5 Easy Chronic Pain Self-Management Skills

Today I want to take a slice of Pete Moore’s Pain Toolkit and share it with you. Who is Pete Moore? He’s a chronic pain warrior who came up with this incredible Pain Toolkit to help others struggling with chronic pain. Here’s the website: https://www.paintoolkit.org/ . The truth is, we can learn to self-manage our chronic pain. Like Pete, I have also learned to do so to a point where, yes I have pain, but no it does not affect my day-to-day life (that’s not to say I don’t have bad days, heck I had bad pain the other night and had difficulty sleeping). One thing we want to do when we have chronic pain is cultivate resilience. Now, I’ve written about resilience before in the past, so I’m not going to go into detail here. For those who aren’t familiar with what resilience entails, here are a few things: optimism, self-belief, willingness, self-control, being able to adapt, psychological flexibility, problem-solving, emotional awareness, social support, and humour, to name a few. So, here are 5 ways we can learn to do this.

Doing these things helps me manage my chronic pain.

1. Goal Setting and Action Planning – I often set goals for myself, even on days that I’m not feeling great. In our third atmospheric river (basically several days of torrential downpour) since November in BC, Canada, I’m again feeling it in my body. But I know my body also needs to move. So I set a goal for how far I will walk in the rain (which is less than my goal would normally be but appropriate for the weather, my body at this moment, etc.). So, set your goals, and prepare for barriers to them. Here’s a podcast episode I recently did on that.
2. Engaging in Activities of Daily Living – Getting out of bed, having a shower, eating breakfast, etc. All the regular stuff we do in our lives. It can be really hard to want to do them when you have an illness or pain, but doing them can also improve our overall well-being. Check out this episode of the podcast for more.
3. Problem Solving – Problem solving can include a lot of different things. Pacing is important and I’ve done a post on that (December 1), prioritizing and planning your days, and really importantly, having a setback plan. What are you going to do when things don’t go the way you planned (in your goal setting and action planning stage). When I was recovering from hip surgery last year, I had to problem solve how to do all of my daily activities because I couldn’t put any weight on my left foot (for 6 weeks!) and I live alone. I still had to figure out how to cook, shower, dress, and even get to some appointments.
4. Be Active – this will mean a lot of different things to a lot of different people, but it really means to move your body. It could be walking, exercise/going to the gym, stretching, yoga. Exercise itself is an evidence-based treatment for chronic pain (here’s the podcast episode). It can be light movement, as long as it’s movement. I can’t go a day without moving my body. Even when I notice I’m having the thought that I don’t want to move or I’m in too much pain, I inevitably actually feel better if I go for a walk or do some restorative yoga.
5. Be patient with yourself – offer yourself some compassion. Change is slow. Like it’s an average of 10 weeks for someone to start noticing differences (in their minds or bodies) when they start to make any changes. If you find you’re having difficulty being patient with yourself, try this mindfulness exercise. I’m definitely guilty of wanting change to occur quickly for myself. But interestingly, when I offer myself patience and compassion instead of criticism, change seems to actually occur more quickly than when I’m only hard on myself.

Remember, change is slow.

I hope this helps you with some pain management. I know it’s things that have helped me and many others. So, just keep making the most of it!

How Can I Become More Resilient?

This isn’t the first time I’ve posted about resiliency on this blog. The truth is, it’s a topic that comes up often. I see it on online support groups, on Instagram, and hear it in conversation with people. I also read it on other blogs, and many healthcare organizations post about it on their sites. Here’s the thing, if you have a chronic illness and you’re not feeling resilient, just know that you are not alone. A lot of people feel that way. Are people born resilient or do we develop resilience? I think it’s an interesting question and possibly a bit of both. Children tend to be more resilient than adults, suggesting we can lose some resilience as we age. In one of my courses for my graduate degree we had to more-or-less do a family tree. Except this family tree was supposed to trace something like a mental health or substance use issue. I chose to trace resilience, and found that going back just to my grandparents generation (that was the requirements for the project) there was a strong theme of resilience (my maternal grandmother/baba faced abuse, neglect, lost 2 children, and she and my mother were trapped in Siberia for a week during the Cold War – I know it sounds too crazy to be true). Yet she not only survived but was a loving parent to her other children and an amazing grandparent. Had my mom not shared my baba’s history I would not have know. She was that resilient.

Three generations of resilience in my family.

The good thing is, that even people with chronic illness can develop resilience. Warning: it does require work on your part. Luckily, some of the work may not feel like work at all… it just requires consistent commitment to it. I want to add, that many of these suggestions overlap with what the National MS Society suggests, in case you don’t want to just take my word for it.

• finding meaning and committing to that action: what is the reason you get out of bed in the morning? If you don’t have a reason it will be difficult to do so. Is it your family? Or work? I know a lot of people with chronic illness go on disability, but work provides meaning and purpose for people. If you are on disability what is your purpose going to be instead?
• improvisation/adaptability/problem solving: I think these all kind of overlap and go together. We often have to improvise in order to do things we enjoy. Maybe we can’t go on the 5k walk with our friends, but we could meet them for coffee afterwards. How flexible and adaptable are you to changing plans? Or asking others to? What’s an alternative way you can participate or do the things you like to do? I would go as far to make a list of ideas (remember when brainstorming there is no such thing as a dumb idea) and try out some to see if they work.
• Self-care: we all know I love self-care, and this includes the basics (getting out of bed, making breakfast, taking a shower) and then doing activities like relaxation techniques, yoga, meditation, or prayer. What hobbies do you enjoy that you can participate in? Pick one a day. Reading is an example of something that is low energy and can be fulfiling.
• Being able to tolerate “negative” emotions: I personally don’t categorize emotions as negative or positive. All emotions are important because they tell us very important things. If you’re not used to be able to just sit with emotions, try out this mindfulness practice that aims at helping people do just that.
• Self-efficacy: I did a post on this recently, and you can read it here. Do you believe you can cope with your illness? Part of this is being a realistic optimist, being hopeful.
• Using skills such as curiosity and humour: When is the last time you laughed? Are you able to have fun and joke around (and not in a self-deprecating way)? Do you get curious about your situation or feelings or sensations or emotions? What are you noticing about them right now as you read this? The noticing self is a helpful skill to develop. We touch on it in this podcast episode (about half way through).
• Radical acceptance: This is a skill from Dialectical Behaviour Therapy (DBT) and essentially the same used in Acceptance and Commitment Therapy (ACT). It is about fully accepting your situation/thoughts/feelings/sensations/etc. Fully. Accepting. It doesn’t mean you have to like it. It’s hard to do a lot of the above without this kind of acceptance.

My curious, nonjudgmental, accepting, “what am I noticing” face.

I hope this helps give you some ideas for building resilience some more. Well-being and a good quality of life do require us to be resilient, and trust me, it is possible even with chronic illness. Here’s the link to the MS Society page on resilience. Take care, and keep making the most of it!

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The Importance of Flexibility

I’ve been thinking a lot about cognitive flexibility lately. It’s often a topic that comes up at school, but beyond that, it’s something we need to think about, not only if we have a chronic illness but also during a pandemic, like the one we’re currently in. Some of you may be asking, what do I mean by cognitive flexibility, so here is my short explanation: it is your mental ability to change your thoughts and behaviour as needed to adapt to different environments and situations. An example would be if you were to move to a different country, with a different culture, and how easily you were able to adapt living there. I’m going to break this post into two parts. First, being cognitively flexible as a chronically ill person, and second, being cognitively flexible as any human being living during a pandemic.

How easily do you adapt to changing situations?

Having any chronic illness or dealing with chronic pain for any reason requires us to be cognitively flexible in order to more easily cope. People with poor cognitive flexibility tend to be more prone to mental distress, though of course that is also a more complicated process. In terms of dealing with chronic illness, I think about how I have to adjust to social outings or exercise or work. Recovering from hip surgery, how am I adapting to being on crutches, and not bending past 90 degrees in the hip. It can be difficult to adjust and adapt to these types of situations. This process is going to be different for everyone. Understanding what your limitations are is certainly important, as is the ability to not give up. One thing that’s important for me is being able to exercise because I’ve found it decreases my overall pain levels. But how do I do that now? Chair workouts is what I came up with. Why? Because they are available on YouTube and I can adapt them to what I can do. Another example from my own life is about cleaning. I’m not a neat freak but I do like a clean house. However, I can’t sweep or mop (I have laminate floors) so in my opinion, my place is a disaster. However, I tend to let that go because it isn’t helpful right now, because I literally can’t do clean the way I normally would (plus I live alone right now so there is no one else to do it for me). I have one good friend who always says, “I know you’re a strong and independent woman but you can ask for help.” What he isn’t taking into account is that I do ask for help when I need it (literally different people bring me groceries, take out my garbage and help me with laundry, including him!). When I don’t ask for help, it’s because I don’t need it, but I am flexible enough to ask for help when I do.

My favourite chair workout channel.

Now, during this pandemic I’ve seen a lot of people post on social media about many things, but I’m going to just use one example for this post, and that is gyms being closed (here in Canada at least). The most common argument against closing gyms (even though it is known that the virus is airborne and we all breathe hard at the gym) is that working out is good for your mental health. 100% it is! As a therapist-in-training I will not argue that fact. What I will say, is how flexible are we being with our workouts? I was someone who worked out at the gym between 3-5 times a week before the pandemic. The first thing I did when the gyms closed was figure out how to utilize the limited space I have in my place to do workouts at home. With zero equipment. Apps, YouTube, online gym programs (my gym literally offered free access to all kinds of stuff to members even though we weren’t paying fees anymore). Yes, it is not the same as going to the gym. It doesn’t offer a social environment, maybe not the same type of workout, but I actually got in better shape working out from home because I didn’t have to go anywhere, just change my clothes. I think it’s important that we look at what we are upset about during this time and figure out ways to do actively make the most out of the situation we are in. I’m not saying it’s easy, nor that there is a solution for every person or situation. For some situations we just need to adapt our mindsets to our current reality.

Image from: https://wiki.its.sfu.ca/permanent/learning/index.php/Cognitive_Flexibility

I hope this give you some food for thought. For now, keep making the most of it!