Notes from the pain management workshop, week 1

A few months ago I signed up for the “Living Well with Chronic Pain” workshop that’s put on a few times a year by my HMO. It’s a six-week course that meets once a week. I figure it would be helpful to share the key insights from each session here, since I know a lot of my followers have similar issues and would like to benefit as well.

The textbook for the workshop is Living a Healthy Life with Chronic Pain. It also comes with a pain-management exercise audiobook on CD.

Most of the members of the workshop are, unsurprisingly, retirees with various geriatric or generally age-related issues, but there are a few folks around my age who are primarily recovering from injuries or managing the symptoms of various chronic conditions. As far as I am aware I am the only attendee there due to chronic overuse injuries. But the actual subject matter under discussion is mostly on the day-to-day management strategies independent of medical treatment and so forth. Basically, it’s a complementary course intended to help with the neurological issues that perpetuate chronic pain as opposed to finding specific treatments for underlying physical symptoms.

Most of this first week was a discussion about where chronic pain comes from; primarily it’s due to the brain getting so used to physical pain signals from whatever conditions there are that it stops being able to differentiate normal stimulus from pain stimulus, and chronic pain in particular is embodied by a very vicious cycle of fatigue, stress, and anxiety.

We were asked to share some of the problems we have because of our pain. A very common refrain was people not being able to do the activities they wanted to, or always being tired but unable to sleep and the various emotional problems of always being sucked dry by pain. I’m the only one who specifically mentioned being unable to work (although someone else in the group said he opted for early retirement because of pain) and when I mentioned that I get sensory overload from being overwhelmed by it I saw a few sympathetic nods.

We were told to sit still for 30 seconds with our eyes closed and to focus on our pain, which we would then rate on the 1-10 scale afterward.

Then we were told to count backwards from 100 in counts of 3 (100, 97, 94, etc.) with our eyes closed, and then to rate on the 1-10 scale afterward; everyone’s rating was lower.

As another fun twist, we were then also asked which time was longer or shorter, and most of us felt the second one was shorter or about the same length. They revealed that the second one was actually 45 seconds.

Anyway, the two big actionable things we got this week were self-distraction techniques, sleep hygiene practices (because sleep is one of the biggest keystones of the chronic pain cycle), and the idea of starting on an action plan for self-care and taking control of the situation.

There were two sorts of self-distraction discussed, ones which take mental focus and ones which are based on a physical activity or a prop or the like (taking a walk, watching TV, petting a cat, etc.). They emphasized that mental focus challenges tend to work better. Ones they specifically recommended:

  • Count backwards from 100, 3 at a time
  • Recite the alphabet backwards
  • Sing a song in your head
  • Imagine biting into a lemon

Then they had us work on a self-care action plan, namely to come up with a thing you want to do (most people opted for something exercise-related, myself and one other opted to improve our sleep hygiene) and take a first step towards accomplishing it. A good action plan has:

  • A specific thing to do, that you are in control of
  • Specific days and times to do it
  • At least 70% confidence in successfully pulling it off

My action plan for the next week is, on Monday, Wednesday, and Friday, to get to bed by midnight. (This is something that my bed has been trying to get me to do too but that was just on a vague “better sleep is better” thing, not a “hey maybe you’ll hurt less and feel better if you do.”) Note that the plan isn’t to fall asleep by a certain time, but only to be in bed and under the covers by that time.

Per the syllabus, future topics of discussion will include:

  • Using your mind to manage symptoms
  • Dealing with difficult emotions
  • Better breathing
  • Fatigue management
  • Pacing and planning (this is one I especially need help with)
  • Evaluating treatments
  • Medications for chronic pain
  • Depression management
  • Working with your health care professionals

I’m not expecting any quick fixes from this, of course, but hopefully it will get me back on track and give me the tools I need to be able to do the things I want and need to do again. I miss working on comics, and I need to be able to finish my music and game projects as well. And I also need to be able to make peace with the times that I can’t. Of course I won’t be able to go back to my old life of working inhumanly/inhumanely hard on a dozen things at once, but hopefully I’ll be able to be, you know. Okay.

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