Chapter 1
Beginning to Take Control of Your Pain
You may still have doubts about whether you can ever enjoy life again while you are in chronic pain, or whether life will ever be worth living with chronic pain. Nevertheless, let’s at least explore how living a life of quality with chronic pain is possible. THe keys are to take responsibility for your pain ( not in the sense of accepting blame for it yourself or assigning blame to others,, but in the sense of accepting ” ownership” of it); to determine exactly what your problems are as a result of the pain; and to reassess your goals in the light of this information. This chapter gives you your first set of tools for begininng to take control of your pain: diary keeping and goal setting. TO start with, however, let’s look at the first of the three keys: accepting ownership of your pain.
Accepting Ownership of Yours Pain
As you define it at this moment, your problem is that you are in pain and the pain won’t go away. This is an important first step, before you can do anything about your pain, you need to acknowledge that it exists. However, you may also feel inclined at this point to blame others for your pain. You may feel that your doctors have failed you by not finding and curing the source of the pain, or at least for not making you feel better. You may believe that your loved ones are not doing anything to help you, or are showing a lack of understanding or empathy about your problem. You may even feel that society is to blame for causing the situation that put you in pain in the first pace, or for not making it easier for you to seek help. The fact that you may be sad, angry, or anxious about the disruption of your whole life as a result of the pain experience is both understandable and normal. Under these circumstances, it may be very tempting to feel that others are to blame for the pain and ought to be responsible for taking it away. Indeed, may people in pain put their whole lives on hold waiting for others– their physicians, their families, or society– to do just this. The difficulty with this, however, is that wanting to give away both the pain and the responsibility for it will only prolong and contribute to your feelings of powerlessness. if you pain is not going away any time soon– and this is the very nature of chronic pain– then taking upon yourself the responsibility for living with it may begin to return control of your life to you. If you can adopt an attitude of “ownership” of the pain problem, you have the potential for gaining the upper hand over it. Although you may need assistance from your health care provider, your family and society in untangling yourself from your pain web, gathering the threads together and reweaving them into a safety net for yourself are ultimately your tasks and yours alone. What you now may be thinking is something like this: ” Oh, great. So I’m responsible for my pain, huh? I’m to blame? That’s what everybody’s been saying– or at least hinting–all along. I feel bad and guilty enough as it is.” That is not what is meant here at all. As you probably already know, self-blame and guilt can be paralyzing emotions. They can make you feel that since you are such a bad and worthless person, there is no point in doing anything at all. Accepting ownership of your pain, on the other hand, means acknowledging that you are a worthwhile prson, that there is a point in doing something, and that you do have choices. It is very different from blaming yourself. Chronic pain is complex, with numerous origins and treatments, and is grossly misunderstood. This will provide you with the information you need to mvoe forward. Even though your life will be different from the way it was before you developed pain, you can change some aspects of the pain, and can learn to accept or work with other aspects so that they cause you less distress. Your task will be difficult– but not impossible.
Determining Exactly What Your Problems Are
ORDER AND SIMPLIFICATION ARE THE FIRST STEPS TOWARD MASTERY OF A SUBJECT– THE ACTUAL ENEMY IS UNKNOWN. — Thomas Mann, THe Magic Mountain ( 1924)
The Importance of Tracking Your Pain Levels
One important way to gain control over your pain is to record it so that you can see how certain factors– for instance, activities, the weather, tension, and sleeplessness– increase or decrease your pain levels. This should be done three times a day, at regular times that are convenient for you. For example, you might record your pain level when you awaken, after lunch, and then again at bedtime. Such consistency is important, because if you record your pain only when you are aware of it, you won’t neccessarily feel it all the time when your pain is altered. Recording the pain at regular intervals will allow you to detect over time whether there are any patterns to your pain experience. These patterns should permit you to determine the exact nature of your problems more easily. Many people are resistant to the idea of recording their pain, and you may be one of them. Not only are you in pain to begin with, but it’s an additional hassle to have to record all this stuff– and three times a day! ” Why do i have to do this? It’s not fair!” you may say. Perhaps the following story may help.
Paula was very angry at the thought of recording her pain levels. Her back hurt and she already knew she was in pain. Why did she have to write it down three times a day? She didn’t have time for such a ridiculous activity. At first, Paula was so misterable that recording the pain just made her realize how bad she felt. Gradually, she realized how much she had denied the pain in her back and how it prevented her from doing anything productive or pleasurable. Not only had she had to give up working outside of the home; she barely kept up with the household chores. Her house certainly wasn’t as clean as it used to be. Even worse, she was irritable toward her husband and yelled at her children. She rearely saw her friends, and really didn’t care any more about going out. Somehow this just wasn’t the way Paula wanted to live. Paula also began to see how she pushed herself throughout the day and then collapsed at night. Her back was stiff when she awoke, and the pain gradually increased during the day. What was causing it? Was she not pacing herself? Was she stressed by her routine? Slowly, the answers because clear. Over time, Paula saw that recording her painhelped her learn more about the relationship her pain had with what she did and how she did it. She was able to incorporate the skills she learned in the pain management program into her daily routine,and was eventually able to bring the pain much more under her control.
If you don’t think that recording your pain will be a chore, that’s great. If you do, consider this: You have done your best in your current situation, and it still has not been effective in controlling your pain. Recording your pain levels can help you determine where you might be stuck and point you in the right direction. You can’t count on remembering exactly what your pain feels like under all conditions over a long period of time. So give the recording method a shot–it just might work for you. Remember: what you know, you can master.
Keeping a pain diary
An effective way of recording your pain is to use the pain diary worksheet that is provided at the end of this book. There is a sample of a completed pain diary form, along with a blank pain diary form that can be copied.
Instructions
On the pain diary, it is important that you differentiate between ” Pain sensation” and ” Pain distress” as follows. ” Pain sensation” refers to the phyiscal component of your pain– for example: th e achiness, stabbing,burning, tightness, and other physical sensations you may feel. ” Pain distress” refers to your perception of pain and is a measure of the emotional suffering you experience– for example, the frusturation, anxiety, anger, or sadness you may feel.
Note the word “feel” can be used to describe both physical/body sensations and emotional/mind reactions. This can give rise to confusion when you try to describe the pain experience to yourself and to the outside world. I began asking patients to make the sensation-distress distinction years ago when i noticed that at the last session of the pain group they were talking about how great they felt, and yet their pain recordings were only decreased a little from the beginning of the program. I was puzzles by this, so i asked them to explain it. They responded without hesitation: ” we still have the pain [ the physical sensation], but we feel so much better about it [ the distress]. We aren’t so helpless. We know what to do about our pain, and we feel in control again.” Much can be done about your level of distress. You can begin by getting in touch with how you experience your pain, both physically and emotionally. You may find that either the physical or the emotional feelings predominate, it will take some time for you to make the distinction. Some of the exercises in the next few chapters will help you to seperate these feelings.
- Record your pain level on the pain diary form three times a day at regular intervals, as described above– for example, morning, noon, and bedtime.
- On the diary sheet there is a space to describe the situation for each pain sensation/distress rating. For example. were you watching TV, eating lunch, sitting at a computer, fixing dinner? Note what activity you were engaged in at the time.
- Rate your pain sensation and distress by using numbers from one to 10. As follows:
0 = No pain/ distress
1-9 = Range in degree of sensation/distress
10 = Worst pain/ terribly distressed
It may take several weeks to establish what the numbers mean to you. This is quite normal. Pain is a personal experience, and you will only be rating your own experience. ( If you have particular or continuing difficulty, however, see the ” Rating Your Pain” exercise under the ” Listening to Your Body” in Chapter 4)
