Living a Healthy Life with Chronic Pain (4 page)

Whether your chronic pain is caused by a known disease process like arthritis or is idiopathic like lower back pain or whiplash, the problems it causes are similar (see
Figure 1.2
). For example, most people with chronic pain suffer fatigue and loss of energy. Sleeping problems are also common. Furthermore, when part of the body hurts, our natural response is to tense the muscles in that area in an effort to protect or “guard” the area from further harm. Usually people are not aware they are doing this. Muscle tension causes us to restrict our movement and ultimately results in muscles becoming weak from not being used. This can lead to physical disability for some. Muscle tension can also cause shallow, ineffective breathing so that our bodies do not receive the oxygen needed to function efficiently. This can make fatigue even worse.

Other significant components of chronic pain are stress, anxiety, and fear. Fear of movement is common. So is fear for the future. Concerns and worries can wear us down and lead to such difficult emotions as anger, frustration, and feelings of helplessness. These emotions in turn can feed symptoms of “feeling blue,” which can lead to depression. Feelings of sadness or
discouragement are normal when dealing with a problem like chronic pain. It can be hard to maintain a cheerful disposition when your condition is constantly annoying and unlikely to go away completely. However, if these sad feelings last for more than a few weeks, there may be an imbalance in brain chemicals often associated with depression. Depression is linked to fatigue, and the more depressed and tired you feel, the more pain you feel. More pain leads to more stress, which leads to more depression and fatigue. And so the cycle continues.

Fred suffers from chronic lower back pain. He is in pain most of the time and has difficulty sleeping because of it. He took early retirement because of his pain and now, at age 55, he spends his days sitting at home watching TV or lying down resting. He avoids most physical activity because of his pain, weakness, and fatigue. Fred doesn’t pay much attention to his diet. He has become very irritable. It even seems too much trouble when the grandchildren he adores come to visit. Most people, including his family, no longer enjoy his company.

Joyce, age 66, also suffers from chronic lower back pain. Every day she manages to walk several blocks to the local library or the park. When the pain is severe, she practices relaxation techniques and tries to distract herself. She has learned to plan her activities around her condition so she can still do things she enjoys, like meeting her friends for coffee and visiting her grandchildren. She even manages to take care of the grandkids sometimes when her daughter has to run errands. Her husband is amazed at how much zest she has for life.

Fred and Joyce both live with the same condition and similar physical problems. Yet their abilities to function and enjoy life are very different. Why? In part, the difference lies in their respective attitudes toward their chronic pain. Fred has allowed his physical and emotional capacities to wither. Joyce has learned to take an active role in managing her pain. Even though she has limitations,
she
controls her life instead of letting the pain control it.

A good attitude cannot cure your chronic pain. But a positive attitude and certain self-management skills can make it much easier to live with. Much research now shows that the experience of pain, discomfort, and disability can be modified by circumstances, beliefs, thoughts, mood, and the attention we pay to symptoms. For example, excessive negative thinking and focusing attention on pain has been found to be a strong contributor to increased levels of pain and disability in people with neck, shoulder, and back pain, arthritis, different types of neuropathic pain, and phantom pain. What goes on in a person’s mind is as important as what is going on in the person’s body.

• You are not to blame.
  You are not responsible for causing your pain or failing to cure it. Chronic pain is caused by a complex combination of genetic, biological, environmental, and psychological factors. But although it is not your fault, you
  are
  the one who is responsible for taking action to manage your pain condition.
  

• Don’t do it alone.
  One of the side effects of chronic pain is a feeling of isolation. As supportive as friends and family members may be, they often cannot understand your struggle to cope every day. However, there are others who know firsthand what it is like to live with a chronic condition just like yours. And many are coping successfully. Connecting with these people can reduce your sense of isolation. They can help you understand what to expect and introduce you to practical tips on how to manage symptoms and feelings. Reaching out can even give you the opportunity to help others cope with their condition, help you appreciate your strengths, and inspire you to take a more active role in managing your pain. Support can come from reading a book, article, or newsletter about how someone lives with chronic pain. Or it can come from talking with others on the telephone, attending support groups, or even by linking with them online through websites devoted to your particular condition.
  

• You are more than your pain.
  When you have chronic pain, too often the focus of attention becomes your pain. But you are more than pain—you are a person. It is essential to cultivate areas of your life that you enjoy. Small daily pleasures can help balance your efforts to manage uncomfortable symptoms or emotions. Find ways to enjoy nature by growing a plant or watching a sunset. Indulge in the pleasure of human touch or a tasty meal. Seek out companionship with family or friends. Focus on your abilities and strengths rather than disabilities and problems. Celebrate small improvements. If chronic pain teaches anything, it is to live each moment more fully. Your pain condition presents legitimate limits to what you can do, but there are many ways to enhance your function, sense of control, and enjoyment of life.
  

• Illness can be an opportunity.
  As strange as it may sound, challenges like chronic pain can provide opportunities for personal growth. Pain can make you reevaluate what is really important, shift priorities, and move in new directions that you may never have considered before.
  

David developed chronic hip and leg pain after a car accident. He has had four surgeries but still is in pain 15 years later. During his journey, he became involved in a support group as a way to cope. Now he is the director of a national chronic pain association. He feels that before the accident he would never have thought he had the skills to be a leader. Chronic pain, he says, taught him to be persistent and work toward a goal. For him, “knowing that I’m involved and helping others” is the key.

Chronic pain often necessitates a change in lifestyle. To do some of the things they like to do, people with chronic pain have to be smarter and wiser in choosing the activities they want to pursue. They may decide to spend more time deepening relationships with family and friends, or they may pick up an old hobby they used to enjoy. For example, Melanie has had fibromyalgia for three years. She loves music and learned to play the guitar when she was younger, but she hadn’t played for years because she was too busy. After her diagnosis, she started playing again and discovered a whole new network of friends in the city where she lives as well as online. She feels her life is richer because of music and her new friends. So although chronic pain is a difficult condition to have and may close some doors, you can, like Melanie, choose to open new ones.

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

Butler, David and G. Lorimer Moseley.
Explain Pain
. NOI Group Publishing, Australia, 2013.

Caudill, Margaret A.
Managing Pain Before It Manages You
. New York: Guilford Press, 2009.

Corey, David. Pain:
Learning to Live Without It
. Toronto: MacMillan Canada, 1993, 2004. Available as a free download at
www.healthrecoverygroup.com/pmp/pain_handbooks.htm
Part 1: Why We Hurt: The Human Body and Pain.

Cousins, Norman.
Anatomy of an Illness as Perceived by the Patient
. New York: W. W. Norton, 2005.

Foreman, Judy.
A Nation in Pain: Healing Our Biggest Health Problem
. New York: Oxford University Press, 2014.

Gruman, Jessie.
AfterShock: What to Do When the Doctor Gives You—or Someone You Love—a Devastating Diagnosis
. New York: Walker, 2010. See also Gruman’s website, which offers a selection of further resources:
www.aftershockbook.com
.

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

Melzack, Ronald, and Patrick Wall.
The Challenge of Pain
. London: Penguin, 2008.

Moseley, G. Lorimer.
Painful Yarns, Metaphors and Stories to Help Understand the Biology of Pain
. Dancing Giraffe Press, Australia. 2007

Selak, Joy H., and Steven S. Overman.
You Don’t Look Sick: Living Well with Invisible Chronic Illness
. Binghamton, N.Y.: Haworth Medical Press, 2005.

Sobel, David, and Robert Ornstein.
The Healthy Mind, Healthy Body Handbook
. Los Altos, Calif.: DRx, 1996.

Sobel, David, and Robert Ornstein.
Healthy Pleasures
, Reading, Mass.: Addison-Wesley, 1989.

Sobel, David, and Robert Ornstein.
Mind and Body Health Handbook: How to Use Your Mind and Body to Relieve Stress, Overcome Illness, and Enjoy Healthy Pleasures
, 2nd ed. Los Altos, Calif.: DRx, 1998.

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

Weil, Andrew.
Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well-Being
. New York: Anchor Books, 2005.

S
OME PEOPLE MANAGE THEIR CHRONIC PAIN
by withdrawing from life. They rest almost all the time, socialize less, and even withdraw from their family. The pain becomes the center of their existence. Other people with the same condition and symptoms somehow manage to get on with life. They may change some of the things they do or the way certain things get done. Sometimes, they may say no to things they used to do. Nevertheless, life for them continues to be full and active.

The difference between these two extremes is not the pain itself but rather how the person with chronic pain decides to manage his or her condition. Please note the use of the word
decides
in the previous sentence. Self-management is always a decision: a decision to be active or a decision to do nothing; a decision to seek help or a decision to suffer in silence. This book will help you with these decisions.

Remember:
you
are the manager when it comes to your health. And, like the manager of an organization or household, you are responsible for the following tasks:

1. Determine what your problem is and think about how you can solve it.
   
2. Make a decision about what you want to accomplish.
   
3. Take action by setting your goal and evaluating your options.
   
4. Make a short-term action plan.
   
5. Carry out your action plan.
   
6. Check the results.
   
7. Make mid-course corrections to your action plan as needed.
   
8. Reward yourself for your success.
   

The material in this chapter will help get you started on accomplishing the responsibilities outlined in this list. Like any skill, active self-management must be learned and practiced. This chapter starts you on your way by presenting the three most important self-management tools: problem solving, making decisions, and taking action.

We begin by discussing the importance of problem solving.

Problems sometimes make themselves known with a feeling of general uneasiness. Let’s say you are unhappy but not sure why. Your first goal is to identify the problem. Upon closer examination, you find that you miss having contact with some relatives who live far away. With the problem identified, you consider different ways to address it and ultimately decide to take a trip to visit the relatives you miss.

In the past you have always driven, but you now find it tiring to drive. You consider leaving at noon instead of early in the morning, making the trip in two days instead of one, or asking a friend along to share the driving. You decide none of these are viable options, so you seek other ways of travel. There is a train that stops close to your destination, or you could fly. After comparing the price of air and rail tickets, you decide to take the train.

The trip still seems overwhelming, so you decide to write down all the steps necessary to make it a reality. These include finding a good time to go, buying a train ticket, figuring out how to handle luggage, seeing if you can make it up and down the stairs on the train, determining if you can walk on a moving train to get food or visit the restroom, and figuring out how you will get to the station. Each of these steps can be addressed as part of an action plan.

To start your action planning, you promise yourself that this week you will call and find out how much the railroad can help. You also decide to start taking a short walk each day, including walking up and down a few steps, so you will be steadier on your feet. You then carry out your action plans by calling the railroad and starting your walking program.

A week later you check the results. Right away, you see that a single call answered many questions. The railroad offers help to people who have mobility problems and has ways of dealing with many of your concerns. However, even though you are walking better, you still feel unsteady on your feet. You make a change in your action plan by asking a physical therapist about this, and he suggests using a cane or walking stick. Although you don’t like using one, you realize that a cane will give you the extra security needed on a moving train.

You have just engaged in problem solving to achieve your goal to take a trip. This example illustrates some of the steps of problem solving. In the material that follows we discuss in more detail the specific steps in problem solving.

The following steps for solving problems are summarized in
Table 2.1
:

1. Identify the problem.
   This is the first and most important step in problem solving—and usually the most difficult step as well. You may anticipate, for example, that the stairs on the train might pose a problem, but it may take a little more exploration to determine that the real problem you need to address is your fear of falling.
   
2. List ideas to solve the problem.
   You may be able to come up with a good list of ideas yourself. And you can also call on friends, family, members of your health care team, or community resources. But remember: these folks cannot help you if you do not clearly identify and describe the problem. For example, there is a big difference between saying that you can’t walk because your feet hurt and saying that your feet hurt because you cannot find walking shoes that fit properly. The first is a vague complaint; the second is an identifiable problem that can be rectified.
   

Table 2.1
Problem-Solving Steps

3.   
Pick an idea to try.
Start with the idea that you feel has the most promise to solve your problem. As you try it, remember that new activities can be difficult sometimes. Be sure to give your potential solution a fair chance before deciding it doesn’t work.

4.   
Check the results.
After you’ve given your idea a fair trial, evaluate the results. If all went well, your problem has been solved.

5.   
Pick another idea if the first doesn’t work.
If you still have the problem, pick another idea from your list and try again.

6.   
Seek additional resources.
Turn to your family, friends, and health care providers for more ideas if you still do not have a solution to the problem.

7.   
Accept that the problem may not be solvable now.
If you have exhausted all your ideas and the problem is still unsolved, your problem may not be solvable right now. You may have to accept that fact. This is some-mean that other problems cannot be solved. times hard to do. But just because a prob-Even if your path is blocked, there are problem can’t be solved right now doesn’t mean ably alternative paths waiting to be discovthat it won’t be solvable later. It also doesn’t ered. Don’t give up. Keep going.