Dos
1. Know that your pain is real
Persistent pain is very complex and often not related to a specific injury or damage. This can lead to people feeling that they have not been believed. Similar to other chronic conditions like heart disease or diabetes there are many factors which will influence pain. These include things like our activity levels & fitness, general health, sleep quality, mental wellbeing and social functioning. Importantly your pain is real regardless of what factors might be involved. Seek out healthcare professionals in your community who have an interest in helping people with persistent pain. This will provide you with the opportunity to tell your story, set goals and work on developing a management plan. You don’t need to go on the journey alone.
2. Stay active
Physical activity is important for everyone. The health benefits of regular exercise are well established. There is no best exercise for people with pain. Choose activities which you enjoy and discuss these options with your Chartered Physiotherapist. The important message is that there is no amount of exercise that is too little. While more is better, a little goes a long way! Over time, regular exercise can help to control your pain as well as improve your sleep and mental wellbeing. For the moment, make sure that your exercise routine complies with the Government’s advice and restrictions in outdoor activities.
3. Focus on meaningful life activities
Pain can be all consuming. It can be difficult to focus on other things. Rather than simply trying to reduce pain, focus on activities and goals that bring value to your life. This might include simple things reading a book, listening to your favourite music or engaging in exercise, adhering to the Government’s restrictions on outdoor activities . It is important to realise that it is possible to live a meaningful live while still having pain. When we use all our resources to try and get rid of the pain, we have little left for anything else. Give yourself priority over your pain.
4. Maintain your social relationships
Many people with pain feel isolated. They stop going out with friends, they are unable to work etc. Feeling lonely can have a negative effect on your mood, sleep and activity levels and can therefore worsen your pain in the long term. Seek out and nurture relationships that are important to you. Start slowly. During the current crisis, while outdoor activities and social gatherings are restricted, social media is a great platform to maintain your social connections. In the long-term, think about joining a group or a class in line with your hobbies for example. Talk openly with your family, friends, peers, employers, healthcare providers, support groups etc. about your issues and worries. You do not need to “hide” your pain. Don’t compare yourself to others and focus on good quality sleep, eating well in addition to staying active.
5. Face your fears
People with pain can over time start to avoid activities or situations that they fear will make their pain worse. The fear of pain can be more disabling than the pain itself. With the guidance of a Chartered Physiotherapist, people are often surprised when they realise what they are able for. Although daunting to begin with, facing these fears and starting back doing these activities in a gradual manner can be very empowering and great for building confidence.
Don’ts
1. Blame yourself or “fight” the pain
Pain is not a sign of weakness. Pain can affect people of all ages. It is easy to get trapped in a viscous cycle of pain whereby attempts to “fight” the pain can lead to regular pain flare ups resulting in lower levels of activity, low mood, disturbed sleep, frustration & more reliance on medication. A better approach is to focus on what would make your life more meaningful. By setting realistic goals together with your clinician, instead of “fighting” the pain, you can work towards achieving these meaningful goals in a gradual and steady manner. Reward yourself for taking these positive steps even when they might not always be successful.
2. Assume persistent pain always means damage
Think of spraining your ankle-the pain is helpful in the short term so you don’t jump or run on it too soon and worsen the injury. In other words, the pain acts like your protector. Rather than meaning damage, the pain in these situations means that you are unlikely to do something to cause damage. The problem arises when these protective mechanisms become overprotective as is often the case with persistent pain. In other words, your body can protect you from certain movements or activities even when the tissues of your body (muscles, ligaments, joints etc.) don’t really require it. Understanding that you can be sore and yet safe to move is often very empowering and can help reduce fear and worry related to pain and lead to less pain in the long term.
3. Rush or panic if you flare up
People’s journey with pain is often full of ups and downs. People typically describe this as “good” and “bad” days. This is quite normal. Rather than seeing pain flare ups as a setback, they are often a useful time to reflect on the situation and identify potential “triggers”-did you have a bad night’s sleep?, perhaps you did more activity than usual?, was work especially stressful?. The point is that flare ups can be seen as a learning opportunity. It is important to develop a toolkit together with your healthcare team to help deal with flare ups e.g. ways to modify your exercise or activities, relaxation techniques, tips for improving your sleep, strategies for dealing with negative emotions etc. This puts people back in control of their situation.
4. Believe everything you hear or read
When people are in pain, it is very understandable that we will “try anything” to help their pain. On a daily basis we hear many claims in the media or on the Internet on the best treatments for people with pain. Often these claims are not backed up by any research evidence and instead rely on “testimonials”. At best some of these untested treatments will be a waste of your money; at worst they may be harmful depending on the type of treatment offered. Usually there is no simple solution for a complex problem like persistent pain. So be wary of anyone claiming of a “cure” that helps everyone. Before choosing a particular treatment avenue it is important to discuss your options with a healthcare professional who is familiar with the best available research evidence on how best to help people with pain. This will help you avoid unnecessary or potentially wasteful treatments that ultimately could prolong your recovery.
5. Rely on scans to tell the whole story
Scans such as X-ray, MRIs or CT scans are useful for a small number of people. They are especially helpful when we suspect a person’s pain is due to a serious medical condition or for surgical planning. Thankfully, these conditions are rare and an assessment with your doctor or physiotherapist will help determine if you require a scan. For the majority of people, scans are often unnecessary and don’t influence the treatment plan. Nowadays, scans are so detailed that they show lots of changes even in people without any pain. For example, 87% of people without any neck pain have a disc bulge on an MRI scan. So it’s important that we don’t always assume that what we see on the scan is relevant for that individual. It often isn’t as scary as it might sound!
Recent podcasts by Dr Derek Griffin:
Pragmatic pain management:
https://player.fm/series/the-physio-matters-podcast/session-74-pragmatic-pain-management-with-derek-griffin-and-felicity-thow
Pain assessment & management:
https://tkex.org/podcast/2020/4/5/derek-griffin-psychologically-informed-practice
