There are two major stages to pain reduction. The first is pain loss or doing whatever it takes to reduce pain. The second is pain maintenance or the ability to prevent relapses of pain flare-ups over time. The intention is to keep pain to a minimal level as best as you can (Ratings of 1-4 for negative scaled items and 7-10 for positive scaled items). Know your triggers that can increase flare-ups, especially cognitive one’s using the executive functioning ability of self-monitoring. Of course, there are situations and experiences we can control and those we can’t control as, for example, life stressors.
In all areas of behavior change; whether it be pain, weight, alcohol, opiates, tobacco, or excessive cannabis other than prescribed medical marijuana, the most critical element is to have sufficient support systems in place and to know your triggers that can induce relapse.
Relapse prevention is just as important as pain reduction. The goal is to reduce negative pain scale ratings, improve positive one’s, then sustain them, keeping the rating levels steady over time.
The inability to maintain behavior change is why certain plans often fail. For example, most people go on a diet plan, then gain their weight back once they’ve lost weight. Why? Because maintenance strategies to keep weight within a reasonable range over time aren’t in place. This is the same rationale for pain reduction and pain-loss maintenance.
Remember! There is a difference between controlling pain and having no pain. You may always have pain, especially when considering that physical pain is impacted by multiple factors including ones emotions, life stressors , cognitive appraisals and fortitude, or lack thereof.
While it is critical to establish and maintain a support system, no one can truly appreciate the level of pain that you experience, not even your most loved ones. Still, you must do everything to involve them in your ‘Pain Management Lifestyle’. Educate them about what your pain is like; when you have it and what you are doing to reduce it. Have them attend any session with your pain management clinician to get to know what you are going through and how you are trying to overcome these experiences by committing to certain strategies. Have them understand that you are grieving the loss of how you once were before the high pain intensity existed. Ask them to be understanding if you ‘lose it” once in awhile as it is common for those with pain to experience high levels of anxiety, anger or depression.
What are helpful strategies to maintain pain reduction over time?
1. Use the scales weekly to self-monitor how you are doing. Note what needs to be reduced (to 1-4) and what needs to improve (7-10) then plan and act on ways to do so over time. Remember, they are snapshots of what your experience is at that moment in time. Make copies of them and complete them at least once weekly to see how you are doing.
2. Know your high scoring, negative cognitive appraisals (infections) , especially those that trigger emotional pain (anxiety, depression and anger)
3. Improve the use of your prefrontal cortex, especially the specific executive functions of self monitoring (catching yourself generating negative cognitive appraisals and insufficient fortitude skills) and cognitive flexibility (shifting when upsets or changes occur). Executive functions of the pre-frontal cortex of your brain are significant contributors to enhance pain reduction. Self-monitoring; in particular, the ability to catch yourself thinking negative cognitive appraisals or infections or doing things that could increase physical pain, is critical as are problem solving and cognitive flexibility or the ability to shift strategies when former one’s aren’t working. .
4. Have a support system in place. Review your ongoing progress regularly with your pain management team. This includes your pain management clinician, your Primary Care Physician and Clinical Nurse Practitioner. The clinician should be either a Licensed Psychologist or Social Worker with particular experience and training in pain management. Join a support group. Utilize websites, social network groups and others trying to reduce chronic pain.
5. Make sure your caretaker(s)(spouses, cohabiters, family members, best friends) obtain support via self care in addition to meeting intermittently with you and your pain management team. You don’t want to burn them out! The significant others in your life need support as well. You don’t want to criticize, alienate or lose them. Rather, you should respect that they need refueling by gaining their own support systems and indulging in much self-care activities. They may want to find support systems for caretakers and be appraised of how you are doing and should meet with you and your pain management team once in awhile to keep informed and give input to the team to help them collaborate effectively with you. In this manner, pain reduction and maintenance strategies can be tailored your needs.
6. Go slowly! Have realistic expectations measured in sub goals rather than anticipating a dramatic change from one level of the scales to another. If you become frustrated, it is probably due to high self standards or not fully letting go what you were formally capable of doing before chronic physical pain existed.
7. Maintain multi-dimensional strategies that you and your pain management team have chosen given the subjective nature of pain and continue to monitor how they are helping or not helping to reduce negative pain scale ratings and improve positive one’s. Change or modify them if they are not effective One size doesn’t fit all!