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!

Video: Pacing & Action Planning for Exercise

If you’re thinking about exercising to help with your chronic pain or overall health, it is important to consider two things: (1) pacing – so that you don’t over exert yourself one day and pay for it the next; and (2) action planning or goal setting so that exercise is realistic for you. Also, remember to always talk to your healthcare team before starting any new exercise routine! If you’re having thoughts about your ability to exercise that are causing you distress, check out this podcast episode.

Keep making the most of it!

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My Experience at the World Pain Summit ’21, Part 2

If you read last week’s blog post then you know that I recently attended the World Pain Summit, put on by the Alberta Pain Society. I did this as both an allied healthcare practitioner (as a clinical counsellor) and as a person with lived experience. By the way, this event is apparently always free to people with lived experience, so keep an eye out for it next year. The summit was 3 days and had so much info, that this is going to be part 2 of a 3-part post, and focuses on the content of Day 2. Without further ado, here’s what I learned.

How Living with a Dog Can Improve Quality of Life and Well-Being in People with Persistent Pain. The first bit of interesting info was a bit of an aside – only 1% of the curricula for healthcare professionals is on pain, which means if your doctor doesn’t understand (and isn’t attending these kinds of conferences) that is likely why (definitely not an excuse – all healthcare professionals should be attending conferences/summits/etc throughout their careers). The most interesting parts of this session was the statistics on dog/pet owners (cats and other kinds of pets count):

  • they report lower pain
  • less depression and anxiety and loneliness – i.e., better mental health
  • improved well-being and meaning/purpose in life

Having a pet also gives you a non-judgmental listener whom you can talk to, and petting an animal releases oxytocin in our brains, which has a calming effect. Yay for pets!

This is my parents’ dog, Beau.

Is Supported Pain Self-Management Your First Choice or Last Resort?: 5 Key Coaching Support Skills. This was present by Pete Moore, a person with lived experience, who wrote a book on the subject. The 5 key skills he talked about were: (1) goal setting and action planning; (2) practicing daily activities – I know ADLs can be hard for some people but they are important to well-being; (3) problem solving; (4) keeping active, moving, including stretching and exercise; and (5) knowing what to do if you have a set-back (i.e., planning for that in advance). Much of this involves having a support team, pacing, prioritizing, being patient with yourself, learning relaxation skills, tracking your progress, and resilience.

Pete Moore presented this cycle, which really resonated with me and probably many others.

How a Pain Doctor is Using Social Media to Spread Knowledge About Chronic Pain. This was a session more for healthcare professionals on how to start a YouTube channel (and why they should). But some interesting factors for Spoonies: the current quality of medical information on YouTube is very low, so please be careful and look for trusted sources (i.e., trained healthcare professionals in different areas).

My YouTube channel is for meditations (with an emphasis on pain and illness).
Let me know if I should include other psychoeducational content and skills.

Trauma, Illness, and Healing – Dr. Gabor Mate’s keynote. I’ve written a ton about Dr. Mate’s work in the past, and there was obviously some repeat in content about trauma, childhood abuse, insecure attachments and stress and their relationship to chronic pain and illness. A couple of things I will share:

  • mind body practices (like yoga) should be included in chronic pain treatment
  • a lot of back pain is associated with psychoemotional stress (tension, stress, trauma)
  • Go to a physician for what they can do (prescribe medications, perform surgery, etc.) and find other practitioners to help you with the other parts of treatment
  • diagnoses are descriptions, not explanations
  • psychological and spiritual support is important

If you’re not familiar with Dr. Mate’s work, check out When the Body Says No (I also did a post about the book awhile back).

Dr. Gabor Mate is world leading expert on the trauma-stress interaction with illness.
Image from: https://californiahealthline.org/news/addiction-rooted-in-childhood-trauma-says-prominent-specialist/

Challenging Chronicity Thoughts: Words Matter. So this was a mental health session, if the title isn’t clear! It emphasized that psychological factors are an important component of pain experience and are the most powerful psychological predictor of adverse health and mental health outcomes associated with pain – they even affect our treatment responses to medications, injections, physical therapy, and most other treatments. Recovery is not just about talking (to a therapist), needs and activity but also about ways of thinking. Two important notes for my fellow Spoonies: (1) pain is perceived by your brain (all in your head) but it is real; and (2) the word pain takes you right to thinking about/feeling pain (check out this podcast episode I did on externalizing language and pain/illness).

Chronicity thoughts are about way more than language. I highly recommend seeking therapy if you find you think about your illness/pain a lot.

Next week I’ll bring you a post on the information from the final day of the summit. I hope that you find some of this helpful when thinking about illness and well-being. Keep making the most of it everyone!

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Top 10’s: Ways to Improve Your Physical Health When You Have a Chronic Illness

I will start off by saying that a “top 10” is no way a comprehensive list, because there are lots of ways you can improve your health (or at least keep it at base line) when you have a chronic illness. A lot of this I’ve learned through my own trial-and-error, through my studies and work in psychology/psychotherapy, and from conversations with other Spoonies and healthcare professionals. So, this is basically my Top 10 list, and I’m hoping you can pull a few things out of it if you haven’t been doing these already. I’m also going to link some of my blog posts and podcast episodes if you want to have a deeper dive into these topics. Also, I couldn’t determine an order for these, so they are not necessarily in order of importance (assuming there is one)!

Are you ready for my Top 10?!

Eating healthy. This is so important and often overlooked. Eating food that is organic and free-range is ideal, though if you’re like me this might not be affordable. If that’s the case, throw in some of that where you can and otherwise focus on the food groups, especially lots of green veggies. Limit your red meats, and of course limit any food that makes your symptoms worse (for some people that’s gluten or dairy). Be open to trying out different diets (Paleo, Keto) or fasting – but always consult with your healthcare professionals first. Check out this blog post on eating healthy, and this podcast episode on living with allergies.

Drink lots of water. 6-8 cups a day is ideal. I’m currently doing a challenge through Shape and Foster and part of that challenge is drinking 1.5L of water per day. Honestly, some days I really struggle but I also notice that the days I drink that much water, I drink less other stuff (that’s not healthy) and I feel the best. Water is important for our overall health and can’t be overlooked! I’ve got a blog post about it, and it is an essential of health which I discussed on the podcast.

Eat healthy, drink water.

Take your meds! Medication management can be super annoying but you’re being prescribed them for a reason, and there is typically a lot of science around them. I sometimes forget to take my meds (not going to lie) but again, I do feel best when I take them as prescribed. This doesn’t just go for Western medication either, try out some Eastern ones (head over to a naturopath, chiropractor, or other practitioner) to get some holistic care going. I’ve got a blog post about health management, and a podcast about holistic options.

Sleep hygiene. It’s so important for our physical (and mental) health to get a good sleep. Our bodies need to feel energized and rested when we wake up. Spoonies definitely have extra challenges with sleep. I often toss and turn because I’m never comfortable. However, doing proper sleep hygiene can at least minimize some of these problems and get your a better sleep. When I have proper sleep hygiene, I notice a 50-80% improvement in my sleep! No jokes! Check out the blog post and podcast episode for more.

Take your meds, get some sleep (or end up looking like this!)

Exercise. Yes, exercise definitely helps with pain reduction, and can increase things like mobility. There is a ton of science behind it. That being said, you have to be careful not to go over your limits (i.e., just push yourself to your edge but not beyond it) because you don’t want to hurt yourself. Low impact is recommended for chronic illness (walking, swimming, etc). If you’re not exercising, then just experiment with small amounts and gradually work your way up. This is another area that it is important to consult with a professional on. I do an exercise vlog post every 3 weeks, and I did a full podcast episode on exercise too.

Spend some time outdoors. Interestingly I just did a post on this last week that got very few views despite the fact that there is again science supporting how much this can benefit both our physical and mental health. Step away from the city if you can, even if just a few hours. Take the opportunity to breathe in fresh air. Tie it into exercise by going for a walk. Tie it in to stress reduction and just let yourself be. Though I don’t have an episode specifically about this, there is a podcast on holistic approaches that ties in nicely.

Exercise and spend time outdoors (my solo trip to LA, 2018).

Reduce your stress. Being calm, and having as little stress as possible (which I get it, sometimes just having a chronic illness is stressful!) is so important. Stress is a common cause of flares in many autoimmune diseases and in generally, always manifests into nasty physical ailments of one kind or another. This is a good reason to learn some mindfulness skills (which I do a vlog post on once a month). I did a whole podcast episode on how stress and anxiety manifest in the body as well – find it here.

Get involved in your care. This often means we have to be our own advocates for our health. That can include being a little “pushy” with our doctors (I mean it’s ridiculous that we have to sometimes but medical gaslighting is a huge problem). It also means that you may have to create a healthcare team for yourself. I’ve found this to be extremely beneficial for me. For more on getting involved check out this blog post and this podcast episode.

Reduce your stress and get involved in your care (and no this is not actually how I meditate lol)

Self-care. There are 5-6 dimensions of self-care (depending on who you ask) and physical self-care is one of them. A lot of the things from this list apply to physical self-care, but you can also add a lot more, depending on what you like – I like Epsom salt baths! I also mentioned that challenge with Shape & Foster earlier which this month is putting an emphasis on physical self-care. Hear more about them on the podcast. I do monthly premium blog posts for self-care which you can sign up for here.

Goal setting. No one can be expected to make any changes to any part of their life – including the physical aspects – overnight. That’s why setting goals can be really helpful. If you’re not currently exercising, then committing to 3 1/2 hour walks per week might a good place to start. Or increasing your veggie intake four times a week. Or spending time outdoors once a week. Whatever it is, make a plan and make it one that is challenging and yet you can stick to. I recently did a blog post on goal setting. This is the podcast episode it ties most nicely in with.

Spend time on self-care and set some goals (my goal to be a llama – jk!)

Okay, this was a longer post than normal but I hope you have a few takeaways! Keep making the most of it everyone!

Goal Setting with Chronic Illness

It can feel hard to set goals for yourself when you’re sick and/or in pain. Be it personal goals, work/career goals, relationship goals, or health goals, they just feel harder to attain and when something is so hard it’s so easy for our minds to give up and just not do it. But we have to be careful, because that giving up can lead to hopelessness, which can lead to depression, which can then make it even harder to set goals and live the life we want to live. You might be saying, “but Kelsey, how can I live the life I want to live when I’m in so much pain, and I’m struggling so much?” And that is a valid question. Journeys to living our best lives aren’t easy for people who are healthy, so they are far less easy for those who are not, which is why I believe that starting to set goals for ourselves early on, before that hopelessness sets in, is essential. (For those of you who are already struggling from depression, goal setting is still very important, but I recommend seeking out a therapist to help you on your journey, this post is going to focus on goal setting when our mental health is doing better).

Sometimes we focus too much on obstacles and stop ourselves from setting goals.

Personal, career, relationship, and health goals are all possible to set and achieve. The easiest strategy for goal setting, that is often used in business AND is what we use in counselling, are SMART goals. SMART stands for Specific, Measurable, Attainable, Relevant, and Time-bound. Setting goals this way, will help you have a step-by-step process that will make it easier to reach your goals. With chronic illness, our goals might be smaller than our healthy peers. Maybe a health goal is to walk around the block rather than run a half marathon (or if your ultimate goal is to run that half marathon, we might have to start with the goal of walking around the block). Before we jump into some examples of these SMART goals, I want to just stop for a minute and talk about realistic versus unrealistic goals. I think it gets a little fuzzy with Spoonies because sometimes we can either limit ourselves in what we believe we can do, or we try to ignore our limitations and believe we can do more than we can. The truth is, only you know if you fall into one of these categories, or if you’re being completely realistic about your goals. Using the marathon example, if you believe you could NEVER run a marathon (even if it is technically possible) than you might limit yourself in the box of continuing to struggle with going for walks (I’m not saying this is or isn’t fitting for you and your story, just an example of what could happen). On the other end, if you believe you could run a marathon within a year but you struggle with pain when you take a few steps, that is also not necessarily realistic (again, depending on you). My point is, we want to have realistic expectations of ourselves when we set goals, and sometimes those can change when we make these smaller goals, and take one step at a time.

Goals can still be set if you have chronic illness – in fact they should be set!
(Niagara, ON, July 19, 2020)

Let’s do an example of a SMART goal with something from my life. (By the way I have a million goals, some of them are “life” goals and will take a lot of time to build up to – thus the baby steps – and some of them are smaller goals). This month I’m participating in a 30-day yoga challenge. So, I’m going to use that as my goal.

  • S(pecific) – Participate in Timothy Gordon’s 30-day yoga challenge (found on YouTube here) at around 5pm every day.
  • M(easurable) – Tracked daily by viewing the videos in order: Days 1-30
  • A(ttainable) – the videos are between 15-30 minutes in length, and I have been doing this style of yoga (yin) for 10 months, so yes it is attainable.
  • R(elevant) – this has a dual purpose for me: to get present and centred in my body (which is helpful for chronic pain and mental health), and for light exercise (also helpful for chronic pain and mental health).
  • T(ime-bound) – I started on March 1 so I will end on March 30.

Therefore my goal is: To participate in Timothy Gordon’s 30-day yoga challenge at around 5pm daily from March 1 to 30, which is based on my current fitness level and will improve my chronic pain and mental health through being present and light exercise.

My current Yoga challenge is indoor, but I’d love to do outdoor yoga again!
(near Peachland, BC, August 30, 2020)

If, for example, you wanted to have a similar goal but were not used to doing yoga or this style of yoga, you could spread it out over two months and do it every other day. I hope you get the idea though. It’s important to set a goal around your health when you have a chronic illness. Just setting one goal at a time, and accomplishing it can feel really good and improve your overall quality of life (which then will likely improve your mood as well). If you have questions about this kind of goal setting, or really any questions at all, feel free to reach out! Also, my podcast episode with Katie and my one with Trachele, are really good to check out as they relate to goal setting with chronic illness.

Until next week, keep making the most of it!

Mental Strength & Resilience for Spoonies

My mom actually suggested I do a post on mental strength and I thought about it for a bit because I find that it is very similar to resilience, which I’m fairly certain I’ve posted about before. However, I did some research and found that while there are similarities there are differences as well and to be honest, both are pretty essential when you’re a chronic illness warrior and can increase positive mental health. I’m going to give you an overview of each concept and how they tie together and some ways that can help you increase them (many of which I have personal experience with) so that we can all grow stronger together in our own separate battles.

It’s not easy to find strength in illness.

First, let’s define resilience. Resilience is our ability to respond positively and to adapt to negative, traumatic, and stressful events, in a way that is constructive. Now let’s define mental strength. Mental strength is our ability to effectively handle stressors and challenges in our lives the best we can despite the situation we find ourselves in. As you can see there are similarities, what I think the biggest difference in is that resilience occurs in the face of significantly impactful events such as trauma, whereas mental strength helps us with less significant (yet still impactful) stressors. We often hear of mental strength in regards to athletes and their ability to practice the same thing over and over. People who are mentally strong like adversity because it’s a challenge not a threat.

Kids are the most resilient of us all – me as a baby circa. 1986/87

The great thing is that both resilience and mental strength can be learned! According to the American Psychological Association (APA), the thoughts, and behaviours involved in resilience can be learned. They state that what makes up resilience includes:

  • your ability to make “realistic plans” and accomplish them
  • self-confidence and self-esteem
  • problem-solving and communication skills
  • emotion regulation

How does this apply to chronic illness? I see it as (1) making realistic plans is including limitations you do have because of your illness but not letting your illness limit you; (2) you can still have self-confidence and self-esteem with a chronic illness; (3) problem-solving and communication actually become more important when you have a chronic illness; and (4) emotion regulation is essential for everyone.

Everyone can build resilience and mental strength.

What are some ways we can build resilience? Let’s break each of these down further:

  • making realistic plans & accomplishing them: includes gaining skills (like going back to school or just learning something new in general); and taking action toward the goals you make for yourself while keeping a positive and hopeful outlook on your ability to accomplish them!
  • self-confidence and self-esteem: accepting change because nothing stays the same, including your illness; engaging in activities that help you learn more about yourself (try something new, be creative, get as active as you can, etc.); view yourself in a positive way (stop the negative self-talk and write down things you like about yourself); and of course, self-care!!!!
  • problem-solving and communication: setting goals for yourself; and making connections with friends, family and colleagues because support is important.
  • emotion regulation: controlled exposure (I would suggest with the help of a therapist); taking a realistic view of crisis situations (I like the phrase, “if that happened, then what would I do?”); and activities such as journaling, meditation and other spiritual practices can help with emotion regulation (I’ll probably do a longer post on emotion regulation at some other time).

So if that’s how we build resilience, what can we do to build mental strength? Turner (2017) states that the elements of mental strength include having a sense of control and purpose of your life and emotions; making a commitment by setting goals for yourself; challenging yourself when necessary; and having that self-confidence. Very similar to what we just talked about for resilience. I’ve got to say that I possess all of these, and I’m not sharing that to make anyone feel like they aren’t enough because they are currently not mentally strong. I’ve had times when I haven’t been strong, it takes a lot of work to get here. My point in sharing is that you can come from a place of anxiety and stress over your health condition and get to a point where you can deal with most things that come your way (I say most because no one can deal with everything perfectly). It just took me a few years of hard work to get here. Here are some ways you can develop your mental strength:

  • gratitude – write down 5 things every day that you are thankful for. I also recommend taking the free Science of Well-being course offered by Yale University. Here’s the link!
  • practice mindfulness – in whatever way you like. I prefer meditation and body scans, and throw in the occasional mindful walk.
  • act “as if” – this is an interesting concept developed by psychologist Alfred Adler. He stated we should act as if things are the way you want them to be (essentially you get to reauthor your life). This one is a bit more complicated and may also deserve its own post.
Image from the Science of Well-Being course.

Before I wrap up this very long post, I want to share research by Pickering & Holliday (2010). They stated that “mental strength contributes to resilience processes and resilient behaviour.” So basically develop your mental strength and you’ll develop your resilience. I mean as we’ve seen there is a lot of overlap between the two so it totally makes sense!

Also, from the Science of Well-Being and I thought it’s great to end on.

Let me know what you think of mental strength and resilience! Comment on the post or shoot me a DM on Instagram (@janeversuspain). I would love to hear from my readers! For now, keep making the most of it!