AS@W
PCHC Positive Coping with Health Conditions
Pain

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Health conditions are often accompanied by physical pain. This can take the form of acute pain (directly tied to physical injury and lasting minutes to a few days) or chronic pain (persisting in the absence of immediate injury, and lasting for months or years). When we speak about applying Positive Coping Skills to pain, we are thinking mainly of skills for dealing with chronic pain.

The Positive Coping Skills can help you better manage the experience of pain so that it interferes less with your life and causes you less suffering.

Activating Your Life

This skill provides a step-by-step guide to becoming active. This means increasing your involvement in rewarding activities in a gradual and realistic way. It is particularly relevant to pain management, because individuals suffering from chronic pain often reduce their level of activity. Individuals with chronic pain reduce activity because they:

  • Feel they do not have enough energy to be active,
  • Feel that others would not want to be around them while they’re suffering,
  • Fear that physical or social activities might increase pain,
  • Believe that staying inactive prevents further injury or aggravation of their health condition.

However, decades of experience with pain patients has made it clear that staying active, within appropriate limits, is a very important part of dealing with pain.

Physical inactivity reduces overall fitness, leads to muscle weakening, causes increased physical tension, and contributes to increased pain. Social inactivity lowers mood and increases your attention to the pain, both of which tend to worsen pain experience. Although people who become inactive feel like they’re protecting themselves, they are actually reducing the chance of improvement.

But before you begin to work on re-activating your life, here are some important tips about increasing your activity level when you’re suffering from chronic pain.

Know Your Limits

Speak to your doctor to figure out which activities are medically contraindicated – meaning activities that would result in tissue injury or damage. Remember, that’s not the same thing as activities that might cause pain. Some activities might be high risk in terms of worsening your health condition, but not cause significant pain; while other activities might cause pain but actually represent a very low risk of worsening the health condition. In fact, some activities that help to improve your health condition, like a program of gentle exercise, also might cause some pain, especially when you first begin. We call this the difference between Activities that Hurt and Activities that Harm. It’s important to know the difference so you can avoid activities that would actually harm you. On the next page is a form you might want to complete with your healthcare provider. Completing this form can help you identify activities that are safe for you to do, as well as help guide the pacing of activity.

In the first column, list activities you do that cause increased pain. In the second column, check off activities that might harm you. In the third column, check off activities that might hurt but aren’t likely to be harmful. For almost all people, walking four blocks is very unlikely to cause physical harm, even if it causes some pain (Hurt yes, Harm no). But for many individuals with health conditions, lifting heavy weights would carry a significant risk of physical harm as well as pain (Hurt yes, Harm yes).

Pencil Hurt-Harm Sheet

Activities that Increase Pain

Harm

Significant risk of physical injury or worsened condition

( Check Check below)

Hurt only

Increase pain, but low risk for physical injury or worsened condition

( Check Check below)
     
     
     
     
     
     
     
     

 

Pace Your Activity

“One of the most important things to remember when you have chronic pain is to not over-do when you are feeling well, and to not under-do when you are feeling unwell.” *

The old saying “slow and steady wins the race” is very true when you’re working to reduce pain. It is important to keep a consistent and steady pace of activity. The aim is to set a realistic activity level, one that avoids physical harm and is within your capacity even on a bad day. After all, your experience of pain may change from day to day. Set your activity goals low enough so that you can realistically reach those goals every single day. If you find it difficult to keep up with an activity goal because it causes too much pain, then the goal is too high and should be lowered. If you’re finding most or all activities too painful, you may want to ask your doctor for suggestions.

* Quote from a pain management specialist.

Solving Problems

An important problem is how to consistently follow recommended schedules of medication and self-care activities. Consistency in following recommendations is known as adherence. The way you adhere to medical recommendations will help determine whether your health condition improves or worsens.

Medications for the relief of chronic pain help to reduce suffering. However, there are risks to the use of pain medications: side effects like nausea or constipation; fear of becoming addicted; and possible reduced medication effect. So, decisions about medication use can get pretty complicated.

For example, you might use the medication whenever you notice pain and take enough so that you don’t feel any discomfort – even if you exceed your dosage. But, this may cause you to run out of medication early and have to return to your physician; it increases the risk of addiction; and it’s not very effective for reducing overall pain levels. Or, you might avoid using the pain medication as long as possible. Individuals taking this approach hold off on taking medication, choosing instead to live with the pain until it feels unbearable, and then use medication. These people may feel like they are avoiding the risk of becoming dependent on the medication. But this way of using pain medication has been found to gradually increase pain experience and medication dependence.

Which brings us to the way that works best: take pain medication according to a fixed schedule that spreads the pain relief throughout your day. This way, you apply the medication most effectively, before the pain has intensified, so you can often prevent intense pain from developing in the first place. Also, this way of handling pain medication is least likely to cause addiction!

Scheduling your pain medication means that you will talk to your healthcare provider about taking your medication at regular times spaced throughout the day. Then you can use medication pillboxes that show which medications have been taken, reminder devices that signal that it’s time for medication, or the Remembering Self-Care method on page 50 in this workbook.

Relaxation

Another skill important for pain control is that of Relaxation. Pain researchers have shown that there is a two-way connection between pain and tension: pain increases physical tension and emotional anxiety – while tension and anxiety worsen the pain. It’s a vicious cycle of suffering.

Diagram

Learning to reduce physical tension and emotional anxiety using Relaxation will help you get better control over your pain. Of course, it won’t be easy to focus on learning relaxation while you’re experiencing pain – but keep slowly working at it. Many individuals with pain problems have used relaxation methods to help control their pain experience and reduce  suffering.