Living a Healthy Life with Chronic Pain (16 page)

Relaxation, imagery, and positive, more realistic thinking can be some of the most powerful tools you can add to your self-management toolbox. They will help you manage pain and other symptoms as well as master the other skills discussed in this book.

As with exercise and other acquired skills, using your mind to manage your health condition requires both practice and time before you begin to notice the benefits. If you feel you are not accomplishing anything, don’t give up. Be patient and keep on trying. However if symptoms get worse, don’t postpone seeing a health care provider. Be sure to tell him or her about any of the techniques you are trying. Give a full picture of what you do to manage your pain condition and your health. This will help ensure safe, coordinated care.

To learn more about the topics discussed in this chapter, we suggest that you explore the following resources:

Ben-Shahar, Tal.
Happier: Learn the Secrets to Daily Joy and Lasting Fulfillment
. New York: McGraw-Hill, 2007.

Benson, Herbert, and Miriam Z. Klipper.
The Relaxation Response
. New York: HarperCollins, 2000.

Benson, Herbert, and Eileen M. Stuart.
The Wellness Book: The Comprehensive Guide to Maintaining Health and Treating Stress-Related Illness
. New York: Fireside, 1993.

Boroson, Martin.
One Moment Meditation
. New York: Winter Road Publishing, 2009.

Borysenko, Joan.
Inner Peace for Busy People: 52 Simple Strategies for Transforming Your Life
.

Carlsbad, Calif.: Hay House, 2003.

Burns, David D.
The Feeling Good Handbook
, rev. ed. New York: Plume, 1999.

Caudill, Margaret.
Managing Pain Before It Manages You
. New York: Guilford Press, 2008.

Cousins, Norman.
Head First: The Biology of Hope and the Healing Power of the Human Spirit
. New York: Penguin, 1990.

Craze, Richard.
Teach Yourself Relaxation
, 3rd ed. New York: McGraw-Hill, 2009.

Darnall, Beth.
Less Pain, Fewer Pills: Avoid the Dangers of Prescription Opioids and Gain Control over Chronic Pain
. Boulder: Bull Publishing, 2014.

Davis, Martha, Elizabeth Eshelman, and Matthew McKay.
The Relaxation and Stress Reduction Workbook
. Oakland, Calif.: New Harbinger, 2008.

Diener, Ed, and Robert Biswas-Diener.
Happiness: Unlocking the Mysteries of Psychological Wealth
. Malden, Mass.: Blackwell, 2008.

Dossey, Larry.
Prayer Is Good Medicine
. New York: HarperCollins, 1996.

Emmons, Robert A.
Thanks! How the New Science of Gratitude Can Make You Happier
. New York: Houghton Mifflin, 2007.

Funk, Mary Margaret.
Tools Matter for Practicing the Spiritual Life
. New York: Continuum, 2004.

Gardner-Nix, Jackie.
The Mindfulness Solution to Pain: Step-by-Step Techniques for Chronic Pain Management
. Oakland, CA: New Harbinger Publications. 2009.

Grenville-Cleave, Bridget.
Introducing Positive Psychology: A Practical Guide
. London: Totem Books/Icon Books, 2012.

Kabat-Zinn, Jon.
Coming to Our Senses: Healing Ourselves and the World Through Mindfulness
. New York: Hyperion, 2005.

Kabat-Zinn, Jon.
Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness
. New York: Bantam Books, 2013.

Kabat-Zinn, Jon.
Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life
. New York: Hyperion, 2005.

Keating, Thomas.
Open Mind, Open Heart: The Contemplative Dimension of the Gospel
. New York: Continuum, 2006.

Keating, Thomas, Basil Pennington, Gustave Reininger, et al.
Centering Prayer in Daily Life and Ministry
. New York: Continuum, 1998.

Lyubomirsky, Sonia.
The How of Happiness: A New Approach to Getting the Life You Want
. New York: Penguin, 2008.

McKay, Matthew, Martha Davis, and Patrick Fanning.
Thoughts and Feelings: Taking Control of Your Moods and Your Life
, 4th ed. Oakland, Calif.: New Harbinger, 2011.

Ornstein, Robert, and David Sobel.
Healthy Pleasures
. Cambridge, Mass.: Perseus, 1989.

Peale, Norman V.
Positive Imaging: The Powerful Way to Change Your Life
. New York: Ballantine Books, 1996.

Remen, Rachel Naomi.
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. New York: Riverhead Books, 2006.

Seligman, Martin.
Authentic Happiness
. New York: Atria Books, 2004.

Seligman, Martin.
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. New York: Free Press, 2011.

Siegel, Bernie S.
Help Me to Heal: A Practical Guidebook for Patients, Visitors, and Caregivers
. Carlsbad, Calif.: Hay House, 2003.

Sobel, David, and Robert Ornstein.
The Healthy Mind, Healthy Body Handbook
(also published under the title
The Mind and Body Health Handbook
). Los Altos, Calif.: DRx, 1996.

Stahl, Bob, and Elisha Goldstein.
A Mindfulness-Based Stress Reduction Workbook
. Oakland, Calif.: New Harbinger, 2010.

Turk, Dennis C., and Frits Winter.
The Pain Survival Guide: How to Reclaim Your Life
. Washington, D.C.: American Psychological Association, 2006.

Wiseman, Richard.
59 Seconds: Think a Little, Change a Lot
. New York: Anchor Books, 2009.

I
T CAN BE DIFFICULT TO STRIKE THE RIGHT BALANCE
between activity and rest when you have chronic pain. In part, this is because it seems like you should stop an activity if it hurts. That’s what we do with acute pain because from long experience, we know that acute pain is nature’s way of telling us to pay attention, to rest, and to heal. Because we have responded to pain this way our whole lives, it’s difficult to get out of the mind-set of “pain = stop activity.”

But chronic pain is different from acute pain, as we discussed in
Chapter 1
. If you have a type of idiopathic chronic pain condition (that is, pain that should have gone away but didn’t), damaged tissues have healed after three to six months. Being active is not going to impact healing because healing has already occurred.

If you have a well-understood progressive disease such as arthritis, stopping activity will only make your condition worse. With chronic pain, you have to think differently about activity. Being active can help you be healthier and live a fuller life. And that is very important. Even in the face of chronic pain, you still want to enjoy and be involved in life and do the things that are important to you.

People with chronic pain typically display one of three activity patterns: avoiding activity, overdoing activity, and pacing activity. Let’s talk about each of these separately.

Some people with chronic pain rest almost all the time. They avoid activity. They started resting a lot when their pain was in the early stages thinking that rest would help, but it didn’t. Now, they have become so out of shape that movement of any kind hurts—not so much because of their chronic pain but because their muscles have become shortened and are tight and tense because they haven’t exercised. Or, they find that they don’t have the stamina to keep at a task for even short periods of time. This is largely due to poor muscle strength. Fear of pain leads people to avoid activity, but avoiding activity actually leads to more pain. It’s a vicious cycle, as shown in
Figure 6.1
.

Resting too much has many other negative effects that can lead to further disability, additional depression, and more pain. Dr. Walter Bortz, who has studied the effects of inactivity, has coined the term “disuse syndrome.” His research shows that physical inactivity leads to deterioration of your heart, bones, and even your mental state. Did you know that you can lose 10 to 20 percent of your muscle mass and muscle strength by being inactive for just one week? Resting too much is not good for your health and well-being. It is also not good for your chronic pain and other symptoms.

The flip side of resting too much is forcing yourself to continue a task until you complete it. This is a common activity pattern for some people on the days when they might be feeling good. They decide that all the chores are going to get done “today,” no matter what. They push on despite their pain and then they collapse in terrible pain at the end of the day. To get through the day, they may have taken extra pain medication, and they may have been irritable and unpleasant to be around. They may accomplish their goal, but they often have to take time off to recover. Recovery can be slow and depressing.

Like the people who rest too much, the people who push themselves and overdo activity are also in a vicious cycle, as shown in
Figure 6.2
. But as this cycle continues, recovery takes even longer. They may become discouraged and begin to do less and less.

Figure 6.1
Vicious cycle of underdoing activity

Both the “too much rest” group and the “big push” group can improve their situation with a technique called pacing. Pacing is strategically balancing activity and rest. This allows you to accomplish the things you want to on most days, while keeping your pain under control.

Pacing is not about avoiding activity. It’s about regulating activity. For the inactive group, pacing involves gradually increasing activity to more normal levels.
Chapters 7
,
8
, and
9
are all about how to become more physically active while keeping safety in mind. For the people who tend to overdo it, it’s about learning to moderate activities. This may involve taking short breaks, changing body position, alternating tasks, and other strategies. People who pace their activities tend to be more satisfied with what they accomplish. They also report feeling more in control of their pain. The box on
page 104
lists pacing tips of successful self-managers.

Figure 6.2
Vicious cycle of overdoing activity