Chronic, or persisting pain can have a large impact on all facets of our lives. Chronic pain has typically been defined as pain persisting for more than 3 months. Experiencing chronic pain takes up a portion of your daily energy and brain space, leaving people unable to fully participate in social or work situations, struggling to maintain strength and mobility, and/ or finding it difficult to perform activities of daily living. A major component of improving chronic pain is self-management. Working alongside health practitioners can help you determine your best chronic pain self-management strategies and implement ways to improve your function while minimising flare-ups.
What Is Chronic Pain Self Management?
Chronic pain is what is experienced after any tissue damage is resolved. It may also be a result of systemic inflammation, postural loading, heightened and sustained stress or a variety of underlying systemic conditions. This pain can be experienced throughout the entire body, or at localised body parts. Because of this persisting pain, people’s opportunities for pain-free movement can become significantly reduced and daily life will become aggravating with frequent flare ups.
It is important to regain control of your chronic pain experience and determine contributing factors that are individual to you. The more information you have about aggravating and easing factors, your functional baseline, and any protective factors (i.e. social supports, highly valued activities) the easier it is to build a graduated self-management plan.
Are Self Management Strategies Effective in Chronic Pain?
Higher levels of self-efficacy have been found to assist people experiencing chronic pain. Self-efficacy refers to an individual’s confidence in their own ability to function despite experiencing pain. Self-management strategies for chronic pain are aimed at empowering an individual about their condition, implementing cognitive and behavioural strategies to deal with and manage their pain and supporting an individual in navigating their social, work and health interactions.
Chronic Pain Self Management Strategies:
Understanding the nature of chronic pain, and its lack of association to tissue damage is key in managing your pain. Realising that “hurt does not always equal harm” can be an empowering element in helping to regain independence and function. We know that pain can be increased by not enough sleep, by increased systemic inflammation, by stressful situations, by lack of social or medical support etc. Figuring out what is relevant to you is a fantastic starting point. The NOI group utilise the concept of DIMS and SIMS (dangers in me and safeties in me) to help support the body and decrease the frequency of tipping over your personal threshold point and provoking symptoms. You can work with your health provider to come up with these, or work independently using the Protectometer workbook from NOI Group.
It is important to consider everything you do in a day when determining your baseline for activity. This is not just ‘exercise’ (e.g., gentle walk or a low impact exercise class), but all activity – things like chores (including grocery shopping, cooking, cleaning) or work and social interactions. All of these add up to the total amount of load on the body in any given day. It is important to consider activity pacing for each day as well as across an entire week/month to avoid overdoing it or increasing too much too quickly. ‘Borrowing from tomorrow’ in activity pacing refers to doing too much on one day, resulting in having less capacity than usual the next day to compensate. Your goals and priorities are also an important factor in creating a pacing plan.
Once you have determined your baseline for a day without flare ups, activity pacing is based around consistent exposure to activity that is 5-10% below that baseline to help build consistent tolerance and endurance without flare ups. This is to avoid a boom/bust cycle where you have a good day and increase your overall activity (the boom), then have subsequent days with increased pain or decreased energy (the bust). The all or nothing cycle leads to overall decreased level of activities, a diminished overall threshold and encourages fear avoidance behaviours.
Low Impact Exercise
The aim of including exercise in your management plan is to improve your physical capacity and endurance. Ideally you are including both cardio and strength training. Options for cardio may include cycling (either stationary or recumbent bike), gentle walks, modified swimming, or water walking. Options for strength may include modified gym exercises, pilates, or aqua aerobics. It is important to work with a health professional to determine what is most appropriate for you at each stage. It is also beneficial to be incorporating mindfulness activities such as meditation or breath work, yoga or journaling. The best option will always depend on your body, personality and priorities.
The Benefits of Self-Management of Chronic Pain
One of the most important elements in improving chronic pain is feeling like you’re in charge. Due to the complex nature of chronic pain, people are often left feeling like they do anything to get better. This lack of control only contributes further to the issues associated with chronic pain. Seeking out a health professional who can help educate you to understand chronic pain and how it impacts your body is key to taking charge of your chronic pain self-management program. Actively changing your behaviour (such as your activity pacing) and cognition (eg believing you can improve) around your chronic pain can help improve self-efficacy, improve quality of life, increase participation, and help to better navigate your experience. Developing a chronic pain self-management program allows you to better cope with day-to-day activities, increase your capacity and resilience to reduce flare-ups while helping you to best manage any pain symptoms with reduced reliance on pain medications and less distress.
Talk to Your Physiotherapist About Chronic Pain Management
Navigating chronic pain can be a confusing journey. If you are suffering from chronic pain and are feeling lost, we are here to help. The team are Barefoot Physiotherapy are here to address any concerns, help you move and feel better and support you in establishing a self-management plan. Book online now or call 1300 842 850 to speak to one of the Barefoot Physiotherapists.