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Explaining Chronic Pain: Key to the Posters

The System

People in pain frequently become involved in a complex system. The poster illustrates this system which includes: home (family and friends); work (co-workers, supervisor, management, union); treatment and investigations (doctors, physiotherapist, psychologist, occupational therapist, chiropractor, naturopath, pain clinic...); and compensation and litigation (insurance company, solicitor, conciliator...). Unfortunately members of the system frequently have competing agendas and the power struggles which result leads to chaos. Loss of control and powerlessness can be experienced by all members. The person in pain looks to the members for support, comfort, explanations and solutions but may experience the opposite: hostility, disappointment, criticism and disbelief. The question “Who is helping?” needs to be asked.

No Responsibility Model
Pie charts illustrate the typical response to injury in the workplace: light duties, investigations and treatment OR rest, investigations and treatment. The injured worker is not invited to take responsibility for recovery and thus the system creates VICTIMS.

Shared Responsibility Model
In this model the injured worker takes at least 50% of the responsibility for recovery through developing self-management techniques.

Chronic Pain Cycle

This model attempts to explain the puzzle of chronic pain. Simple falls and minor car accidents can result in chronic debilitating pain syndromes. Investigations do not reveal tissue damage which can explain the severity and widespread nature of the pain instead we need to look at a more complex explanation incorporating physical, psychological and social factors as contributors to the syndrome.

The injury itself can be a result of physical stressors (car accident, lifting injury, over-use injury) but these often occur in the context of emotional stress (conflict, time urgency, perfectionism, excessive demands). Indeed emotional stress alone may cause pain. Pain is experienced by a person not just a body and the person reacts to the pain according to what they are told, their past experiences, the meaning of the pain and the treatment they are given. Unfortunately, a cycle of negative thoughts and feelings can develop which leads to a pain sensitisation state (pressure and movement, previously not painful, become painful). The body then reacts to this pain sensitisation with muscle tension, postural changes, guarding and restricted movement. The person in pain becomes inactive and unfit which leads to more pain and the cycle is complete.
Once the cycle has begun it continues independent of the injury. As well as the person’s reactions, pain causes reflex muscle spasm and some pain sensitisation occurs simply from having chronic pain. There are important consequences of the model: physical treatment, alone, fails; psychological treatment, alone, fails; passive treatment, alone, fails; beliefs become reality; and self-management is essential.

Attitudes To Pain

People react to pain in ways which can actually amplify their pain. Learning to change a reaction (automatic) into a response (conscious choice) can transform a person’s experience of their pain. The characters on the poster depict the different attitudes people have to their pain. Avoidance, resistance, helplessness and hopelessness tend to open the pain gate or amplify the pain. Acceptance, curiosity, courage and patience tend to close the pain gate and reduce the pain. If a person becomes aware of the ways they react to pain they can then make a choice about ways they could respond instead. The poster demonstrates how reactions (reaching for pain killers, rushing to the doctor or physio) can be replaced by actions (relaxing, moving gently...). Similarly, reactive thoughts (I’ll never get better, I can’t stand it...) can be replaced by responses (It’s temporary, I can handle it...). The poster emphasizes the importance of a person’s relationship to their pain. When a reaction is turned into a response pain relief will follow. As the pain becomes less bothersome more activities become possible and life becomes enjoyable.

Self-Management of Pain

This poster depicts the self-manager who says:

“ I am in control, I am organised, I can heal myself.”

The self-manager holds a clipboard to represent organisation and a wand to represent the inner healer or potential for self-healing.

The four aspects of the self-management program are:

Relaxation, Exercise, Attitude, Occupation

Attitude permeates the whole program, attitudes to relaxation, exercise, occupation, pain, disability, and the system, determine how successful the program becomes. Learning to live in the present is a way of letting go of emotional baggage which keeps the person trapped. A pessimist can become an optimist when the opportunity for self-development is realised.

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, visualisation and meditation can all provide release and relief. It is the daily practice (10-20 minutes or more) which produces results.

Exercise is a way of moving out of pain. Learning to move with awareness takes the person beyond the obstacle of exercise causing pain. Aerobic exercise (5-6 times weekly) and SSS (stretching, strengthening and stabilising) daily, are an essential part of the path out of pain.

Occupation can provide a reason to get well. Feelings of self-worth are restored as the self-manager finds direction, meaning and purpose in life.

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