When you get injured or have surgery, you expect to hurt for a while, but you know that in time, you'll heal and the pain will leave. Unfortunately, for some chronic conditions, this is not the case.
Chronic pain is different. Sometimes, it's an after effect of an injury that appears to have healed. Sometimes, it's a lingering symptom of a past illness. And in some cases, chronic pain develops out of the blue, with no link to trauma or disease. However you try to explain it, chronic pain is something of a mystery. Tests and examinations may uncover nothing abnormal, but your body's distress is real. Over time, physical pain takes an emotional toll, making your body hurt even more. Anxiety magnifies unpleasant sensations, and sleep problems leave you feeling weak and helpless. Persistence, poor response to treatment, unknown cause, sleep disruption and emotional fallout. These are the hallmarks of chronic pain. And the longer you've had it, the less likely it will be to disappear, no matter what you do. But chronic pain doesn't have to rule your life. Here's how to take control.
If you've been going from doctor to doctor, now's the time to settle on one and build a good relationship. The right doctor could be a family physician or a specialist with expertise in your underlying condition, for instance, a rheumatologist if you're dealing with arthritis, etc. Or you may want to work with a pain management specialist. If you have a primary doctor, he or she may be able to refer you to one. Otherwise, major hospitals and multispecialty group practices are likely to have pain management specialists on staff. If a hospital has a pain clinic, you can find a pain specialist there. If not, check with the hospital departments that may have a pain management component, for example, in physical medicine, anesthesiology and/or psychiatry.
When selecting a pain
specialist, look for someone who:
· Is knowledgeable about chronic pain.
· Wants to help.
· Listens well.
· Makes you feel at ease.
· Encourages you to ask questions.
· Seems honest and trustworthy.
· Allows you to disagree.
· Is willing to talk with your family or friends.
· Has a positive attitude toward life and your condition.
Even if you're working with a pain specialist, you need a primary doctor to manage your overall health. Keep both doctors informed about the details of your condition, and make sure they both have access to all your records. It's particularly important for every doctor you consult to know what pain medication you're on, who's prescribing it and what, if any, additional drugs you take for other reasons. Sharing this information reduces the risk that you'll accidentally overdose on pain medication or experience a dangerous drug interaction. Once your pain is under control and you're on a stable regimen of medications, your primary care doctor can provide ongoing prescriptions.
When you have chronic pain, it can dominate your thinking, sometimes in ways that aren't obvious. To become informed about your condition, for instance, you may spend a lot of time monitoring pain-related publications and Internet newsgroups. Of course it's important to understand what's happening to your body and perhaps connect with people who have similar problems. But constantly reading and talking about pain keeps you focused on what's wrong when you could be finding ways to build on everything that's still right.
Start by setting simple, measurable, reasonable and attainable goals. Think about times when your pain has gotten out of control, and figure out how to keep it from overwhelming you again. For instance, if you often have to take extra doses of pain medication at night because you've forgotten to take a scheduled dose during the day, ask your doctor about changing your dosing schedule or otherwise simplifying your regimen. Then set a goal of using your medication exactly as prescribed for two weeks, with the understanding that you'll call your doctor if problems arise. Once you've gone two weeks on a stable regimen, make it your next goal to stick to the schedule for two more weeks, then for four. In time, these simple steps will add up to a big change. You'll have established one of the most important parts of an overall pain management plan, perhaps for the first time since you developed a pain condition. Now you can move on to new goals. Another example: Your back pain is as bad as ever, and your doctor says it will stay that way unless you do a simple set of exercises at least once a day. You're embarrassed to admit it, but you've never been able to complete the exercises without getting short of breath and making your stiff knee act up. In this complicated situation, you might burden yourself with an unrealistic goal. Get on the stick and do the exercises, for instance. But here's an attainable goal: Come clean with your doctor. Exercises for back pain should not leave you breathless. If they do, you need your doctor's help to find out why and take care of the problem. Another goal might be to ask for a referral to a physical therapist or exercise trainer who'll show you the best techniques for strengthening your back muscles without straining anything else. In both examples, the process is the same. You identify an obstacle that prevents you from taking a step toward feeling better. Then you find a way around the obstacle and go on to the next challenge.
Many other habits and thought patterns may contribute to a constant struggle with pain. When you identify these contributors, you can get busy neutralizing them by setting and reaching new goals. Some possible targets:
· Irregular sleep, such as napping in the evening and staying awake most of the night.
· Unhealthy food choices.
· Smoking
· Drinking alcohol.
· Using recreational drugs.
After months or years of nearly constant pain, you may have developed habits known as "pain behaviors." You express pain in your movements, facial expressions, words and tone of voice, often without even realizing it. Occasionally, you complain directly about your pain, and you avoid normal activities out of fear that they'll make you hurt more. Unfortunately, the time you spend resting and protecting painful areas actually does more harm than good. The other problem with pain behavior is the sense of helplessness it gives you and conveys to the people around you. If your display of pain makes your spouse and children less demanding, and perhaps even more caring, it's only natural that you'll be less inhibited about letting discomfort show. You may come to believe that unless you're suffering, you don't deserve their attention and consideration. No one sets out to follow this pattern, but it often emerges, and getting out of it takes a lot of self-awareness and emotional strength. Family and individual counseling may be helpful. If you can identify and isolate specific pain behavior, such as staying in bed for much of the day, you may benefit from setting and reaching goals that address that behavior one step at a time.
All your planning and goal setting should have one overarching aim: to put chronic pain in its place. You don't want it and you don't deserve it, but it's there. You could let it disrupt your career and damage your relationships. Or you could learn new ways of coping that keep it in check and free you to enjoy the full life you're entitled to have.
The best advice for staying in control of your pain is to regularly use pain management strategies, such as exercise, relaxation and pacing yourself. The more you use them, the more beneficial they'll become.
To maintain your progress and avoid relapses:
1. Follow through on your goals. Focus on your areas of greatest concern. Then set some specific, measurable and realistic goals to help you deal with those issues. For each goal, be sure to break your journey into small, achievable steps. Create a checklist, and put an “X” by each step you reach. To help strengthen your motivation, ask a family member or a friend to periodically review your checklist.
2. Monitor your progress. Seeing the accomplishments that you've made can motivate you to continue toward your goals. Use charts to display your progress.
3. Write out a contract. Some people find that making a personal commitment to improving their lives and managing their pain helps in following through on their plans. More than just a goal, a contract becomes a pledge associated with other binding agreements you've made throughout your life.
4. Plan your day. When you specifically schedule time for something, such as exercise or going to a movie, you're more likely to do it. Also use to-do lists or notes on a calendar to remind you of your priorities.
5. Control your surroundings. Look around your house and change things that might lure you back into unhealthy habits. Is your bed still sitting in the living room so that you can avoid the walk upstairs to your bedroom? Are the drapes pulled to keep your rooms dark? Make your house feel like a home, not a hospital or a mortuary. When you walk around your house, you want to see evidence of a person who lives a happy and active life.
6. Seek and accept support. Accepting help from others isn't a sign of weakness, nor does it mean that you're failing. You need support from others to keep you on track and to help you when you have difficult days. In addition to support from family and friends, consider joining a chronic pain support group.
7. Work with your doctor. Your doctor can be one of your biggest advocates. Keep your doctor updated on your progress and any obstacles you may encounter. He or she often can help you overcome those obstacles. If your doctor isn't willing to work with you, you may want to find a doctor who will.
8. Stay positive. List as many positive statements about yourself as you can and repeat them to yourself when you're feeling discouraged or in danger of slipping back into some of your old patterns of unhealthy behavior. If you do have a relapse, accept that setbacks sometimes occur. Take comfort in your past successes. They're proof that you've got the skills to succeed again.
9. Prepare for challenging situations. Make a list of situations that could disrupt the positive lifestyle changes you've made. Whatever they are, prepare a response plan that you can activate when needed. Perhaps you've been walking for 30 minutes each day, but you know the weather soon will change and you don't like being outside in the snow or cold. How do you still fit in your 30-minute walk each day? One option might be to walk indoors at a nearby mall. Or, perhaps, a local school allows indoor walking during certain hours. You might also consider purchasing a treadmill. If pain limits your exercise, ask your physician or therapist for alternatives. For example, swimming may have less impact on your joints than walking. A recumbent bicycle can place less strain on your back than a traditional bicycle.
10. Reward yourself. Rewards are a great way to reinforce positive change. When you reach a goal or successfully execute one of your pain strategies, treat yourself to something enjoyable, perhaps a movie, a sporting event, or a massage.
Everyone has bad days now and then. Holidays can be difficult. Then there's tax time or unpredicted severe weather overnight. A visit from relatives also may qualify. Whatever the reason for your bad day, you can get through it. One of the best ways to minimize the disruption and quickly get back to your usual activities is to plan for difficult days. Think through ways to cope with upcoming challenges when you're having a good day. Anticipating future difficulties can only make already bad day worse.
Here's how to plan ahead for a difficult day:
· Identify the events and situations that make for difficult days. Knowing the most common reasons for your difficult days will help you better prepare for them. Think about some recent bad days. Was there a reason for your increased pain? Could it have stemmed from too much stress, overdoing it on the weekends, traveling or lack of exercise?
· Identify your warning signs. Do you get a warning sign when a bad day is headed your way, such as a headache, excessive fatigue or onset of the blues?
· Maintain a normal schedule. A difficult day is not a time to overdo it ó or to do nothing. Lying around won't improve your pain or make the day go by any faster. Get out of the house. When you're hurting, it's natural to want to be alone. But this only gives you more opportunity to think about your pain. Go shopping or visit a friend who can keep you occupied.
· Seek other diversions. Read something enjoyable. Watch a funny movie or call a friend who has a good sense of humor.
· Try to relax. On a difficult day, spend more time practicing your relaxation techniques, such as listening to soothing tapes or practicing your breathing exercises.
·
Use
medications wisely. If you've weaned yourself from medication, don't let a
bad day tempt you into taking it again. Remind yourself that it's only a
temporary solution and that you're better off without it. If you're taking
medication, don't change the dose in an attempt to reduce the pain. You only
increase your risk of side effects, and the increased dose may not help your
pain.
Many people end up limiting their activities simply because they are afraid of worsening their pain. This type of thinking can result in self-fulfilling prophecies, as your body gets used to doing less and less. Negative thoughts also can color how you see your situation. Even minor problems can appear catastrophic, making it all too easy to just give up. These are very common reactions to chronic pain, and it may be very difficult to overcome them on your own. You may want to consult a mental health counselor. These professionals can help you learn to break negative patterns of thinking. Be patient with yourself and your situation as you learn to use these strategies. It's hard work to reclaim the life stolen from you by chronic pain. But the results are well worth it.