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A Message from the Coordinator
September 2012

 

 

Self Management of Pain
 
If you were unable to attend the September 13, 2012 Oregon Pain Management Commission Meeting, you missed a great opportunity.
 
In honor of “Pain Awareness Month,” commission members conducted a special education workshop titled “Empowering the Patient through Self-Management of Pain.” OPMC members spent the afternoon sharing their expertise related to the above theme. It is impossible to capture all of the information discussed at this event in a brief message. However, I would like to share a few of the gems that presenters shared.
 
Dr. Catriona Buist discussed the role of behavioral health in the management of chronic pain. She discussed both physical and mental de-conditioning that can develop as a result of chronic pain. When an individual has a painful sensation from an initial injury or tissue stress, they may worry about the cause of pain and its future consequences. The individual may avoid movement and activities (such as work, hobbies, etc.) due to the fear of making the pain worse. This increase in disuse can cause loss of fitness, depression and social withdrawal—all which can cause more pain. More worry about the cause of pain and its future consequences can set the individual into a vicious cycle as noted above.
 
Mental de-conditioning can also occur. An individual has pain, the individual experiences initial psychological distress such as fear, anxiety, worry, etc. The individual may then have the development or exacerbation of psychological problems. Finally, the individual may accept the “sick role” and continue with abnormal illness behavior.
 
In order to effectively self-manage chronic pain and to counteract the mental de-conditioning that can occur, there are three key shifts in perspective that must occur.   
  • The individual must accept the diagnosis of chronic pain.
  • The individual must understand the mind/body connection with regard to pain symptoms. Previous messages about the mind/body connection and pain self-management: http://www.oregon.gov/oha/OHPR/pages/pmc/message/2011-12.aspx and http://www.oregon.gov/oha/OHPR/pages/pmc/message/2011-10.aspx
  • The individual must change (from a passive orientation) to an active orientation regarding self management of pain. If you attended the September event or if you are reading this message with the intent to utilize new information as a tool to manage your chronic pain, you are taking an active orientation.
    Here are some roles in which a psychologist may act to help an individual manage chronic pain. A psychologist may help an individual develop a flare up management plan with self-management tools; may teach stress management (diaphragmatic breathing, self-hypnosis and biofeedback); may help an individual accept their pain and move towards an active orientation of behavior change; may address issues that are barriers to progress (fear of movement, grieving the loss or life changes, anxiety and depression) and may help with relapse prevention.
     
    Participants at the September 13th event actually had the opportunity to practice some stress management techniques. Teresa Keane, Psychiatric/Mental Health Nurse Practitioner, led the audience in practicing diaphragmatic breathing and presented a progressive muscle relaxation exercise. From participant feedback, I can tell you that the audience very much enjoyed and benefitted from these exercises.
     
    To learn more about how you can utilize stress management to assist you in managing your pain, there are free online web resources. At the University of Maryland Relaxation Center website, select audio tapes that will guide you through a variety of stress management tracks, including progressive muscle relaxation and guided imagery: http://www.umm.edu/sleep/relax_tech.htm
     
    Margo Traines, licensed occupational therapist, was another speaker who presented information on pain, occupational therapy (OT) and modifiable life factors. She discussed neuroplasticity: the brain’s natural ability to form new connections in order to compensate for injury or changes in one’s environment. She noted that the rehabilitation effects of OT positively affect the neurochemistry and neuroplasticity of the central nervous system. These positive changes can improve quality of life by affecting sensory and motor function, increasing self efficacy and participation in activities of daily living. Changes can also decrease dependency on medication, decrease suffering, and decrease the negative impact of pain on physical, emotional, psychological and cognitive factors.
     
    An occupational therapist may work with an individual examining the biological, psychological, and social aspects of the person performing occupations of interest, choice and necessity. The occupational therapist will assess an individual’s environment and available tools, ask core questions about modifiable life factors and help design a lifestyle plan to decrease harmful factors. They will try to increase life promoting factors, and increase function, meaning and self efficacy for the individual with pain.
     
    Both Dr. Buist and Ms. Traines discussed an example of a modifiable life factor. They discussed the importance of good sleep and how poor sleep can impact chronic pain. Some of the sleep tips they shared included:
    • Maintain a regular bed and wake time schedule including weekends
    • Assess your sleep routines and habits that are changeable (such as sleeping with a partner or pets, etc.)
    • Establish a regular, relaxing bedtime routine that fits your desires
    • Create a sleep-encouraging environment by assessing your bed and room for sensory input, comfort, access to the bathroom, etc.
    • Workout regularly, but complete workout a few hours before bedtime
    • Avoid nicotine, caffeine and alcohol
    • Assess comfort measures that may be affecting your sleep such as positioning, clothing, water, food, noise, and lighting. 
      Ms. Traines noted that when thinking about how to modify a sleep environment an individual may be able to make a small change even if a big change isn’t possible. For instance, she noted that even if you can’t afford to replace an entire mattress set, perhaps a new pillow or new body pillow will make your sleeping arrangement more comfortable.
       
      If you missed the “Empowering the Patient through Self-Management of Pain” event, I hope that you have found some encouraging information in this message. And if you would like one of the handout booklets that were available at the event, please e-mail your request with your name and mailing address: Dorothy.E.Allen@state.or.us. There are still some booklets available and they will be sent out on a first come, first served basis until they are all gone.
       
       
       
      Kind Regards, 
       
      Kathy Kirk, RN