Pain Management Programme : Life Lessons and Personal Promises

As part of my ongoing health management, some months ago I found myself at the first in a nine week Pain Management Programme recommended by my consultant. Long term pain had changed my life so much and by attending this, my ongoing life would hopefully receive a bit of a shake up and improve my daily situation. I had signed up for twenty seven hours 'rehab' covering the following areas:

• Pain education
• How our daily choices affect our pain
• Managing our threat systems
• Topical pain 
• Movement   
• Relaxation 
• Mindfulness 

Each session would be run by occupational therapists and physiotherapists at a health centre.
Other support each week would include:

• One to one therapy
• Relaxation
• Pain education
• Goals around movement and activity
• Distress
• Psychological support.

Over nine posts, I will share my personal experience and the strategies learned during these sessions. I think mindset is hugely important in programmes such as this and while I was starting to run out of steam living with my range of conditions, going in to this programme with an open mind was key. I was certainly ready to learn a few new ways forward. In this first session, we were taken through each area of study.

Initially, we introduced ourselves and learned the wide variety of issues we had under the umbrella of chronic pain. We were reminded that acute and chronic pain are very different: acute is pain due to injury while chronic pain is long term persistent pain. The levels of pain can be similar but require different strategies for management and with pain, a huge range of other invisible symptoms persist. Scans and medical interventions only do so much and it is impossible to know the level of pain someone is experiencing. The school of thought had seemed to be medicate and operate when I first became ill years before, but over time, while living through various medications, ongoing physiotherapy and medical procedures such as injections and nerve ablations hadn’t really worked for me.

We learned that discomfort and distress are intrinsically linked. Living with pain causes a person to exist in an eternal state of distress and therefore causes people to retreat from life. Agoraphobia is a very common side effect for those with persistent pain and while getting out is hard for many living with this condition, in time staying in and hiding your condition away becomes easier than sharing the new you with others. I certainly experienced this first hand and saw other group members nodding their heads.

We have to find ways forward managing pain, mental health and often careers, families and social lives. It’s so important to work on finding a balance between doing important activities and pacing yourself. We need to think about the value of the activity and decide if it’s worth the trade off.

Understandably, the brain requires training to dampen down these feelings of distress and threat messages.Living with pain over time develops well-worn paths throughout the nervous system. But these embedded pathways through your system cause wider threat pathways as other connections develop and then before you know it, issues occur in different parts of the body which then develops muscle tension, pins and needles, hot/cold spots and so on.

Our bodies are designed to protect and save us from distress and so these heightened threat systems are just our brains being protective. It sets its own little threshold for when there is a threat and alerts us as we approach a ‘danger zone’ or flare up after activity. However, over time these heightened systems flare up sooner and sooner each time. In reality, just a little activity can cause flare-ups of pain that can occur in rather random places as you are short-circuiting!

Chronic pain occurs due to an highly excitable system. Conditions such as fibromyalgia changes the signalling of sensitivity in our bodies.
Nerves are constantly collecting information to send to the brain signalling that a person needs to move or stretch. There are tried and tested ways to lessen threat to the nervous system and in effect neutralise this Piccadilly Circus Party going on in the body.

We learned that we need to gently push through sensitised vigilant points in our body regularly just to gently lessen the short circuiting. We were assured that through the course we would be able to make peace with our bodies and heed the warning signs that we need to rest to avoid a flare. Mine are brain fog, increased pain, my balance worsens, nausea and fatigue. It's not an exact science but most importantly we would be learning to be self-compassionate and give ourselves permission to rest when necessary.

In the group we discussed our own feelings about our situations. Negativity, anger, shame, loss, guilt and frustration were but a few of our common states.

We were told that tension release is a positive move and we would be working through a whole host of strategies which would give our brains a break from our continuing battle with our bodies.
By giving ourselves 5-10 minutes Time Out now and again, a couple of times a day at least, engaging with a routine through each day would train us in relaxation. Gentle movement and repetitive gentle exercise help bring blood to those tightly knotted areas and lessen the pain. Blood is good - by bringing blood to those sensitised nerves the pain will lessen. Joints may pop or crack as sitting still for any length of time creates a vacuum in our joints which then increases pain but we were told this was not something to worry about.

We then discussed our general daily routines. There were usually full of work and caring for others. We were told we will have to choose activities that we can do each day but without overdoing it. Sometimes people call these their spoons and choose a certain number a day so as not to overdo it.. As we live with chronic pain we do learn how much or how little causes a flare up.

A huge element of positively managing persistent pain is by ensuring activity nurtures these areas. So if you spend all energy on housework without nurturing the social or psychological needs we have, this impacts on our mood, self esteem and confidence.

As we live with chronic pain, all our experiences are different. This is because we at made up of all our core beliefs and values, all of which are established by our late teens.
Our core beliefs and values about pain will change our pain experiences.

For example, how we are brought up around pain, around family members who are ill, how our peers and family react towards those in pain and how we are trained to deal with our own pain. This overtly affects our relationship with our own pain problem.

We were then taken through a range of simple Qi Gong exercises, a 3000 year old Chinese philosophy and practice which works with life force energy through movement to tone and move blood to the nerves. Like a WD40 for the joints and nerves. Essentially we would be working on exercises to improve:

• Movement of spine
• Weight transference
• Balance
• Stretches
• Body symmetry
• Breathing techniques

These actions and practices over time reduce threat and help to desensitize the nerves. Qi Gong has been useful in the past and I was alarmed to realise I had stopped my daily exercises years before.

Coffee afterwards revealed a real mix of opinions about this course: hopeful, cynical, suspicious, skeptical, unsure, hopeless. Our health issues were many and varied and we had a whole range of medication trials, operations, procedures and therapies under our belts. We sipped on good coffee (a great cafe always helps) and bonded through our sheer determination to improve our situations somehow. I hoped this course would play a significant part.