Living a Healthy Life with Chronic Pain (26 page)

For some people, just the feelings of increased endurance and well-being are enough to indicate progress. Others may need proof that their exercise program is making a measurable difference. You can use one or both of the following fitness tests. Not everyone will be able to do both tests. Pick the one that works best for you. Record your results. After four weeks of exercise, repeat the test and check your improvement. Measure yourself again after four more weeks of your exercise action plan.

• Use a fitness monitor
  . One of the least expensive pieces of exercise equipment is a pedometer. Because distance can be difficult to set, the best pedometers measure your steps. If you get in the habit of wearing a pedometer, it is easy to motivate yourself to add a few extra steps each day. You will be surprised at how these add up. A more expensive option is one of the new digital fitness wristbands that keeps track of step count, calorie burn, and other useful information.
  

• Measure distance
  . Find a place to walk, bicycle, swim, or water-walk where you can measure distance. A running track works well. On a street you can measure distance with the odometer in a car. A stationary bicycle or a treadmill with an odometer provides the same measurement. If you plan on swimming or water-walking, you can count lengths of the pool. After a warm-up, note your starting point and then bicycle, swim, or walk as briskly as you comfortably can for 5 minutes. Try to move at a steady pace for the full time. At the end of five minutes, mark your spot or note the distance or number of laps. Immediately take your pulse or rate your perceived exertion from 0 to 10. Continue at a slow pace for three to five more minutes to cool down. Record the distance, your heart rate, and your perceived exertion.
  

• Repeat the test after several weeks of exercise
  . There may be a change in as little as four weeks. However, it often takes eight to 12 weeks to see improvement.
  

Goal:
To cover more distance, to lower your heart rate, or to lower your perceived exertion.

• Set a time
  . Measure a given distance to walk, bike, swim, or water-walk. Estimate how far you think you can go in one to five minutes. You can pick actual distance, a number of blocks, or lengths in a pool. Spend three to five minutes warming up. Start timing and begin moving steadily, briskly, and comfortably. At the finish line, record how long it took you to cover your course, your heart rate, and your perceived exertion.
  

• Repeat the test
  after several weeks of exercise, as you would for distance.
  

Goal:
To complete the distance in less time, at a lower heart rate, or at a lower perceived exertion.

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

Fenton, Mark.
The Complete Guide to Walking for Health, Weight Loss, and Fitness
. Guilford, Conn.: Lyons Press, 2007.

Fortmann, Stephen P., and Prudence E. Breitrose.
The Blood Pressure Book: How to Get It Down and Keep It Down
, 3rd ed. Boulder, Colo.: Bull, 2006.

Karpay, Ellen.
The Everything Total Fitness Book
. Avon, Mass.: Adams Media, 2000.

Knopf, Karl.
Make the Pool Your Gym: No-Impact Water Workouts for Getting Fit, Building Strength, and Rehabbing from Injury
. Berkeley, Calif.: Ulysses Press, 2012.

Nelson, Miriam E., Alice H. Lichtenstein, and Lawrence Lindner.
Strong Women, Strong Hearts: Proven Strategies to Prevent and Reverse Heart Disease Now
. New York: Putnam, 2005.

White, Martha.
Water Exercise: 78 Safe and Effective Exercises for Fitness and Therapy
. Champaign, Ill.: Human Kinetics, 1998.

“You just don’t understand!”

H
OW OFTEN HAS THIS STATEMENT
summed up a frustrating discussion for you? Whenever you talk with someone, you want the person to understand. And you are understandably frustrated when you feel you have not been understood. Failure to communicate effectively can lead to anger, helplessness, isolation, and depression. Such feelings can be even worse when you have chronic pain.

Pain gets in the way of interaction with others. For example, pain can distract you so that you don’t listen very well when others are talking to you. Pain can make you angry and irritable, and sometimes you may vent these feelings inappropriately—at family, friends, or coworkers. Pain can make you feel so overwhelmed that your world begins to shrink in size and revolve solely around you and your pain. Your communication with others can become self-centered. In the long run, these styles of communication turn off the people you care about most. The result: poor relationships
with family members, friends, coworkers, or members of our health care team.

When communication breaks down, it affects your pain and symptoms. Your muscles tense, pain can increase, blood sugar and blood pressure levels may rise, and there is increased strain on the heart. Worry caused by conflict and misunderstanding can make you more irritable, further interfere with concentration, and sometimes lead to accidents. Clearly, poor communication is bad for your physical, mental, and emotional health.

For a self-manager, effective communication skills are essential. In this chapter we discuss tools to improve communication. These tools will help you express your feelings in a positive way. We give tips to help you minimize conflict, ask for help, and say no. We also discuss how to listen, how to recognize body language and different styles of communication, and how to get more information from others. In
Chapter 11
, we discuss how to more effectively communicate about your pain and other symptoms with your health care providers and how to work with the health care system.

Keep in mind that communication is a two-way street. As uncomfortable as you may feel about expressing your feelings or asking for help, chances are that others are also feeling the same way. It may be up to you to make sure the lines of communication are open.

When communication is difficult, take the following steps. First, review the situation. Exactly what is bothering you? What are you feeling? Here is an example.

Bob and Jim had agreed to go to a football game. When Bob came to pick him up, Jim was not ready. In fact, he was not sure he wanted to go because he was having trouble with his back. The following conversation took place.

In this conversation, neither Bob nor Jim had stopped to think about what was really bothering him or how he felt about it. Each blamed the other for an unfortunate situation.

The following is the same conversation but with both people using more thoughtful communication.

In this dialogue, Bob and Jim talked about the situation and how they felt about it. Neither blamed the other.

Unfortunately, people often use blaming communications in these situations. For example, maybe we are not listening, get caught, and then we blame the other person. Even then, thoughtful communication can be helpful. Consider the following example.

In this example, only Cathy is using thoughtful communication. Jean continues to blame. The outcome, however, is still positive. Both people get what they want.

The following are some suggestions for using good communications and creating supportive relationships:

• Show respect
  . Always show respect and regard for the other person. Try not to preach or be excessively demanding. Avoid demeaning or blaming comments such as, “Why do you always spoil my plans?” The use of the word
  you
  is a clue that your communication might be blaming. Try to start sentences with the word “I” instead (we discuss this practice more in the pages that follow). A bit of tact and courtesy can defuse
  many of these situations (see the section on Anger in
  Chapter 4
  ,
  page 63
  ).
  

• Be clear
  . Describe a specific situation or your observations using the facts. Avoid words like
  always
  and
  never
  . Don’t make or respond to unhelpful generalizations. For example, rather than react to Jean’s accusation, Cathy responded by clearly explaining her last-minute pain, as well as her hopes for continuing to enjoy Jean’s company despite the pain and fatigue.
  

• Don’t make assumptions
  . Ask for more detail. Jean did not do this. She assumed that Cathy was rude because she did not call. It would have been better if she asked Cathy why she hadn’t called earlier. Assumptions are the enemy of good communication. Many arguments arise from one person expecting the other person to be able to read his or her mind. Ask questions if you don’t understand something.
  

• Open up
  . Try to express your feelings openly and honestly. Express your own needs directly and clearly. Don’t make others guess what you are feeling or what you need—chances are they may be off base. Cathy did the right thing. She talked about wanting to go, not wanting to disappoint Jean, and hoping that her fibromyalgia symptoms would get better.
  

• Accept the feelings of others
  . Try to understand their perspective. This is not always easy. Sometimes you need to think about what was said instead of answering at once. You can always stall a bit by saying “I am trying to understand” or “I’m not sure I understand; could you explain some more?”
  

• Use humor—sparingly
  . Sometimes gently introducing a bit of humor works wonders. But don’t use sarcasm or demeaning humor, and know when to be serious.
  

• Avoid playing the victim
  . You become a victim when you do not express your needs and feelings or expect that someone else should act in a certain way. Unless you have done something to hurt another person, you should not apologize. Apologizing all the time is a sign that you view yourself as a victim. You deserve respect, and you have a right to express your wants and needs.
  

• Listen first
  . Good listeners seldom interrupt. Wait a few seconds when someone is finished talking before you respond. He or she may have more to say.
  

Many of us are uncomfortable expressing our feelings, especially when it may seem as if we are being critical of someone else. But there are some guidelines to follow that can help us better express our feelings without making our listeners feel attacked or on the defensive.

If emotions are high and we feel frustrated, our communication may be full of “you” messages. “You” messages are sentences that begin with the word “you.” In a heated discussion, “you” statements are often accusative and confrontational. They suggest blame, causing the other person to feel under attack. Once we start flinging “you” statements around, the other
person is on the defensive, and barriers go up. The situation just escalates from there, leading to anger, frustration, and bad feelings.

“I” statements are direct, assertive expressions of your views and feelings. To craft “I” messages, avoid the word
you
and instead report your personal feelings using the word
I
. For example, say, “I try very hard to do the best work I can” rather than “You always criticize me.” Or “I appreciate it when you turn down the television while I talk,” not “You never pay attention.” Here are some more examples:

Watch out for disguised or hidden “you” messages. These are “you” messages with “I feel …” stuck in front of them. For example, “I feel that you are not treating me fairly” is actually a disguised “you” statement. A true “I” statement would be, “I feel angry and hurt.” Here’s another example:

Of course, like any new skill, crafting “I” messages takes practice. Start by really listening, to yourself and to others. (Grocery stores are a good place to here lots of “you” messages as parents talk to their children.) In your head, turn some of the “you” messages into “I” messages. You’ll be surprised at how fast “I” messages become a habit.

To get started, adopt the following format for your “I” message communication:

For example, imagine you have baked a special bread to bring as a gift to a friend. A family member wanders into the kitchen, sees the bread on the counter, and cuts out a large slice. You’re upset because, with a piece missing, the gift is ruined. You might say to the bread eater: “I see you cut into my special bread [fact], but I think you should have asked me about it first [opinion]. I’m really upset and disappointed because I can’t give it as a gift now [feeling]. I’d like an apology, and I’d like you to ask me first next time [want].”

Table 10.1
Ensuring Clear Communication

“I” messages are a great tool but there are some “I” message cautions to keep in mind. First, they are not a cure-all. They only work if the listener is able to really hear them. This can be a problem if the person is used to hearing blaming “you” messages. Even when you switch to “I” messages, your listener may be so accustomed to “you” messages, they may not be able to hear your new method of communication. If using “I” messages does not work at first, continue to use them. Things will change as you gain skill and old patterns of communication are broken.

Second, some people use “I” messages as a means of manipulation. They may often express that they are sad, angry, or frustrated in order to gain sympathy from others. If used in this way, problems can escalate. Effective “I” messages must report honest feelings, not be used as attention-seeking devices.

Finally, note that “I” messages are not just about conveying disappointment or upset. They are an excellent way to express positive feelings and compliments. For example, “I really appreciate the extra time you gave me today, doctor.”

Good communication skills help make life easier for everyone, especially those with long-term health problems.
Table 10.1
summarizes some words that can help or hinder this communication.

In addition to using “I” messages, the following are methods that you can use to reduce conflict.

• Shift the focus
  . If a discussion gets off topic and emotions are running high, shift the focus of the conversation. That is, bring the discussion back to the original topic. For example, you might say something like, “We’re both getting upset now and drifting away from the topic we agreed to discuss,” or “I feel like things other than what we agreed to talk about are coming up, and I’m getting upset. Can we discuss these other things later and just talk about the topics we originally agreed on?”
  

• Make sure you understand each other’s viewpoints
  . Do this by summarizing what you heard and asking for clarification. You can also switch roles. Try arguing the other person’s position as thoroughly and thoughtfully as possible. This will help you understand all sides of an issue, as well as convey that you respect and value the other’s point of view. It will also help you develop tolerance and empathy for others.
  

• Look for compromise
  . You may not always find the perfect solution to a problem or reach total agreement. Nevertheless, it may be possible to compromise. Find something on which you can agree. For example, you may decide to do it your way this time and the other person’s way the next time. Agree to part of what you want and part of what the other person wants. Or decide what adjustment you’ll make and what the other person will do in return. These are all forms of compromise that can help you through some difficult times
  

• Say you’re sorry
  . We all say or do things that, intentionally or unintentionally, hurt others. Many relationships suffer—sometimes for years—because people have not learned the powerful social skill of apologizing. Often all it takes is a simple, sincere apology to restore a relationship. Apologizing is not fun, but it is an act of courage, generosity, and healing. It brings the possibility of a renewed and stronger relationship, and it can also bring peace within yourself.