My Ultimate Pain Coping Skills Part 1: Self-Monitoring

I decided to do a 4-part series on some of my favourite pain coping skills. They are all either my favourites because I have found them to be particularly useful for me, or that reason plus I have seen them be useful for other people. I will also add that I always double check to see if there is any scholarly literature on the subjects I write about, and there definitely is for all of these coping skills. So, without further ado, lets start off with self-monitoring.

What is self-monitoring?

You might be asking, what is self-monitoring? It is a part of our awareness (executive functioning in the brain) that we all have, that tracks our behaviours and the impacts they have on us and our environment so that we can alter our behaviour in the future if we choose to. We all use this pretty often. For example, adjusting to social norms would be using self-monitoring. So would reviewing your work for mistakes (because ideally you won’t want to make the same ones in the future). We can break self-monitoring down into two types. Qualitative – or what I’ll call subjective monitoring – which is how our emotions, sensations and behaviours change throughout the day and during different situations. Then there is quantitative – or what I’ll call objective monitoring – which is the frequency, duration, and difficulty of our behaviours.

What the heck does this have to do with chronic pain? Sometimes people with pain over-self-monitor in that we overthink our pain and our behaviours which is typically not helpful (I’ll get to that in a minute). When done properly, self-monitoring can be used to help us accept our emotions and sensation, create some distance between us and our thoughts about pain, and get us to do behaviours/actions/set goals/whatever you want to call it, that will improve our lives or just in general fulfill us! And this is what I see is often difficult for chronic pain warriors. For example, if I notice that a certain activity causes me more pain than normal, I would mentally note that as well as the frequency, duration and difficulty of the activity so that I can make adjustments in the future (i.e., not to the activity, do the activity for less time, do the activity less – or more, depending on the situation – often, or do a similar activity that is less difficult). A few years ago I did a pole dancing class. Super fun and a great workout. However, I did notice that my hip pain increased, especially after the class was over. I decided that while though it was fun, the friend I went with and I have lots of other activities we can do together and I exercise in other ways, that maybe this wasn’t the workout for me. I adjusted. Another example is hiking. I know how long a hike I can do (about 75-90 minutes max.) before I have expended too much energy and/or crossed my pain threshold. What does that mean? I still hike because I LOVE hiking, but I do it for 90 minutes or less, followed by rest.

I knew how much hiking I could handle on my Costa Rica trip.

Earlier I mentioned that when we over-self-monitor we often do things that aren’t helpful. This also happens when we don’t self-monitor our pain at all. Let’s tie it into that pain cycle I wrote about a few weeks back. In the pain cycle we see that being less active leads to a loss of fitness, weak muscles, and joint stiffness. If you self-monitor and notice that if you lay on the couch all day this happens but if you go for a (short) walk it doesn’t lead to these specific symptoms, that might lead you to do the walking. Pain cycle again says that then we create lists of “no go” things we cannot do, and this leads to sleep problems, tiredness, and fatigue, which also leads to stress, fear, anxiety, anger, and frustration. Okay, so doing less isn’t necessarily helpful even though our brains say it will be. We can also skip ahead in the cycle and go to negative thinking and fear of the future and how that leads to depression and mood swings. Monitoring our thoughts is helpful at this stage. And then there is time off work, which inevitably causes money worries and often ties into relationship concerns. And then everything leads back to more chronic pain. I want to point out with the activity portions of the above paragraph, that pacing is essential and I did a whole post on that a few weeks ago.

What can we do to start self-monitoring in an effective way? First thing is to keep track of your pain. This can be mentally, but if you have brain fog or just tend to forget it can be more effective to write it down in a journal. There’s a few ways you can track it. Just a general 1-10 score for the day and a list of what you did during the day. Or, if you want to be more effective with your activities, you could write a score before and after each activity you did to track changes. That will also tell you when there was no to little change so you know if you can keep doing the activity the same way, for the same amount of time. The other important thing to track in the journal can be other triggers to pain. For this one, I would suggest tracking emotional pain (sadness, anxiety, anger, etc.) as much as physical pain. Why? The body-mind connection. Often the more depressed we are, the more pain we have (and vice versa). Same with anxiety. It’s easier to make adjustments when we know what’s going on.

Find a way to track your pain AND activities AND emotions.
Image from: https://www.templateroller.com/template/39579/pain-tracker-form.html

Okay, longer post than I anticipated but I hope that it’s helpful for all of you warriors! Keep on making the most of it!

What is the Chronic Pain Cycle and How Do I Break It?

The chronic pain cycle is essentially what happens to us when we are in pain and let it consume us. First off, this is normal! I totally remembering being there myself. Usually we try to address only part of the cycle, without managing the whole thing (i.e., we like those prescribed medications from our doctors but still get frustrated when they don’t fix everything). I thought today we could talk about a few different versions of the cycle, and address a few ways to address them so that pain is less consuming and we can get back to a life that is closer to what we want.

First off, some of the examples of the pain cycle are pretty basic. Pain leads to sleep problems leads to mood problems leads to decreased activity leads to low energy leads to decreased pain. Or pain leads to muscle tension leads to reduced circulation leads to muscle inflammation to reduced movement leads to pain. And any case, you can start pretty much anywhere in the cycle, but you always end up with more pain. A more comprehensive version of this cycle is shown in the diagram below.

Here’s the problem: our brains tell us that we shouldn’t move, we shouldn’t be active, that things will never be good for us, that we will never have normal lives, etc., etc. because they are trying to keep us safe. Unfortunately, all the research shows that our brains are incorrect and that these thoughts really don’t do us any service. They keep us trapped in the cycle. I remember when I first decided to start making changes for myself. I took myself to physiotherapy (physical therapy for you Americans), the chiropractor, the naturopath, massage therapy, and psychotherapy, because I wanted some relief. What I was encouraged to do was break the pain cycle. How?

  1. Psychoeducation/Health education about chronic pain. I know most of you won’t read scholarly journal articles (as I do) about all of this and that’s fine, but there is a wealth of information on the internet (think clinic websites: Mayo Clinic, John Hopkins, etc.). Also, if you talk to health care provides (your specialist, or any of the above that I’ve mentioned) they will be happy to provide you with the knowledge you need to start making different choices. You just have to be open and willing to listen.
  2. Increase fitness and exercise. This might be as simple as stretches and easy exercises given to you by the physiotherapist, chiropractor or massage therapist. It might also include actual cardio and/or strength training. This should of course be paced, and you should come up with a plan with your healthcare specialists. I went to the gym and got a personal trainer who had worked with people with autoimmune diseases before.
  3. Take your medication. Inflammation in particular is often best addressed with some sort of medication. Of course, there are alternative ways to address it as well, such as through diet or supplements. I like the approach of doing both. I take my medication as prescribed and then balance that with diet.
  4. Address side effects of medication, such as weight gain or others. This might be with your doctor – adjusting doses or which medication you take – or it could be done holistically through other therapies (as mentioned above), exercise, and diet.
  5. Address the cognitive issues that arise. This means anxiety, depression, sleep issues, stress, fear, frustration, anger, negative thinking, rumination, etc. While these are normal experiences, they can make it harder for us to make changes. These can be addressed through sleep hygiene, meditation, and psychotherapy.
Going on adventures even with pain.

Where am I in the pain cycle? Look, to be honest, some days it’s not perfect and I fall right into the cycle. However, most days I can openly and curiously acknowledge and accept my pain, breaking the cycle before it begins. I use all of these tools and healthcare providers because it helps. I know from experience that chronic pain does not have to be life consuming.

I’ve linked episodes of the podcast and my meditation channel throughout this post if you want more information. Until next week, keep making the most of it!