Understanding pain
Research suggests that more than a third of our population experience a persistent pain. This long term condition is hard to cure and can significantly impact your everyday life. However, there is a way how to self manage the condition and learn to Live Well With Pain.
To understand pain in less than five minutes, click on the video below.
It’s time to rethink persistent pain
Leading neuroscientist Lorimer Moseley and colleagues have created a powerful short animation that explains and guides the journey to acceptance and living well with pain – focusing on dealing with the pain (the beast) and the self.
Read some inspirational Real life stories from REAL people living with persistent pain.
To help you learn the skills you need to effectively self-manage your pain, follow the Ten Footsteps to guide you through the process. Click on each Footstep to explore them in more details:
Pain and the brain
First of all it helps to understand pain and how it affects our life. Persistent pain is very different from the kind of pain you experience when you touch something hot or injure yourself.
It goes on long after the original cause, and affects different parts of the brain and nervous system.
Sensations can resemble the original injury or damage, so it feels as though the damage has not healed, when it actually has.
It’s like a radio switched on permanently and the volume turned up. So what can you do to change it? Is it possible to turn the volume down?
The you tube video below will explain how the brain can keep producing pain after tissue damage has healed.
Helping people to understand more about how the brain affects their experience of pain is one way of shifting away from the medical model and towards person focused self-management model.( booklet attached explaining pain)
Pain and the brain
First of all it helps to understand pain and how it affects our life. Persistent pain is very different from the kind of pain you experience when you touch something hot or injure yourself.
It goes on long after the original cause, and affects different parts of the brain and nervous system.
Sensations can resemble the original injury or damage, so it feels as though the damage has not healed, when it actually has.
It’s like a radio switched on permanently and the volume turned up. So what can you do to change it? Is it possible to turn the volume down?
Helping people to understand more about how the brain affects their experience of pain is one way of shifting away from the medical model and towards person focused self-management model
Acceptance
Accepting persistent pain as part of your everyday life is a huge help. Rather than struggling to avoid or reduce your pain, you can learn to observe, understand and accept it. This is not easy – it can be hard to accept that you are not the person you were. However, as you accept things have changed, you can switch your energy and focus to living well.
To understand more about chronic pain, acceptance and commitment, please watch the video below:
Pain and me: A story of acceptance
See below guide to help you think and talk about persistent pain
Pacing
Pacing is a crucial skill to help people break out of the ‘boom and bust cycle’ of behaviour and adopt balanced levels of activity. It is a central feature of becoming more active despite the pain.
How can pacing help in managing persistent pain?
Pacing means changing how you exercise and do daily activities so as not to flare-up your pain and to gradually increase what you are able to do.
Pacing helps you to become more active and fitter, stronger and healthier.
Pacing is about choosing when to take a break from an activity – before pain, tiredness or other symptoms become too much.
Positive changes reported by people who learnt to pace:
- Doing more – Ablet to achieve goals and tick more things off their ‘to-do’ list.
- Sleeping better – Improved sleep at night.
- More control – Gain control over the pain and activity levels.
- Less medication – Reduced dependency on medications and fewer side effects.
- Brighter moods – Life became more enjoyable – more fun.
- More energy – Increased strength and energy and ‘get up and go’ attitude.
- A better social life – Manageable pain improved confidence about social life plans.
- Less pain – Experiencing less pain and fewer setbacks that didn’t last as long.
- Less effort – Less effort was required to achieve daily tasks and activities.
Good pacing or bad pacing?
Generally speaking, there are three unhelpful styles that people with persistent pain often use. As you read about unhelpful pacing styles below, decide which pacing style you currently use.
1. Overactive pacing
This means doing too much activity or too many tasks over a short space of time.
This happens if you are having a good day, with less pain, or your mood is better. You try to do too much and end up with more pain and tiredness and miss out on enjoyable things due to time for recovery.
2. Underactive pacing
Underactive pacing means that you are doing too little activity to help keep up your strength, stamina and flexibility in your muscles, ligaments, joints and bones.
Most of your time is spent resting, sitting or lying down, which is understandable, especially as lack of fitness makes muscles and other tissues tight, weak and painful.
However, this can add to your pain, so over time you end up doing less because of the pain.
3. ‘Boom and bust’ pacing
Often people use pain and energy levels as a guide to their activities and pacing them. This means they risk doing too much activity on good days (overactive), which makes their pain worse. They are then forced to rest while the pain settles down (underactive).
This is a mixed style of pacing, which is unhelpful in the long term. It’s sometimes known as ‘boom and bust’.
Use the My Daily Pacing plan to help plan your daily activity.
Setting Goals
Goals are a helpful way of noticing and recording the progress you make over time. Sometimes though, for people with persistent pain, reaching your goals may be so challenging that it doesn’t even seem worth trying. Achieving your goals may take longer and require more planning. However, this doesn’t mean it’s impossible. This is where goal setting comes in.
Goal setting top tips:
- Avoid an unpleasant chore or a really tricky goal like loosing weight, as these can demotivate you.
- To get started with SMART gaol setting, experiment by trying a really easy goal.
- Don’t overdo it. People with pain often aim too high, or try to do things too early or quickly, which often leads to set backs and failure.
- Your goal should be a bit of a challenge but no too difficult so that your pain becomes too difficult to manage.
- Don’t be afraid to review and revise your goals as you go along.
- It isn’t a test. So if it seems a struggle, try a more fun rewarding goal.
- Try sharing your gaols with other people -it will help them to understand what matters to you and how they can help you make progress.
Relaxation and Mindfulness
There is plenty of evidence showing that relaxation and mindfulness can help people with difficult health problems such as persistent pain. For example, we know it can lessen pain levels, reduce stress and improve concentration. So let’s look at how you can make a positive difference to your life and your pain by learning how to unwind your body and your mind
Some activities to help you unwind:
- Gentle exercise programmes like Yoga, Tai Chi or Pilates
- Sitting in a beautiful garden and smelling the flowers
- Listening to a relaxing or favourite music or sounds of nature
- Taking a photograph of a beautiful scene
- Attending a local relaxation group, gym or self-help group
- A warm bath and using scented oils
Useful resources:
Websites:
- Relaxation techniques – Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (cntw.nhs.uk)
- Breathworks – Mindfulness and Compassion Training
- Mindfulness Courses, Training Online – Mindfulness Based Cognitive Therapy (oxfordmindfulness.org)
- Home – Live Well with Pain
Books:
Sleep
If you’re living with pain and struggling with sleep then you’re not alone. It’s very common for people with persistent pain to have difficulties getting to sleep or staying asleep. Recent research shows that by adjusting what you do during the day, as well as night, it is possible to achieve a healthier sleep pattern.
It’s a vicious cycle
You have probably discovered that poor sleep can have some unhelpful effects on your day-to-day life.
After a broken night’s sleep you may find:
- It’s harder to concentrate
- You are short tempered with other people
- Your mood is low
It’s very common for people to find that poor sleep makes their pain seem worse. They can find themselves in a vicious cycle where pain makes sleeping difficult, and poor sleep worsens pain.
The really good news is that there are lots of changes you can make to help you to sleep well.
Over a period of five to six weeks these can make a huge difference.
Communication
You can’t see pain, so how can other people understand what you’re dealing with? People living with pain know that talking those around them can be a challenge. We need to find ways to tell people what we need and why.
Connecting through open and honest talking
People living with pain sometimes tell us that they begin to wonder how to talk to their relative or friend, because so many conversations become dominated by pain, appointments or medicines.
As a consequence, the small things in life that are part of normal chat – such as something you might have seen on social media, or whether there is enough cat food to last the week – begin to be lost.
The relationship can end up falling into one or more common communication traps: Resource attached above
Explaining your experience to others
It can help to let people know how the pain limits you. Other people can’t see the invisible effects of pain. So talk to them about ways they can support your goals or help you live better with pain.
Some people find it useful to make a list of things they need people to know about what it’s like living with persistent pain.
Try making different lists for:
- People I am close to
- My friends and work colleagues
- My employer
- Health care professionals
- Other people
Managing moods
It’s normal to struggle with moods when you have persistent pain. Emotions or moods linked to pain can take over day-to-day life.
Many people with pain say that finding positive ways to manage their mood changes makes a valuable difference to their pain and their lives. So how do they do it?
We all go through periods of ‘moodiness’ when we feel irritable, sad, frustrated or worried. People with pain often find they feel:
- Angry and frustrated
- Fearful and worried
- Low and unmotivated
If you have these feelings then you probably find that they get in the way of your day-to-day life and feel quite overwhelming at times. It is common to think that there is nothing you can do as they just ‘take over’ and go on for a long time. This is because these mood changes come from the struggle of living with pain.
This is not your fault. It is more about how our human mind works when it is stressed with pain, we feel unwell or deal with difficult life events. The mind is trying to make sense of everything that is happening and cope with it all.
The good news is that you can do things to manage your moods better.
Useful resources:
For more information, please click on the image below to see all Self Help Leaflets
Medicines and Nutrition
We now know that pain medicines only reduce pain for about 40 percent of people in the long term. And the side effects of pain medicines can have a major impact on your life.
A combination of these side effects, together with being less active because of the pain can lead to becoming overweight. This affects at least 50% of people with pain. So getting your life back on track often involves making changes with your medicines and nutrition.
1. Medicines
Medicines that people take when they have pain are often referred to as ‘painkillers’. That term might make you think that if you take them, the pain will go. However, pain medicines are unlikely to do that for most people, most of the time.
The reason we use pain medicines is to try to reduce the intensity of the pain you have. Intensity is better described as ‘how much’ pain you feel. If you feel less pain, it should help you to do more of the activities you need to do and those you enjoy.
What are the problems with pain medicines?
There have been large increases in the number of pain medication prescriptions issued in the UK over the last 20 years. However, the number of people living with pain is also increasing and the medicines do not seem to be making much difference.
We call pain medicines ‘painkillers’ but now understand that 4 in 10 people will get much benefit from taking any of them.
For medicines called opioids, which are drugs like codeine, tramadol and morphine, it is likely to be 1 in 10 people who get benefit.
Medicines that can actually make things worse
We now realise that opioid medicines can sometimes make pain worse.
We think this happens by causing your nervous system to become more sensitive so that pain intensity gets worse- you feel more pain.
All people taking these medicines experience side effects. Sometimes these occur quite soon after starting a medicine or having a dose increased.
However, we realise many more people are likely to be experiencing long-term side effects from using pain medicines for more than 3 months.
To understand more about opioids, download the Opioid leaflet.
Opiodis and Driving:
Drugs and driving: the law – GOV.UK (www.gov.uk)
FPM-Driving-and-Pain-patient-information.pdf
Think about whether your medicine help you manage your persistent pain. This tool may help you decide about using your medicine in better ways for you.
Managing Setbacks
Setbacks are very common in managing pain. Being confident to deal with them is a ‘must have’ skill for an easier time. So let’s look at how to deal with setbacks effectively . Setbacks can be due to many reasons – think of them a bit like what can happen to athletes in training.
For athletes, a setback can be due to injury, tiredness or mental challenges. A setback with pain is similar and is often linked to tiredness, pacing difficulties or mood issues.
A setback could also be caused by changes in your medication, especially if these changes happen too quickly or at a time when you have other things going on.
Sometimes setbacks can happen for no obvious reason at all.
Maintaining your progress- Learn how to maintain your progress for when setbacks happen
Understanding setbacks- Learning more will help you manage setbacks effectively
What are your triggers?- Identify the things that could trigger a setback for you
Make a setback plan- Plan how to manage setbacks now, so you’re ready when one comes