Learning to Manage Pain
By Bruce Campbell
If you struggle with pain, you will find many ideas for gaining control in Margaret Caudill's workbook Managing Pain Before It Manages You (Guilford Press, 2002). The book is the self-study version of an in-person class proven to be effective in helping people with chronic pain.
Research has shown that participation in the class leads to reductions in the severity of pain and the extent of pain's interference with daily life. The class also lessens anxiety and depression and leads to fewer doctor visits.
The book, which is written in an informal and engaging style, is a rich resource of ideas and strategies, and includes many step-by-step exercises to teach skills for living well with ongoing pain. Here are a few key ideas to give you a sense of what the book offers.
Tracking Pain and Two Types of Pain
One strategy for gaining control over pain is to track your pain levels so you can see what increases or decreases your pain levels. Common factors include overall activity level, specific activities, tension, weather conditions and sleep problems. The book provides an easily-understood pain diary form that can be filled out in a few minutes a day.
The pain diary and much of the book is based on a distinction between the physical sensation of pain and emotional reactions to pain. The latter is also called the experience of pain. Sensation may be achy, throbbing, stabbing, pounding or tightness. Emotional responses include frustration, anxiety, anger or depression. These feelings are a measure of suffering.
The levels of physical sensation and emotional response are not necessarily the same. For example, people in her class often tell her that they feel much better at the end of the course, even though they rate the physical sensation of pain about the same.
They tell her that while they still have pain, they feel much better about it. "We aren't so helpless. We know what to do about our pain and we feel in control again." Their experience of pain has changed, even though they still have the physical sensation.
Using a pain diary reveals that both sensation and emotional reaction vary. Sources of variation include shifting attention, mood, fatigue, muscle tension and other factors. A person can use knowledge of these sources to reduce the experience of pain.
For example, distracting yourself from pain by immersing yourself in activity reduces suffering. Similarly, doing things to improve mood will reduce suffering, as will reducing muscle tension.
Pain and Stress
The book also describes how to break the links between pain, stress and other symptoms. Caudill writes that when a person is perpetually stressed, as is the case with chronic pain, the body cannot establish balance or homeostasis. Lack of balance contributes to symptoms such as sleep problems, fatigue, headaches, poor concentration, muscle tension, anxiety and depression.
In addition to the burden pain places on the body, if a person lacks confidence about their ability to cope with pain, their experience of pain is increased. Caudill writes, "If you feel overwhelmed as a result of your pain and do not take time to balance the stress effects of pain, you will most likely begin to experience other stress-related symptoms."
Relaxation techniques offer a powerful antidote to the effects of stress. The book gives step-by-step instructions for the Relaxation Response and other relaxation techniques. Caudill recommends people use a relaxation procedure once or twice a day for total of 20 minutes.
Self-Talk: How Thoughts Influence Pain
Another section of the book explores how our thinking affects our experience of pain. Thoughts like "What happens to me is determined by chance" or "Whatever happens to me is out of my control," are associated with disability and lack of control.
Caudill writes, "A self-defeated, hopeless frame of mind will most likely contribute to the interpretation of pain signals in a negative way, increasing distress and despair." In contrast, gaining information about pain and learning new skills are associated with regaining control.
One skill is to change your thoughts about yourself or self-talk. Some types of self-talk are associated with disability and ineffective coping. Two examples are overgenerlizing ("Because of my pain, I'll never be able to enjoy anything anymore") and all-or-nothing thinking ("If I can't play baseball, I can't do any sports").
In addition to describing many types of overly-pessimitic self-talk, the book also describes techniques for changing self-talk to make it more realistic and helpful.
Adjustments to Reduce Pain
You can reduce pain by changing how you do things. The book offers many strategies grouped into the categories of pacing, adapting and delegating. (The book offers a form to help you decide which of the three approaches to use for any particular problem.)
Pacing involves taking breaks from activity before getting to the point of exhaustion. To use pacing, begin by noting what positions (e.g. sitting or standing) or activities (vacuuming, combing hair) increase pain and how long it takes to increase pain two points on a scale of 1 to 10 (for example, from 5 to 7). Then break up the activity into sections, each lasting slightly less than the time it takes to intensify pain.
Adapting an activity means to change how you do something so that it can be done more easily. For example, you might sit down to shower, rearrange items in the kitchen to make them easier to grab or lie down to when calling a friend.
Delegating means finding someone else to do a task. For example, you might reassign some household chores such as cleaning, laundry and grocery shopping.
In Conclusion
Margaret Caudill has created a program that can be helpful to many people with pain conditions, including fibromyalgia. Her approach focuses on improving people's sense of control or self-efficacy, the foundation of our program as well.
One participant gave a good summary of the benefits of the program when she said, "I know I'm going to have a good day because I know how to make it a good day."
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