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Self-Management

Why Self-Management?

Has chronic pain ruined the quality of your life? Like the person shown in the picture it may be dominating your life affecting your capacity to work and enjoy other activities. Life may be a struggle against the pain and fatigue: it may have become joyless or even meaningless. Relationships with family, friends and your partner may have deteriorated, no longer providing support, instead contributing more pain. You may be feeling useless as you do less at work and home and wondering how you can have the confidence to return to work or do your share of things around the home.
Many people with chronic pain end up feeling frustrated and furious because no-one can tell them what is wrong and no-one seems to be able to fix the problem. Fear about what is wrong and the future can result in lots of worry and sleepless nights. Depression can set in as the pain continues without relief. The character in the picture has a head full of distressing thoughts and is unable to find a solution to the problem but continues to call out for help.

People respond with all sorts of coping strategies to deal with pain and the changes in the quality of their lives. Can you recognize some of your coping strategies?

  • Keep searching for the cause
  • Keep searching for the cure
  • Wait until it goes away
  • Grin and bear it
  • Ignore it
  • Keep hoping it will go away
  • Wait for someone to fix it
  • Keep trying new treatments
  • Keep hoping someone will fix it
  • Wish it weren’t like this
  • Pray for a miracle
  • Carry on regardless

The remarkable part of this whole disaster is that most people feel that they have no choice and continue to use the same coping strategies for months and even years. Instead of finding relief their misery generally grows or they just manage to keep going. The simple message of self-management is that you do have a choice and you don’t have to remain a victim of your pain.

The Medical Model and Self-Management or Self-Healing

Most of us learn from early in our lives that we go to the doctor when we are sick or in pain and that the doctor cures us by diagnosing the problem and providing treatment. This is called the Medical Model because we hand responsibility over to the doctor to work out what is wrong and fix it. Unfortunately, it does not seem to be very effective in managing chronic pain. Patients end up on a medical merry-go-round trying to find out what is wrong and what can be done to fix it. Everyone ends up frustrated and disappointed when there are no answers and the pain continues.

There is a better way to work with Chronic Pain, or pain that continues beyond the normal healing time, which involves you working with your doctor and other practitioners. Sometimes this may be just a physical therapist (physiotherapist, chiropractor, osteopath, feldenkrais practitioner) but will often include a psychologist or counselor, and rehabilitation provider. Some people attend a pain clinic where all these practitioners work together as a team. However, the key to the success of this approach is your participation.


Introducing Self-Management

What seems to be a catastrophe can become an opportunity as you learn the skills of self-management. You won’t have to wait any longer: for the pain to go away, for someone to tell you the cause, or someone to fix it for you. You can learn how to take responsibility for healing yourself. Your doctor and therapists become partners in this healing process, guiding and supporting you. Self-management is just what it says: you will learn how to manage your condition.

This will involve learning new skills and changing old habits. If you think back to a time when you were learning something new, you will remember that you needed to practice what you had learnt and the more practice you did the more skilled you became. The same applies for self-management. You will need to open your mind to learning new ways of perceiving and doing things, and then you will need to practice them. Many people with chronic pain have made self-care a low priority in life and understanding the reasons for this can be an important part of your recovery. A good diet, exercise, relaxation, rest, recreation, time alone, and time with family and friends, are all part of good self-care. Top of page



Where are you now?

  1. Do you do some form of aerobic exercise 5-6 times per week for 20-30 minutes ?
  2. Do you relax or meditate, daily, for 15-20 minutes ?
  3. Do you do mobilizing and strengthening exercises 5-6 times per week for 10-20 minutes?
  4. Do you believe this condition is potentially reversible ?
  5. Have you accepted primary responsibility for healing yourself ?
  6. Are you having a lot of passive treatment ?
  7. Do you rely on medication to reduce your pain and control your mood ?

A “Yes” answer to the first 5 questions and a “No” answer to questions 6 and 7, will help you reverse your chronic pain condition and become a self-manager.

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A Prescription for Self-Management

Just like taking medication, the program works if you follow the prescription, but you will need to try it first to discover the benefits. This prescription gives you an idea of the amount you need to practise each part of the program. With good planning you can find time for it, even with a busy schedule. Make it a habit, like cleaning your teeth, and you will really notice the days you don’t do your program. If you miss your exercises you may notice that you become stiff and if you don’t do your relaxation practice you may become irritated or anxious.

RELAXATION/MEDITATION
Relaxation can take the tension out of life and learning to let go and “go with the flow” leads to inner peace. Muscle relaxation, breathing techniques, visualization and meditation can all provide release and relief. It is the daily practice which produces results.

 
TYPES
HOW OFTEN
HOW LONG
1. AWARENESS Of your muscle tension
Of your self-talk
Of your reactions
As much of the day as possible  
2. PRACTICE SESSIONS Visualization
Breathing Techniques
Muscle Relaxation
1-3 times daily 10-20 minutes
3.CALM BREAKS Calming Techniques
Doing Nothing
3 or more times daily 1-5 minutes

EXERCISE
Exercise is a way of moving out of pain. Exercise doesn’t cause pain when you move with awareness.

AEROBIC
Walking or
Swimming or
Cycling
5-6 times per week
(for getting fit)
4 times per week
(for maintenance)
30-40 minutes

30 minutes
SSS
Stretching
Strengthening
Stabilizing
Daily (for getting fit)
5 times per week
( for maintenance)
10-20 minutes

ATTITUDE

“Belief becomes Biology” (Norman Cousins)

Attitudes (thoughts and feelings) of fear, anger, anxiety, depression, resentment, helplessness, guilt, and so on are expressed in our bodies as tension, pain or illness. Letting go or releasing these attitudes is perhaps the most important part of healing

Be Patient, Persistent, Positive


 

A pessimist can become an optimist as he/she takes charge of his/her life and learns the skills of self-management.

Pessimist
Optimist

OCCUPATION

Feeling good about yourself is the bottom line. Healing can happen when we feel satisfied with our work or role in life. Feelings of self-worth are restored as we find direction, meaning and purpose in life and learn to accept ourselves.


People who Live, Love & Laugh rarely get sick



Obstacles to Self-Management

Many things can get in the way of you learning to manage your condition and heal yourself. Let’s have a look at some of the obstacles.

1. “It Hurts To Move”
Once chronic pain has set in many activities of daily living become painful. The person in pain does less and less because most activities cause pain. The last thing a person in pain wants to do is exercise because exercise causes pain. The secret is in learning how to move without aggravating your condition. Movement is the path out of pain.

2. “I Hate Exercise”
Many people with chronic pain hated exercise before they developed chronic pain. The prospect of exercising their way out of pain does not have a lot of appeal. They will do anything to avoid exercising. They believe that exercise is boring and takes a lot of effort.

3. “I Can’t Relax”
When asked how they relax, many people with chronic pain say that they have never relaxed. They tell me that they like to keep busy and if they stop to relax, all that they can think about is the things which still need to be done. There is never enough time to do what they expect to do.

4.
“I can’t get off the merry-go-round”
People with chronic pain can end up on the medical merry-go-round when they are searching for the cause of their pain and a cure for it. For those receiving compensation for a workplace injury or a car accident, there are endless visits to specialists for the insurance company, their lawyers and seeking opinions for themselves. Their lives can become consumed by medical appointments and visits to their treating practitioners. Each doctor or practitioner may refer them on to someone else and they find that they can’t get off the merry-go round.

5.
“ I Am Scared To Take Responsibility”
Whilst people treat pain as something purely physical, it is seen to be in a mechanical body which is not functioning properly like a car that’s will not working. The car is taken to the garage to be fixed by the mechanic just as a malfunctioning spine is taken to the doctor or chiropractor to be fixed. It is as though it does not belong to the person and just needs a repair job to fix it. To allow for the possibility that pain is more than a physical problem, that what we are thinking and feeling influences the pain, is to begin to own the problem. This is not saying that the problem is “in the mind” but that the mind and body are not separate, they communicate constantly. You can play a part in your healing by learning more about the relationship between the mind and body. Taking responsibility gives you the power to heal yourself.


Goals for Self-Management of Chronic Pain

  1. More involvement in all aspects of life
  2. More mobility, strength, fitness and ease of movement
  3. More physical and mental relaxation
  4. Better balance between activity and rest - pacing yourself
  5. Better understanding of pain
  6. Less reactivity to pain
  7. More self-awareness
  8. More self-acceptance
  9. Less worry, fear, anger, frustration and depression
  10. More peace, joy and happiness
  11. Less medication
  12. Fewer visits to the doctors
  13. Fewer visits to other health care practitioners
  14. More play and pleasure
  15. More purpose in life

LESS PAIN

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