Key techniques for living well with pain

Using cognitive behavioural techniques has been proven to help those living with chronic pain. Here, Frances Cole, Helen Macdonald and Catherine Carus, authors of Overcoming Chronic Pain 2nd Edition, share their advice for living well with pain.

Balancing daily activities through pacing

People living with chronic pain find that pacing is one of the key everyday skills to learn and use. This is so that you can achieve your goals without increasing your pain or letting tiredness force you to stop.

Healthcare professionals and people living with pain use the term pacing, describing it as ‘an active self-management skill where the individual balances time spent on activity and rest for the overall purpose of achieving a gradual increase in the range of tasks, activities and roles over time’. Put another way, it is about choosing when to take a break from an activity without being forced to stop by pain, tiredness or other symptoms, not ‘letting pain be your guide’ or a trigger to stop and rest. Positive changes that people with pain noticed after they learnt the skills of pacing and balancing their range of activities include: sleeping better, more control, less medication and brighter moods.

Being fitter and staying active

Our bodies are designed to move and stay active, even if we have chronic pain. It is possible to make rewarding changes to your activity levels easily, safely and without increasing your pain. Being fitter and more physically active has lots of benefits, and research shows that exercise and activity help with managing moods, like anger and depression, improving concentration, reducing setbacks and improving sleep. Being active helps people achieve their day-to-day and longer-term goals. Gentle physical activity is good even on bad pain days as it helps the brain, the body and the pain networks to cope better.

Sleeping well

Sleeping well with pain is possible, and it can help to lessen the way pain affects you from day to day. Everyone is different in how much time they spend sleeping and how much sleep they need. When we are less active, we need less sleep, but we can feel more tired. Our need for sleep changes with age. Some things to consider:

• Getting into a regular sleep pattern
• Having a regular winding-down routine
• Preparing your bedroom
• Dealing with worries and unhelpful thoughts
• Dealing with sleeping too much

Managing anxiety, worry and fears

People with chronic pain often feel anxious. Pain itself is a threat, and it is normal to find yourself worrying or feeling fearful about many things in life, including changes in yourself and in the pain. Here is a simple four-step guide to manage your anxiety:

• Step 1: Start to notice automatic thoughts and feelings
• Step 2: Explore the unhelpful thinking styles or errors in the list below and notice any automatic negative thinking patterns
• Step 3: Challenge any negative unhelpful thoughts; discover they may not be 100 per cent true
• Step 4: Develop and practise more balanced thinking

Communication and sharing concerns

Living with pain often means having to speak about it, either to give someone information, to ask for help, or to raise a concern. Sometimes, your partner, family and friends feel closer because they are facing problems together with you. They may know exactly when you need help, when you need to be left alone and when you need to talk. Sometimes communication becomes more difficult, or even breaks down. It may feel as if their sympathy has run out, or as though they have never really understood how your pain condition affects you. People are different in how much they talk about feelings and what they want. When someone has long-term pain, there may be a fear of hurting feelings, or getting irritable and frustrated, but there are simple ways to better your communication:

1. Think about your present situation

Are there times when you feel as if others don’t understand what you need?

2. Get ready to talk about it

It helps to be clear and specific about what the issues are that need communication. Once you have decided on the issue, you might want to think how to share it and manage your feelings. It may be that you want to raise a concern or ask someone to do problem solving with you.

3. Talk about it

It is useful to set the rules for the conversation and to have some key ways to open it; for example, ‘I am going to be as open as I can’, or ‘I need you to listen to me, then I will listen to you’, or ‘I want to talk to you because I trust/ respect/love you’. This can minimise unhelpful interruptions and improve active listening.