Persistent Pain

People with chronic pain cope with it in different ways. Below are three examples of how different people have tried to deal with their pain.

 EXAMPLE 1  
  •  Some people stay active until they can do no more and then rest to recover before returning to an activity for as long as they can again.
  • This may result in their pain getting worse or flaring up as they carry out an activity for too long. The time taken to rest may steadily increase.
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Emma’s activity levels were high. She fought with her pain and tried to “beat it” e.g. she was constantly more active than her pain allowed.

She didn’t want to “give in” to the pain and felt it had “won” if she had a rest. She pushed through the pain and wouldn’t stop and rest. Her motto was “no pain, no gain”.

In the end she found this way was hard work and very tiring. She often suffered from low mood, was upset, frustrated and felt she had failed.

Sometimes there seemed little choice but to push to try to stay at work. Resting was not an option, the kids had to be fed, dropped off and picked up from school etc.

In this example the pain won in the end and Emma was tired out, depressed, upset and had given up fighting with her pain.

  EXAMPLE 2  
  •  Some people manage very little and stop an activity at the slightest hint of pain in order to avoid over activity and ‘making things worse’.
  • If such people begin to feel pain earlier and earlier in the activity this may stop them from participating at all.

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Jim did more on good days. He wanted to get things done when the pain was less, activity was not so hard and he had more energy. It was a chance to shop and garden.

Sometimes he got away with doing quite a lot of things, but it usually ended up having a bad day the next day, or a few days later.

He would rest and recover until the pain eased when he started overdoing it again.

For Jim the pain was very much in control. When the pain was less he did more and when the pain was more, he did less.

As time went by he seemed to be able to do less and less each time he had a good day.

Jim couldn’t plan ahead because he didn’t know how he would be feeling.

   EXAMPLE 3  
 
  • Often patterns of activity develop as people try to manage their pain.
  • Life must go on, and day-to-day activities have to be done.
  • People may say they have little choice and that they feel trapped or controlled by the pain.

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Sasha said she couldn’t carry on trying to beat the pain.

The good day/bad day cycle was too much of a roller coaster.

She avoided doing much for fear of flaring-up her pain.

She didn’t do much but at least she felt she could keep on top of it.

But she had a poor quality of life, wasn’t able to do much, had little fun and often her mood was low.

She also felt a lot less fit and was tired when she tried to do anything.

How to manage your activity

  • It is better to take a balanced approach to your activities, so you don’t burn-out or become completely inactive.
  • You need to take an active interest and involvement in the management of your pain; breaking the vicious circle of feeling worse and doing less.
  • Some people may feel pain almost all the time; it is there in the background. When it gets worse and flares up, they find it difficult to cope.
  • It is important that you spot the things that are making it worse and find ways to make this happen less often. Learning what to do when your pain is worse will also help, so that it does not add to the problem and end up making things worse.
  1. Choose exercises you enjoy e.g. weights, yoga, walking, swimming etc
  2. Consider some aerobic exercises in all programs e.g. walking, swimming etc.
  3. Some discomfort with exercises is acceptable
  4. Avoid exercises which causes pain to continually increase or spread down arms or legs
  5. Start slowly and consistent across days
  6. Don’t do more on good days and less on bad days
  7. Slowly pace up the exercises by increasing exercises volume before intensity
  8. Consult your physiotherapist if you are not sure

Suggestions

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a. Plan how you intend to start an activity and how long you will do it for. Just as an athlete

in training you can then gradually build this up to a level which you are happy with. This pacing of your exercises helps you to introduce things in a controlled and responsible manner.
b. Set yourself positive goals which are realistic, specific and measurable you will begin to see how you are progressing.
c. Prioritise your activities so that you are achieving things in the order that you would like to. Also if you are finding things difficult
d. then you can have finished the tasks most important to you.
e. Exercise whenever possible, this will not only keep you fit and take your mind of things, but may also help you feel better.

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Doing too little or too much both can increase pain. So the solution is to pace your activities so you don’t ever do too little or too much.

Setting daily goals on, say 30 minutes walking, can be very useful. You do this 30 minute walk every day, and this does not depend on how much pain you are feeling on that day (remembering that persistent pain is not ‘useful’ pain as it is not related to any ongoing inflammation or tissue damage).

Your body will get used to normal activities and these in time will become easier and more comfortable to do. Think of the knock-on effect on your mood and confidence. It can only improve, right?

Slowly and steadily you can increase the baseline activity level. In this example, to perhaps 35 minutes. Don’t increase too much or too quickly.
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