Chronic Pain Management Service

When living with persistent pain, your priorities can understandably change to focusing more on what needs to be done, rather than focusing on what you would like to do.

This can often mean that you may prioritise the things you need to do over the things that you do for enjoyment. It can be difficult to feel as though you have enough time, or the ability, to do the things that you might want to do. Setting achievable goals to support you to break down activities can be a helpful way to reintroduce valued activities back into your life.

Before writing down your goal, think about the following questions:

• Is your goal something rewarding/valued to you personally? For example, it is not focused on the needs of  someone else
• Is it realistic? – In the time that you have given yourself, will you realistically be able to work towards this goal?
• How confident are you with setting this goal?  It is good to gauge this out of 10, with 10 being  extremely confident and 1 being  no confidence at all in achieving the goal. Ideally, this should be at 5 and above.

Below are some questions to help you start thinking about what is important to you. You can download these questions as a goal setting worksheet to print out and fill in:

• The first short-term goal I will achieve is
• When do I start? set yourself a start date and a proposed end date
• Who can help me? List family members, friends and co-workers who can help you meet your goals. Preferably have at least 1 person who will encourage you if the going gets tough:
• What resources will I need to meet my goal?
• What possible obstacles could get in my way?
• What will help me overcome any obstacles?

The goal ladder below is a nice visual aid to help you work towards your goal.  Write your goal at the top of the ladder and use the rungs below to break down the steps you might take towards your goal.

It is very common for people with persistent pain to have difficulties with sleep. This can be getting off to sleep, disturbed sleep or not feeling rested after sleep. There are different stages of sleep. Our body and mind recovers, heals and rests in the deeper stages of sleep. When someone has persistent pain their nervous system is sensitised making it harder for that person to go into a deep sleep. 

The circadian rhythm is your body's internal body clock and when properly aligned, it promotes restorative sleep. When the circadian rhythm is out of sync, it can contribute to sleep problems. Applying good sleep hygiene (focused on sleep behaviour and your environment) can help optimise the circadian rhythm, thereby increasing the likelihood of good sleep. The following points are some healthy changes that can make a difference to your sleep and wellbeing:

• Spend some time in natural light during the day
• Try to maintain your levels of activity during the day
• Avoid stimulating food or activities 6-8 hours prior to bed (food, alcohol, screen time)
• Stick to a regular routine (waking up, eating and bed time,)
• Take part in relaxing, calming activities prior to bed
• Ensure your bedroom environment is cool, quiet and dark

There is more information on the Sleep Council website, or see this sleep document regarding pain and sleep.

Pacing is not always about doing less. Sometimes, it is good to think of pacing in terms of how much energy you have to use during the day, and how is the best and most efficient way to use this. Most people fall into one of two categories: either doing too much or doing too little. There can be consequences of either overdoing or underdoing activities that you did not intend to occur. For example, it can bring about, a flare up of your pain, or mean that you’re unable to do the things you want to do. You may have noticed that a flare up can take days or even weeks to settle back down. During this time, you are likely to be less physically active, meaning you may be missing out on enjoyable activities, having time out of work and being unable to complete daily tasks that are important to you.

When your experience of pain settles, it is not uncommon to feel tempted to catch up on the activities you might have missed whilst you were managing an increase in your pain. This increase in activity can itself contribute to a flare up, repeating this cycle again. We use the term ‘boom-bust cycle’ to describe this pattern.

It can be helpful to see how active / inactive you are by keeping an Activity Diary. Using a diary can encourage us to be reflective about the amount of activity that we are actually doing each day. When you have an idea of your energy levels throughout the day, you can start putting strategies in place to manage this better.

The Traffic Light System Tool can also be a useful tool to help categorise certain activities to help you pace them throughout the day. This tool helps you categorise your activity levels into:

• “Activities that definitely make your pain worse, or make you feel more stressed / agitated” which are marked as RED activities
• “Activities that are borderline and vary” which are marked as AMBER activities
• “Activities that don’t make your pain worse, or make YOU feel better” which are GREEN activities

The most effective way of managing energy levels is for your day to have a combination of all 3 of these throughout the day.

We will all have some tasks that are classed as a red activity, however if your day is all red activities then this will likely impact your experience of pain. If we approach red tasks in combination with green activities this can help you to manage your pain by balancing out the types of activity you are doing throughout the day.

The activities you do should be performed to your personal tolerable pain levels. This means it will vary between individuals and you should only go as far as is reasonably comfortable for you. This may include slower and smaller movements. If you are unsure on what activity to do or how much, please speak to a health care professional first. 

Have you ever been told to “relax” or “just breathe”?

Our breath is the one automatic bodily function that we have conscious control over. We hold a lot emotion in our breath, for example, you may ‘gasp’ in shock or hold your breath when in pain. It is also common to breathe shallowly when you are in pain, triggering the sympathetic nervous system further. Tapping into our breath as a form of relaxation has been shown to boost the parasympathetic nervous system, which in turn can help your pain experience.

Here are a variety of relaxation techniques, all of which are aimed at slowing us down. Some are breathing orientated, while others involve visualisation and muscle relaxation.

Full video

Diaphragmatic breathing

 Square breathing

 5 Finger technique

 Progressive muscle relaxation

Heartmath breathing

Guided imagery and visualisation

Mindfulness of breath

There is significant evidence to suggest that maintaining a level of activity is part of good pain management. This does not have to mean going to the gym or out for a run, activities such as chores around the house or looking after others are all tasks that use our muscles and joints.  When we become less active our bodies decondition (see picture below) and this can amplify our pain. Over time, our nervous system can become more sensitive to movement so physical tasks become more of a struggle. Most people will say that they are less active now but their pain has still worsened.

It doesn’t really matter what form of activity you do, any movement is good.  For example, studies have found that housework chores can burn up to 315 calories an hour. Tai chi, although a more formal type of activity, has been found to reduce pain and increase function and mood for those who experience persistent pain. You can try Tai Chi for yourself as we have created two videos, one that is a warm up, that is practised on our pain management programme, and should be done first, and one that uses the form from our tai chi class. Some prefer a more structured approach like these seated exercises or static exercises like in this poster from Versus Arthritis.

If you are unsure of what activity to do or how much, please speak to a health care professional first. It is normal to experience some discomfort when doing exercises, and individuals may start at different points. Pain should not increase excessively during or immediately after the activity. Discomfort should return to pre-activity levels 24-48 hours after the activity has finished.

These exercises/activities should be performed to your personal tolerable pain levels. This means it will vary between individuals and you should only go as far as is reasonably comfortable for you. This may include slower and smaller movements.

The evidence suggests that a multifactorial approach to managing chronic pain is much more effective than one treatment alone. Unfortunately, medicines alone rarely offer more than a modest reduction in chronic pain but they do have their place. It is important to ask yourself “what are my medicines doing for my pain?”

Below are a selection of videos explaining the role and use of different medications in managing chronic pain.

Patient experience

Paracetamol

Anti inflammatories

Neuropathic pain

Opioids

If your goal is related to going out more or building confidence, below are some links for local groups that may be helpful.

The WELLIES Project

Therapeutic learning activities with animals, plants, creativity and the countryside for people recovering from mental ill health. Therapeutic learning activities with animals, plants, creativity and the countryside for people recovering from mental ill health.

Age UK Friendship services

Age UK and our partner charity The Silver Line offer free telephone friendship services so you can enjoy chatting with someone over the phone, all from the comfort of your own home.

Whether you’d like to speak to someone every week, or just want to talk when the need strikes, we’re here to help.

Midlands Partnership University NHS Foundation Trust Wellbeing & Recovery College

The Wellbeing and Recovery College provides recovery-focused education courses that are accessible to everyone in our local communities. We work together to create an environment of hope, control and opportunity for us all.

Staffordshire Connects

Staffordshire Connects is a social support hub for activities, support, and advice for people in Staffordshire

Everyone Health Staffordshire

Commissioned by Staffordshire County Council, we are here to help with every aspect of health, fitness and wellbeing, with all of our FREE programmes proven to have long term benefits. Commissioned by Staffordshire County Council, we are here to help with every aspect of health, fitness and wellbeing, with all of our FREE programmes proven to have long term benefits.

Live Life Better Derbyshire

Whether you want to feel fitter, lose weight or quit smoking we're here to help the people of Derbyshire to Live Life Better. Whatever your goal, you'll be amazed how a little extra support and advice can make a big difference.