Last week we looked at chronic pain - what it is, and how it develops. This week, we're going to be talking about pain management. Pain management is the main part of my day job, so I've got a lot to say about it! Hopefully, people will find it helpful.
First thing's first - the reason we're looking at pain management rather than pain curing is that we can't take away chronic pain. Remember last week when we talked about your nervous system changing? That's not something we can reverse. Over time, if you're managing your pain well, you might experience less pain as your nervous system learns new ways of managing the sensations it's getting. But most people tell me that if they lapse back into old habits, their pain increases again.
Of course, everyone knows someone whose aunt Linda's best friend's cousin took CBD oil or did a course of reiki and their pain went away. And genuinely, I'm happy if that happened. Nobody wants to be in pain, and if I could take it away I would. But those treatments don't work for everyone, and are usually being touted by someone who is selling them. For most people, pain management is as good as it gets (and don't get me wrong, that can still be pretty good).
Second, in order to start managing pain, you have to accept that it's going to stick around for a good long while. If you try pain management as a way of controlling or getting rid of your pain, you'll find that when that doesn't happen you get frustrated (understandably - you were expecting the pain to go away and it didn't). That means you're less likely to continue with management strategies, and that means that your pain might get worse. You conclude that pain management strategies don't work (because now you feel worse) and nothing changes. I don't want that for anyone I see, but it does happen sometimes.
So, how can you start to regain some of your life back from chronic pain?
Come on, you knew this was coming. Chronic pain is your body's alarm system working overtime, it's not an indicator of any damage or that you will harm yourself more if you exercise (check this out with your medical professional if you're not sure). That said, if you suddenly decided to do a 5k after being sedentary for weeks, your alarm system would get sent into overdrive. You'd probably conclude that it's not safe for you to do activity, or that you just can't do it due to the pain.
When exercising with chronic pain, you need to start small and build up very slowly over time. I work a lot with highly specialist pain management physiotherapists, who often take people through gentle stretching exercises that can cause some muscle soreness afterwards, especially if you've not done anything for a long time, but that in the long-term can help people to progress towards their goals. For example, if you're struggling to turn your neck to the right to look in your car mirror, gently stretching the muscles there can make it easier. Note that I didn't say less painful - just easier. And if it's easier, that's got to be better for you.
My blog on pacing might give you a few ideas as to how to start building up activity, but it's really important to start off steady. Just because you won't damage yourself (as in, your spine won't snap) doesn't mean it won't hurt.
Chronic pain is stressful. It's designed to be - your body produces adrenaline in response to pain, so chronic pain is likely to lead to your body being chronically stressed out after a while. There are lots of things you can do to manage this, but probably one of the more accessible things is relaxation.
Relaxation is an easy idea to grasp but can be difficult to master. YouTube has some really good videos for learning, but it's important to do it regularly. It's like playing a piano - the more you do it the better you'll get, and if you stop playing for a few weeks expect to be rusty! I would start with 10 minutes at a time and do that twice a day, building up to maybe 20 minutes twice a day or 30 minutes once a day.
This might sound strange, but goal-setting is actually one of the core pain management techniques I help people with. When you don't have a chronic health condition it's not something you think about outside of your annual work appraisal, but we're constantly setting goals and targets for ourselves on a daily basis. Tapping into that can be really helpful for people with chronic pain.
Suppose you have a goal of playing more with your grandson, who's two years old. That's not very specific, so let's make it that you want to be able to play with the new building blocks he got for his birthday, and you want to be able to do that for 30 minutes. To do that, you need to be able to get down onto the floor with him. He can be a bit wriggly, so you need to be able to reach over and keep him on the mat next to you, and you need to be able to reach forwards to pick the blocks up after he knocks the tower down. You also need to be able to get back up once you've finished! Quite quickly you can see that something that a lot of people might take for granted is actually a fairly complex activity. And once you've broken it down, you can start practising getting on and off the floor, and reaching forwards, as well as sitting for 30 minutes in preparation.
Explain to friends and family
So often people tell me that others don't understand because they aren't experiencing the pain. That's true in so much as they can't feel what you can feel, but we wouldn't expect that of health conditions such as diabetes or asthma. Part of the problem is that chronic pain is hard to explain, and so often people who live with pain don't have a great understanding of what's going on themselves, which makes it even harder. If loved ones don't have a good understanding, they can fall prey to incorrect assumptions about pain - for example, chronic pain fluctuates in intensity, so some days people can do more than on other days. That doesn't mean that on a bad day they're being lazy, or they're lying about what they can do - it just means that today is a bad pain day.
Additionally, a lot of people don't want to explain how they feel and how pain works because they don't like asking for help, or don't want to be a burden. When you have chronic pain, it's really important to find a way to ask for what you need - people can only say no, and if they care about you they'll help you as much as they can. Therapy can help people to manage thoughts around being a burden, or not being good enough, or just help people to adjust to their health condition.
Ultimately there are lots of ways to manage chronic pain - it's not the end of the world (although it can feel like it) and it doesn't have to mean that you get worse over time. If you have any questions, I'm happy to answer them in the comments!
Dr Sarah Blackshaw: Clinical Psychologist, blogger, tea drinker, interested in dinosaurs and shiny objects