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Living Well withChronic Paincarol@caroldmarsh.comCarol Marsh Health and Wellness Coaching LLC

DAY ONEPain The Toll of PainSensitizaion

What is pain?*“A localized sensation of discomfort or distress, resulting from the stimulation of specialized nerve endings.”People vary in their responses to pain: what is excruciating to youmay be mildly annoying to me.Pain can be useful and protective, but chronic pain can be overwhelming.Chronic pain is pain that lasts after illness or injury has healed; pain that lasts more than three months.* This presentation is taken from Mayo Clinic’s Guide to Pain Relief, Second Edition

How do you Feel Pain?*“Pain results from a series of electrical and chemical exchanges involving three major components of the pain pathway:Peripheral nervesSpinal cordBrainPeripheral nerves: network of fibers that branches through your body.Spinal cord: where nerve cells filter pain messages from peripheral nerves.Brain: the thalamus receives the pain messages and interprets them.*Mayo Clinic Guide to Pain Relief pp 19-21

The Pain Pathway*The pain pathway begins where the pain stimulus occurs on your body.*****Pain messages move through the peripheral nerves and to the spinal cord.*****Your brain interprets the messages as pain, including:locationintensityand nature (burning, aching, stinging, etc).*****Your brain sends pain-suppressing checicals to the pain source and triggers other responses.*Mayo Clinic Guide to Pain Relief; page 20

More about the Pain PathwayThe pain pathway is not only about physical sensations.Pain signals pass through several areas in the brain, and these influence how you experience pain.Pain signals pass through thelimbic system (emotions and feelings) andfrontal cortex (thinking).In the brain, pain signals “may be altered by a number of factors such as anxietyfearpast pain experiences and memories.**Mayo Clinic Guide to Pain Relief, pp 23-24

Sensitization*It’s not clear how and why pain becomes chronic. unless it’s from a chroniccondition such as fibromyalgia, arthritis, migraine, etc.After an accident or injury, chronic pain may result from damage to peripheralnerves or to the spinal cord.Once it has been damaged, the nerve may misfire, or the damaged end might“sprout a tangle of disorganized nerve fibers, (neuroma). This bundle of nervetissue then starts sending spontaneous pain signals. These fibers also refuse tofollow the normal checks and balances that keep pain at bay.”**Mayo Clinic Guide to Pain Relief, p 26

The Toll of Chronic PainChronic pain is difficult to treat.Medications and injections are available, but none of these treatmentsis effective by itself.“Living well with chronic pain has a lot to do with your attitude andyour lifestyle. If you have a negative attitude and view yourself as avictim of your pain, the pain will continue to control you and consumeyour energy. “On the other hand, if you approach your condition with a positiveattitude and a willingness to change, you’re likely to be successful incoping with your pain.”**Mayo Clinic Guide to Pain Relief, page 28

Being realistic:the toll of chronic pain*Living with chronic pain can be like riding a roller coaster. Some daysare good and you feel happy, in control. Other days are bad, you canbecome depressed and feel helpless. Pain affects much of your life:Loss of sleepPhysical deconditioningEmotional upheaval / depressionDifficulties at work and schoolDamaged relationshipsSubstance misuse*Mayo Clinic Guide to Pain Relief, pp 60-66

That’s the reality -But you CAN learn to managechronic pain and live well ...so let’s get started.

DAY TWOPAIN MANAGEMENT BASICSSmart GoalsJournalingHabit-ChangeExercise and Activity

Your pain management programFind the right doctorUnderstands your condition and believes in what you‘re doing(Maybe a pain specialist?)Is knowledgeable about chronic pain;Wants to help you;Listens well;Makes you feel at ease;Encourages you to ask questions;Seems honest and trustworthy;Allows you to disagree;Is willing to talk with your loved ones or friends.*Mayo Clinic Guide to Pain Relief page 168

Your pain management programThe choice is yours: you can continue to dwell on your discomfort, oryou can do something about it.*SpecificMeasurableAttainableRealisticTimelySMART GOALS*Mayo Clinic Guide to Pain Relief page 161

Your pain management program*JOURNALING about your painA journal can help you:Determine which therapies and activities help you the most;Open your eyes to aspects of your daily life that contribute to your pain;Visualize your goals;Monitor progress on your goals and daily action steps;Make connections and find patterns;Express your feelings;Organize and sort through your problems and emotions;Get things off your chest.Mayo Clinic Guide to Pain Relief page 164

Your pain management program*JOURNALINGWhat might you write about in your journal?Pain level (0 to 10) - helps you learn your pain patternActivities - discover what increases and decreases your painProgress - even (especially!) tiny improvementsMood (scale of 0 to 10) - how aligned is mood with pain?Sleep - how many hours, # times you awakenedMayo Clinic Guide to Pain Relief pp 164-167

Your pain management program*Changing Habits Habits are hard to change!Our brains tend to want to stay with what’s familiar, even if it’snot good for us any longer.Here are some tips:Find more efficient ways to do daily chores and tasks.Look to change habits like how you get dressed, when you tendto stand too long or sit too long.Organize closets, cabinets so things you use often are in reach.Be willing to accept that an activity might not be right for you.*Mayo Clinic Guide to Pain Relief pp 194-195

Your pain management program*Staying AcitveYou might not know that exercise can help reduce pain:It releases endorphins that can alleviate anxiety and depression.It strengthens muscles and joints, reducing stress on your body.But what if you feel worse the day or the day after you exercise?Please remember: begin GENTLY, find a BALANCE.Your pain may get worse before it gets better. But at the sametime, listen to your body and stop doing what feels injurious.ALWAYS clear a new exercise regime with your doctor!*Mayo Clinic Guide to Pain Relief pp 168-169

Your pain management program*Types of exercise - begin gentlyFlexibility exercises (most days)Range of motionStretchingAerobic exercises (20-30 min 5 days/week)Dance, bicycling, golfing, hiking, walking, swimmingStrengthening exercises (5 days/week)Stronger muscles help reduce fatigueTry to do strength exercises 5x a weekALWAYS clear a new exercise regime with your doctor!*Mayo Clinic Guide to Pain Relief pp 171-184

DAY THREEBehavioral, Emotional, and Family CyclesBreaking the CyclesBalance, Moderation, and Changing Habits

The Behavioral Cycle*Chronic pain changes your daily routine and your behavior.STAGE ONEDecrease in activity on pain daysSTAGE TWOIncrease in activity on days when pain is betterSTAGE THREEMore pain, less activitySTAGE FOURLoss of strength, physical de-conditioningSTAGE FIVEWithdrawal and isolation *Mayo Clinic Guide to Pain Relief ;age 49-52

Emotional Cycle*STAGE ONEFear and concern; worry, pain gets hard to ignoreSTAGE TWOHope and promise; find out what’s causing pain, try remediesSTAGE THREEAnger and frustration; depression, upset, what have I done wrong?STAGE FOURGuilt and withdrawal; can’t do fair share, “let people down”STAGE FIVERenewed hope*Mayo Clinic Guide to Pain Relief pp 56-57

Family Behavioral Cycle*Families and loved ones tend to show a lot of support at first. Theymay help you with tasks, be emotionally supportive. They begin toassess your pain and monitor how well you can manage activities.When your pain doesn’t improve (becomes chronic), their patiencemay begin to run out. They may become resentful. They know it’s notyour fault, but it’s difficult to separate the pain from the person.They may begin to withdraw, pay less attention to you.*Mayo Clinic Guide to Pain Relief, page 57

Breaking the Cycles*A message of hope:It is possible to break free from these cycles.When you manage your pain, you are better able to keep it in thebackground most of the time. You can concentrate on things that giveyou pleasure, relationships, etc.You can feel more in control of your life.*Mayo Clinic Guide to Pain Relief page 58

Balance, Moderation, Changing Habits*Remember -Managing pain helps you break free of unhealthy cycles and habits.Balance your day - Self-care, Work, LeisurePlan a schedule ahead of timePrioritize for good boundaries and self-careDelegate tasks as neededEvaluate whether your expectations are realisticEducate family and friends re what is best for you*Mayo Clinic Guide to Pain Relief pp 187-190

Balance, Moderation, Changing HabitsGetting organized*Think before you actMake lists, have everything ready beforehandKeep commonly used items handyOrganize at work and homeReduce clutterTry not to let chores and tasks pile upMake sure you can easily find things you needAlways put keys, phone, etc. in the same placePlan for leisure time*Mayo Clinic Guide to Pain Relief pp 190-191

Balance, Moderation, Changing HabitsModeration*Monitor how long, how often, and how fast you do things. This iscalled “pacing” yourself.Pacing: manage your strength and stamina for what you have planned.Break apart lengthy tasksAlternate activitiesPrioritize tasks and activitiesTake as many rest breaks as possibleWork or play at moderate paceChange the frequency of tasks*Mayo Clinic Guide to Pain Relief pp 192-193

DAY FOURSELF-CARE BASICSSleepFood and NutritionAlcohol and SmokingSpirituality

Self-CareThe basic elements of self-care*Getting a good night’s sleep regularlyHealthy relationship with foodLimit alcoholQuit smokingAttention to spiritual lifeAttention to emotional health*Mayo Clinic Guide to Pain Relief page 201

Self-CareSleep*What are the benefits of regularly getting a good night’s sleep?Feel refreshedImproved attitudeBetter energyMore staminaBoosts immune system*Mayo Clinic Guide to Pain Relief page 201

Self-Care“During the night, you cycle from light sleep to deep sleep and back,usually 4-6 90-minute cycles per night.”Types of sleepREM (rapid-eye movement): brain and body activities slow; includes delta sleep (deep sleep) NREM (non-rapid eye movement): closed eyes move rapidly and brain activity increases, thinking and dreaming*Mayo Clinic Guide to Pain Relief page 202Stages and types of sleep of sleep*

Self-CareSleep - factors that keep you from sleeping well*PainStressAnxietyRegular use of sleeping pillsDepressionLack of physical activityPoor sleep hygieneChange in your environment*Mayo Clinic Guide to Pain Relief page 201

Self-CareGood sleep hygiene*Relax before bedtime - deep breathing and muscle relaxation, warmbath, light snack, read, listen to soothing music, journal.Establish regular hours - get up and go to bed at the same timeevery dayDon’t try to sleep - the harder you try, the more awake you’ll beLimit bedroom activities - sleep and sex only, no TV or workCareful what you eat - avoid heavy meals, choose a light snackAvoid or limit caffeine, alcohol, nicotine - caffeine and nicotine cankeep you awake, alcohol disrupts sleep even if you feel tired*Mayo Clinic Guide to Pain Relief page 202-203

Self-CareSleep hygiene (continued)*Get comfy - including cool temp in roomMinimize interruptions - close bedroom door, use a white noisemachine, drink less so you won‘t have to get up to peeHide the clock - knowing what time it is can cause anxietyKeep active during the day - try to get 30 minutes per dayAvoid or limit naps - 30 minutes is best during mid-afternoonSchedule worry time - address your worries well before bedtime, andfind solutions, journal or make notes about solutionsCheck your medications - they might be causing insomnia*Mayo Clinic Guide to Pain Relief page 203

Self-CareRelationship to food*Food can’t control your pain. But a nutritionally balanced diet canimprove the way you feel.For good health and to achieve and maintain a healthy weight, youwant to eat a healthy balance of foods each day. See Mayo Clinic Healthy Foods Pyramid, next page.*Mayo Clinic Guide to Pain Relief page 211

Mayo Clinic Healthy Foods Pyramidhttps://images.app.goo.gl/3o48XqKGDD2y3JGg6

Self-CareMayo Clinic Healthy Foods Pyramid, explained*Vegetables - minimum four servings of vegetables daily, fresh orfrozen are best, canned are high in sodiumFruits - minimum three servings of fresh or frozen daily, avoid driedfruit and fruit juice, which are high in calories and sugarCarbohydrates - 4 to 8 servings of whole grains (cereal, bread, rice,pasta) and starchy vegetables (corn, potatoes, some squash) dailyFats - 3 to 5 servings daily (oils, butter, margarine, salad dressing,mayonnaise), try to reduce amountsSweets - up to 75 calories daily, avoid sodas, candy bars, pastries*Mayo Clinic Guide to Pain Relief pp 211-214

Self-CareWhat the heck is a serving?A serving of carbohydrates - one slice of bread, one small roll ormuffin, half a bagel, one ounce breakfast cereal, 1/2 cup cookedcereal, rice, pastaA serving of fruit - one fresh fruit (apple, orange, banana etc.), seelabel for serving size on canned, packaged fruitA serving of vegetable - 1/2 cup cooked, 1 cup rawA serving of protein - 2-3 ounces poultry, beef, or fish; see packagelabel for milk, yogurt, etc.

Self-CareAlcohol and smoking*Limit alcohol - it can increase the potency and side effects of yourmedication and over-the-counter medications like ibuprofen; it’slinked to dementia; using it for pain relief can lead to addiction.Quit smoking - it contributes to chronic pain by increasing fatigue andmuscle weakness; replaces oxygen in your blood so your tissues andmuscles get fewer nutrients*Mayo Clinic Guide to Pain Relief pp 214-219

Self-CareIf you think you have unhealthy habits with smoking and/oralcohol, there are many support systems out there. I can support your finding help, but I cannot provide that help.

Self-Care“The role of spirituality is an important aspect of well-being that’soften overlooked. Spirituality is as much connected with the spirit andthe soul as it is with any specific belief or form of worship. “Spirituality is about meaning, values, and purpose in life. For somepeople, spirituality is feeling in tune with nature and the universe. Forstill others, spirituality is expressed through music, meditation, or art.“Researchers at Georgetown University School of Medicine found atleast 80% of studies (on spirituality and health) suggest spiritualbeliefs provide health benefits. People who consider themselvesspiritual generally live longer, recover from illness more quickly, sufferless depression and addiction, and cope better with serious disease.”*Mayo Clinic Guide to Pain Relief page 222

DAY FIVEEmotions and BehaviorsMaintaining Your Progress

Emotions and BehaviorsDepression*“Pain and depression are closely related. Depression can cause pain--and pain can cause depression. Sometimes they create a vicious cyclein which pain worsens symptoms of depression, and then the resultingdepression worsens feelings of pain.”Some signs and symptoms of depression: Feelings of sadness or unhappiness; Irritability over small matters;Insomnia or excessive sleeping; Agitation or restlessness; Angryoutbursts; Fatigue or tiredness; Slow thinking or movement; Feelingworthless; Trouble concentrating; Frequent thoughts of death, dying,suicide; Crying spells for no apparent reason; Unexplained physicalproblems (back pain, headache).*Mayo Clinic Guide to Pain Relief pp 225-227

Emotions and BehaviorsIf you think you may be suffering from depression:CALL YOUR DOCTOR

Emotions and BehaviorsDepression: recognizing your losses*The healthy person you once wereUntroubled family relationshipsYour independenceGatherings with friendsFeelings of energy and creativityJob satisfactionA sense of happiness and well-beingSexual intimacyMayo Clinic Guide to Pain Relief p 229

Emotions and BehaviorsDepression: grieving your losses*“Many people respond to chronic pain with the same feelings thatoften accompany the loss of a loved one.”DenialAnger or frustrationDepressionGuilt and shameAcceptance*Mayo Clinic Guide to Pain Relief pp 229-232

Emotions and BehaviorsAnxietyIt’s normal to feel anxious or worried at times. Everyone does. But ifyou feel anxious all the time or your anxiety is interfering with yourdaily life, you need to talk to a doctor.“Like depression, chronic pain and anxiety tend to go hand in hand.When you have chronic pain, you may fear the worst. You may worryabout re-injury, your job status, changes in finance, or increased pain.”*CALL YOUR DOCTOR if you suffer from constant anxiety*Mayo Clinic Guide to Pain Relief page 232

Emotions and BehaviorsAnxiety“A tool you can use to objectively examine the cause of your fears andanxieties is POSITIVE SELF-TALK along with talking to your doctor.”Positive self-talk“Self-talk is the stream of thoughts that run through your head everyday. Your automatic thoughts may be positive or negative. Some arebased on logic and reason. Others may be misconceptions.”*Mayo Clinic Guide to Pain Relief page 230-231

Emotions and BehaviorsAnxietyPOSITIVE SELF-TALK ExamplesInstead of “my pain makes me unlovable,”I’m worthy of being loved as I am.Instead of “pain controls me and my happiness,”I can enjoy life regardless of pain.Instead of “I used to do so many things and now I can‘t do anything.”I can do a lot more than I thought.*Mayo Clinic Guide to Pain Relief page 230-231

Emotions and BehaviorsAnger“Unrelenting pain, interrupted sleep, job difficulties, and insurancebattles--there are a lot of things that can make you angry when you’reexperiencing pain. But it’s unhealthy to stay angry.” “Whether it’s short-term and intense, or lingering and subdued,mismanaged anger can hurt you in so many ways.”“Anger can lead to headaches, backaches, high blood pressure,irritable bowel syndrome, and other health problems. Anger can alsoinfluence your pain. It typically produces muscle tension, making itdifficult to relax.”*Mayo Clinic Guide to Pain Relief page 233

Emotions and BehaviorsAngerIdeas to help you manage your anger:Identify your triggers (circumstances, topics, individuals)Identify symptoms of emerging anger (physical, mental)Respond to your symptoms (time-out, deep breaths)Give your self time to cool down (walk, exercise, distractions)Don’t bottle up your angerFind release valves (music, art, books, journaling)Get a new perspective (manage your unrealistic expectations)REMEMBER: You can’t keep yourself from getting angry, but you canmanage your anger so it doesn’t become an ongoind problem.”Mayo Clinic Guide to Pain Relief pp 233-235

Emotions and BehaviorsPerfectionism*“Some people are perfectionists, constantly striving for excellence.”Maybe, before chronic pain, you kept a perfectly clean and tidy house.Maybe you regularly worked 50-60 hours. Maybe you were a golfwhiz.“As long as you compare yourself to how you used to be [beforechronic pain] you’ll feel miserable about your performance.”“There is, however, a way to keep an upbeat outlook.”*Mayo Clinic Guide to Pain Relief pp 235-236

Emotions and BehaviorsKeeping an upbeat outlook*“People who don’t adapt to new challenges are more likely to becomediscouraged and depressed. But those who are flexible enough toadjust their expectations generally have a positive attitude about lifeand manage to stay active.”Use your positive self-talk skillsInstead of “I can’t work a full-time job plus keep a perfect house,”I can at least clean up the dirty dishes in the kitchen and make surethe floors aren’t littered with newspapers and clothes.*Mayo Clinic Guide to Pain Relief page 236

Emotions and BehaviorsLearning to assert yourself*“Sometimes, one of the toughest tasks is learning to say no, evenwhen doing so is in your best interest.”“You put your thoughts, feelings and health aside for the sake ofothers.”“Assertive behavior is based upon ‘I’ statements. ‘I’ statements tellpeople how you feel without placing blame or creating feelings ofguilt.”*Mayo Clinic Guide to Pain Relief pp 236-237

Emotions and BehaviorsAsserting YourselfSteps to being more assertive*Observe your behavior (be honest!)Think before you respond (not a knee-jerk response)Plan for a difficult situation (imagine how you’ll respond)Pay attention to your body language (how your gesturing, posture,look person in the eye)*Mayo Clinic Guide to Pain Relief pp 237-238

Emotions and BehaviorBoosting your self-esteem*Structure your day with goals you can meetSpend time with othersTalk with a supportive friendFind new friendsTreat yourself to something you enjoySpruce up your appearanceList reasons people like youList things you do well - and do them*Mayo Clinic Guide to Pain Relief pp 238-239

Maintaining Your ProgressIt helps to feel you have some control.Dealing with bad days*Know your warning signsWhat signals can you identify that indicate a bad day is coming?Identify common triggersCan you find a common occurrence or incident that triggers bad days?Develop a game planMaintain a normal schedule as much as you can.Get out of the house.Seek other diversionsUnderstand what helps you relax and use it.Remember: This will pass.*Mayo Clinic Guide to Pain Relief pp 259-261

Maintaining Your ProgressTEN ways to maintain your progressONEDon’t forget your goalsTWORemind yourself with your journal, wellness kit, etc.THREEMonitor your progressFOURPlan your dayFIVEKeep positive (use your self-talk skills)*Mayo Clinic Guide to Pain Relief pp 261-263

Maintaining Your Progress(continued)SIXAccept help when you need itSEVENTeam up with a health care professionalEIGHTSay or write down positive things about yourselfNINEPrepare for challenges in advanceTENReward yourself when you reach a pain management strategy*Mayo Clinic Guide to Pain Relief pp 263-264

Final ThoughtsKeep your eye out for articles, ideas and links to add to your Wellness Kit.Subscribe to reputable health or wellness blogs, newsletters ormagazines - you’ll keep your knowledge up-to-date.If you like, you can sign up for my free, once-a-month newsletter:Wellness: You Deserve It. subscribepage.io/mKu9OrStay in touch - carol@caroldmarsh.comCongratulations! You’ve chosen wellness despite your pain.