Ten Footsteps, Your journey to living well with pain

The information on this page has been adapted from original content from livewellwithpain.co.uk

Footstep 1: What do we know about persistent pain?

Persistent pain is very different from the kind of pain you experience when you touch something hot or injure yourself. It goes on long after normal healing and repair time, and affects different parts of the brain and nervous system.

The best way of reducing pain is to help your mind and brain to turn it down. Read the other nine footsteps to find out how to do this.

Persistent pain can cause a range of problems, including:

• Excitable nerves. Slight pressure can cause unpleasant and painful sensations like pins and needles or electric shocks.
• Sensitivity. Skin, muscles or nerves can be more sensitive to pressure, touch or heat.
• Faulty brain activity. The systems that turn down pain don’t work.
• Low mood. Living with persistent pain can cause strong feelings such as anger and frustration.

Footstep 2: Acceptance

Accepting persistent pain as part of your everyday life is a huge help. Rather than struggling to avoid or reduce your pain, you can learn to observe, understand and accept it. This is not easy – it can be hard to accept that you are not the person you were. However, as you accept things have changed, you can switch your energy and focus to living well.

Things that help with acceptance:

• Slowly adjust how you do things.
• Try to think and view yourself and life differently.
• Patiently shift your focus to what you really want to do each day.
• Learn how to switch your attention from your pain to other things – your breathing, for example.
• Use some techniques from mindfulness, such as mindful stretching.
• Find the best type of support and help.

Footstep 3: Pacing every day for better time

Pacing is taking a break before pain, tiredness or exhaustion force you to stop. Many people use pain to guide their activity levels. On a ‘good day’ they try to get as much done as possible until their pain and tiredness increase, forcing them to stop and rest for much longer. This is called the ‘boom-and-bust’ cycle.

How to pace well:

1. Decide which activities you need to pace. If any daily activities are difficult because of your pain or they cause your pain to increase, they probably need to be paced.
2. Work out how much effort to put into each activity without causing more pain. Reduce your activity so that you stop or take a rest long before you would usually experience pain. Then, steadily build up your body stamina by increasing what you do before each break.
3. Find the balance of activity and rest breaks so if your body is feeling stiffer, more tired or pain than usual, you can adjust the balance. This means you take more breaks, use less effort or go more slowly or change to an easier activity at that time.

Footstep 4: Set goals, action plans and rewards

Goal setting is about focusing on the things in your life that you want to change. Your goals need to be SMART:

SMART goals

S = Specific. State clearly what you want to achieve.

M = Meaningful. The goals really matter to you.

A = Achievable. They require some effort but are not too difficult.

R = Realistic. You can fit them into your life.

T = Time-based. They can be achieved within the next few weeks or a couple of months.

A few examples of SMART goals:

• Read a good book within the next month.
• Pot plants in the greenhouse by the end of the month.
• Try out a new recipe every weekend.
• Go to the next midweek football match with friends.
• Swim and relax in the sauna every week.

Action plans help you work out how to achieve your goal, what you need to do, when you will do it, how often and who else you can involve.

Regular rewards can help you to make progress. Whether big or small, make sure that your rewards are things you really value and make them pleasurable.

Footstep 5: Getting fit and staying active

Fitness is more fun with friends!

Being more active and building fitness can help – even if it was not really part of your life before pain arrived.

Three things are important:

1. Stretching helps loosen tight muscles, ligaments and joints and increases flexibility.
2. Strengthening exercises will build stronger muscles and joints and improve balance.
3. Stamina activities help you to do things for longer without more pain or tiredness.

Things that will help you to get fitter and stay active:

• Create SMART goals and an action plan to guide you (see Footstep 4).
• Find out what’s available in your local area.
• Choose things that are fun and easy to do.
• Enjoy activities with other people.
• Gently increase the amount of time spent doing activities.
• Give yourself regular rewards.
• Tell others about your progress.

Footstep 6: Managing mood

It is normal to struggle with moods when you have persistent pain. People often feel angry, frustrated, fearful and unmotivated because of it.

Here are some things that you can do to manage your moods better:

• Notice negative and unhelpful thoughts, and find ways to balance or soothe them.
• Practise balanced thinking – imagine what a best friend would say if they knew what you were thinking. Ask yourself, ‘Are my thoughts 100 per cent true and believable?’
• Do things that unwind and soothe your mind, such as walking the dog, listening to music and breathing calmly.
• Create a list of positive things you have done that day or week.
• Practise being kind to yourself by pacing and giving yourself pleasurable rewards.
• Learn from others with similar pain issues.
• Find out about self-help resources to manage your moods.
• Share your plans with people you trust and get their support.

Footstep 7: Sleep well more often

Many people with pain find that their sleep is disrupted. New research shows that by adjusting what you do during the day, as well as night, it is possible to achieve a healthier sleep pattern.

Four things are important for better sleep:

1. Your daily routines. Try to go to bed and get up at the same time each day.
2. Your activity levels. Increasing activity in the day can help you to sleep better at night. Take care to avoid energetic exercise shortly before sleep.
3. Your food and drink habits. Avoid caffeinated drinks late in the day and big meals late in the evening. You should also avoid drinking too much before bed.
4. Your bedtime routine. Follow the same wind-down routine every evening and make sure your bedroom is dark and used only for sleep – don’t watch TV or do work in bed!

Footstep 8: Healthy eating, managing relationships and work

Healthy eating
Eating well and having a normal-range weight will help you to build better health and cope well with pain.

There are many things that you can do to help achieve a healthy weight – and they don’t always involve a diet! Ask your doctor or pharmacist for a medication review, as some drugs can contribute to weight gain. Reducing portion sizes, cutting out snacks and switching to a Mediterranean diet can help, too.

Managing relationships
Connecting with others can feel like the last thing you want to do when pain dominates your life. Yet doing things with other people is likely to lift your mood and distract you from focusing on your pain. It can also motivate you to do more of the activities you enjoy.

Coping with work
Staying at work or returning to work gives your life routine, structure and purpose. Here are some tips that can help:

• Think about what needs to happen for you to return to work.
• If you are looking for work, be flexible about what you might do.
• Ask for a phased return starting with just two to three hours per day and building up from there.
• Be prepared to accept any support that is offered at work.

Footstep 9: Relaxation and mindfulness

Unwinding your body and mind can make a positive difference to your life and your pain. We know that relaxation and mindfulness lessen pain levels, reduce stress and improve concentration.

Mindfulness is being aware of your body and mind in the ‘now’. It’s about noticing what you think, feel or want at this moment without being too critical or judging yourself. There is plenty of evidence showing that mindfulness can help us to live better with difficult health problems such as pain.

Like any other skill, mindfulness needs daily practice and guidance to use it confidently. You can learn it from someone who knows about mindfulness, sign up for an internet course or join a local class.

Here are the different types of relaxation that you can practise:

1. Breathing and muscle relaxation. This includes techniques such as ‘belly breathing’ or tightening and then relaxing parts of the body.
2. Refocusing your attention. You can do this by shifting your attention away from your pain using visualisation techniques.
3. Choosing relaxing activities. Anything that helps you to unwind will be good for your pain, such as reading a magazine, listening to music, walking the dog or doing a puzzle.

Footstep 10: Managing setbacks

Setbacks are common while managing pain. Having the confidence to deal with them is a ‘must have’ skill. A setback plan helps you to cope better and reduces the sense of panic that they sometimes cause.

Here are some things that you can include in your setback plan:

• Cut back on normal activities for a few days and take more regular breaks.
• Keep gently active and avoid long periods of bed rest.
• Begin gentle stretching as soon as possible to regain flexibility.
• Practise relaxation or mindfulness breathing.
• Try not to get into negative thinking – tell yourself this is temporary and you have a plan to get back on track.
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Discover more ways to manage pain…

Books

• Overcoming Chronic Pain self-help CBT book, Cole et al, 2005 (ISBN 9781472105738)
• Manage your Pain Nicolas et al, 2012 (ISBN 9780285640481)
• Pain is Really Strange Steve Haines and Sophie Standing, 2015 (ISBN 9781848192645)

Websites

• www.painconcern.org.uk – useful range of videos and sources of help
• www.healthtalkonline.org – people with pain share ways to cope and live well
• www.nhs.uk – for guides to healthy eating, exercise, fitness and a pain toolkit resource
• www.breathworks-mindfulness.org.uk – explores mindful practice with courses and resources
• www.paincd.org.uk – audio resource about ways to living with chronic pain