Communicating with Family and Friends
11 Communicating with Your Health Care Professionals
16 Medicines and Treatments for Chronic Pain
18 Managing Specific Chronic Pain Conditions
19 Managing Angina Pain, Coronary Artery Disease, and Related Conditions
20 Planning for the Future: Fears and Reality
This book is not intended to replace common sense, professional medical or psychological advice. You should seek and get appropriate professional evaluation and treatment for problems—especially unusual, unexplained, severe, or persistent symptoms. Many symptoms and diseases require and benefit from specific medical or psychological evaluation and treatment. Don’t deny yourself proper professional care.
If your symptoms or problems persist beyond a reasonable period despite using self-care recommendations, you should consult a health professional. What is a reasonable period will vary; if you’re not sure and you’re feeling anxious, consult a health care professional.
If you receive professional advice in conflict with this book, you should rely upon the guidance provided by your health care professional. He or she is likely to be able to take your specific situation, history and needs into consideration.
If you are having thoughts of harming yourself in any way, please seek professional care immediately.
This book is as accurate as its publisher and authors can make it, but we cannot guarantee that it will work for you in every case. The authors and publisher disclaim any and all liability for any claims or injuries that you may believe arose from following the recommendations set forth in this book. This book is only a guide; your common sense, good judgment, and partnership with health professionals are also needed.
HAPTER
1
Self-Management
and Pain
N
OBODY WANTS CHRONIC PAIN
in their lives. Unfortunately, about 30 percent of people worldwide live with chronic pain conditions, many of which have no identifiable cause. We wrote this book to help people explore healthy ways to manage and live with their chronic pain condition so they can enjoy more fulfilling, satisfying lives.
This may seem like a strange concept. How can you live a healthier, happier life when you are hurting? To answer this, we need to explore what happens with most chronic health problems. Whether it’s heart disease, diabetes, depression, or any of a host of others, the conditions that cause chronic pain also cause fatigue, loss of physical strength and endurance, emotional distress, and a sense of helplessness or even hopelessness. A healthy way to live with chronic pain is to work at managing the physical, mental, and emotional problems caused by the condition. The challenge is to learn how to function at your best even with the difficulties pain can present. The goal is to achieve the things you want to do, to get pleasure from life, and to be as healthy
as possible. That is what this book is all about. Before we go any further, let’s talk about how to use this book. It is not a textbook; in fact you might want to think of it as a workbook rather than as a traditional book. You do not need to read every word in every chapter. Instead, we suggest you read the first two chapters and then scan the table of contents to find the specific information you need. Read the sections that feel most relevant to your situation. Feel free to skip around and to make notes right in the book.
You will not find any miracles or instant cures in these pages. What you will find is hundreds of tips and ideas to make your life easier. This advice is from physicians, psychologists, physical therapists, registered nurses, and other health professionals who specialize in working with people in chronic pain. It also is from people like you who have learned to positively manage their own chronic pain.
Please note that we said “positively manage.” If you have chronic pain, there is no way to avoid managing it, but there are different ways to approach it. If you choose to do nothing but sit and watch TV all day, that is one way of managing. If you rely on medication alone to manage your pain, that is another management style. But the management style we advocate in this book is different from these two approaches. This book teaches you to be a positive self-manager by being proactive about your pain and working with your health care professionals. We believe that if you adopt this positive management style, you will live a healthier life.
In this chapter we begin by discussing the importance of being your own self-manager and the self-management skills that will help you successfully live with your chronic pain condition every day. These skills are useful not just for chronic pain management but for the management of any chronic disease condition. This is good news because people often have more than one chronic condition. Learning these key self-management skills will allow you to successfully manage not just a single condition but your entire life. After introducing the basics of self-management, we then go on to define pain and discuss the difference between acute and chronic pain. We also cite the most common problems experienced by people with chronic pain and provide a list of resources so you can learn more about pain.
The first responsibility of any chronic pain selfmanager is understanding your condition. This means more than learning about pain and what you can do about it. It also means carefully observing how chronic pain and its treatment affect your physical and mental health and how it affects those around you. With experience, you and your family will become experts at this.
Your second responsibility as a self-manager is communicating your unique situation, experiences, and preferences to your doctor and others on the health care team. They need to know how you are feeling and how the pain is impacting all aspects of your life. In other words, to effectively manage your condition you must be an observant person who communicates openly with his or her health care providers.
When you develop a painful condition, you become more aware of your body. Minor symptoms that you ignored may now cause concerns. For example, you may wonder is this pain in your arm a signal of a heart attack? Is this pain in your leg a sign that you should stop exercising? Is your pain spreading to other parts of your body? Does the pain in your back signify something more serious? There are no simple, reassuring answers to questions like these. Nor is there always a fail-safe way of sorting out serious signals from minor, temporary symptoms that can be ignored.
Even though chronic pain can be unpredictable, it is helpful to be aware of the natural rhythms of your particular condition. Chronic illnesses usually wax and wane in intensity. Symptoms do not follow a steady path. Most times, chronic pain is like that too—although sometimes you may feel as if it’s all a downward path and the outlook is bleak. In general, you should check with your doctor if symptoms are unusual or severe. You also should contact your doctor if symptoms occur after you start a new medication or treatment plan.
Throughout this book we give specific examples of what actions to take if you experience certain symptoms. However, you should not rely solely on the information in this book. Partnership with your health care provider is critical. Self-management does not mean going it alone. Get help or advice whenever you are concerned or uncertain.
Think of self-management like this: Both at home and in the business world, managers direct the show. But they don’t do everything themselves. Managers work with others, including consultants, to get the job done. What makes them managers is that they are responsible for making decisions and making sure those decisions are carried out.
As the manager of your chronic pain condition, your job is much the same as any other manager. You gather information and work with a consultant or team of consultants consisting of your physician and other health professionals. Once they have given you their best advice, it is up to you to follow through.
In this book, we describe many self-management skills and tools to help you address the problems of living with your condition. We do not expect you to use all of them. Pick and choose. Experiment. Set your own goals.
What you do may not be as important as the sense of confidence and control that comes from successfully doing something proactive to deal with your situation
.
Whenever we try a new skill, our first attempts may be clumsy, slow, and show few results. When this occurs, it is often easier to return to old ways than to continue trying to master new and sometimes difficult tasks. The best way to master new skills is through practice, perseverance, and thoughtful evaluation of the results. Always keep this in mind as you develop effective self-management skills for your chronic pain condition.