CHRONIC PAIN CHAMPIONS
  • Home
  • Pain truths
  • Pain Quiz
  • Free e-book
  • Support Group
  • Resources
  • Education
  • Blog
  • Think Positive
  • Tinnitus
  • About
  • Connect

My thoughts

Are you tired of trying? Fighting the pain?

1/23/2023

 
Does it seem like everything you do to eliminate the pain doesn't work or becomes less effective over time and you have to do  or take more of it?

Are you hoping the next doctor you see will have the magical cure?

Stop treating the pain as acute
Most conventional and alternative medical treatments, including medicines, supplements, diets, massage, devices like TENS and spinal cord stimulators, heating pads, manipulation, injections, and surgeries treat pain like it is acute - aiming to reduce or manage pain sensations and fix biomedical structures.

While these treatments are typically effective for acute pain, they often have limited success for people living with chronic pain because they ignore the numerous psychosocial contributors to chronic pain.

I found relief from the pain when I changed how I think about it, feel about it, and behave in relation to it. I quit focusing on the pain, fighting the pain, and shopping for a magical medical cure.

Through pain rehabilitation, I learned how to accept the pain and how to self-manage my condition. This process led me to stop the use of medicines including opioids, benzodiazepines, anticonvulsants, muscle relaxers, amphetamines, beta-blockers, antidepressants, and over-the-counter analgesics as well as other passive interventions like supplements and injections for my pain.

I've taken control. You can do the same.

The best 22 minutes to help change your pain experience
Watch this video from Dr. Christopher Slette from the Mayo Clinic Pain Rehabilitation Center (the program I attended). Dr. Sletten explains the differences between acute and chronic pain and the principles of pain rehabilitation. 

Other helpful related links
  • We can't treat chronic pain like acute pain - my blog post
  • Pain rehabiliation works - my blog post
  • Cognitive behavioral therapy for pain - my blog post
  • Self-management resources - my website
  • The Pain Management Workbook - Dr. Rachel Zoffness
  • Mayo Clinic Pain Rehabilitation Center

thoughts are powerful: We aren’t our pain.

11/9/2022

 
It can be easy to become our pain and develop a "fix me" patient mentality.
 
Change your thinking from "I’m a patient in pain" to "I'm a person living well, despite the pain." Change your thinking from "The pain controls me" to "I'm in control."
 
I no longer identify myself by my diagnosis or even as a chronic pain patient. I'm defined by who I am and what I do.
 
I’m Tom Bowen – husband, father, dog father, Iowa Hawkeye fan, clown, friend, author, educator, and pain advocate.
 
I'm not Tom Bowen – neuroma of amputation stump, post-concussion syndrome, tinnitus, hearing loss, fibromyalgia, chronic pain syndrome, chronic fatigue, irritable bowel syndrome, costochondritis, neuropathy, migraine/chronic headaches, sacroiliac joint dysfunction, anxiety, and depression.

I'm in control.
 
Need help changing/controlling your thoughts?
Check out these resources:
  • Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach
  • How Cognitive Control Can Boost Well-Being
  • Replacement Thought Examples
  • Positive thinking: Stop negative self-talk to reduce stress
  • Doing What Matters in Times of Stress: An Illustrated Guide
  • DIM SIM Therapy
  • The Pain Management Workbook
Picture

Do you talk about your pain?

8/11/2022

 
It’s common for patients to talk about their pain levels and treatments with family and friends. Although talking about pain can help us validate our experience, it can actually worsen our symptoms by adding more attention to the pain.

You can’t make positive steps in your life when surrounded by negativity 
Stay away from people who only want to complain about pain, and avoid sharing your pain with others unless there is a positive goal associated with the conversation. Talk instead about things you enjoy and find meaningful. Fill your life with joy and hope!

It’s natural for people to ask about your pain, but you have the power to change the discussion. Thank them for asking but explain that you’d rather focus on something else. Suggest a more life-affirming topic of conversation.

I choose not to talk about my chronic pain to myself or with others, including my doctors (unless there is a new symptom that needs acute treatment).

Learn more
  • Should You Stop Talking About Your Pain? (Dr. Evan Parks)
  • Reducing Pain Talk: Coping with Pain Series (Institute for Chronic Pain)

The importance of forgiveness and gratitude

8/4/2022

 
"Pain is physical AND emotional 100% of the time."
​- Dr. Rachel Zoffness

Pain is an experience with biopsychosocial factors, including our emotions.

Often times, people living with chronic pain can become angry and less thankful. There may even be some perceived misjustice, as was in my case.
 
It can be helpful to let go of the unpleasant emotions like anger, unappreciation, and blame as they can negatively affect the chronic pain experience, disrupt relationships, and worsen our symptoms – turning up the pain volume.
 
While being forgiving, kind, and grateful won’t magically make the pain disappear; they can help lessen the pain and suffering, foster better health, build self-efficacy, and make life more enjoyable.
 
Learn more and learn how
  • How to Forgive in Six Steps
  • Jack Kornfield: 12 Principles of Forgiveness (13:42)
  • The power of forgiveness (3:28) - I saw this while as a patient at the Mayo Clinic Pain Rehabilitation Center
  • A Grateful Day with Brother David Steindl-Rast (5:22)
  • How to let anger out | Thich Nhat Hanh answers questions (9:18) - listen to what he tells a little girl how to deal with anger
  • Taking the Steps to Forgive Yourself
  • Forgiveness: Letting go of grudges and bitterness
  • Control anger before it controls you
  • 10-minute meditation: Loving kindness (10:07)
  • Practicing Gratitude Is More Important Now Than Ever
  • Your 5-day gratitude challenge: 5 exercises to increase your gratefulness
  • How Cognitive Control Can Boost Well-Being
  • Positive thinking: Stop negative self-talk to reduce stress
  • Doing What Matters in Times of Stress: An Illustrated Guide
  • The Pain Management Workbook - I highly recommend this book from Dr. Rachel Zoffness ​
 
Read the research
  • Forgiveness is an emotion-focused coping strategy that can reduce health risks and promote health resilience: theory, review, and hypotheses
  • Forgiveness and chronic pain: a systematic review
  • Forgiveness and chronic low back pain: a preliminary study examining the relationship of forgiveness to pain, anger, and psychological distress
  • Associations between anger and chronic primary pain: a systematic review and meta-analysis
  • Loving-kindness meditation for chronic low back pain: results from a pilot trial

medical cannabis for chronic pain?

7/8/2022

 
Updated 12/1/22
​

Some people find medical cannabis helpful for chronic pain, especially in the short term, but there are questions about long-term effectiveness and safety.  Cannabis wasn’t recommended by Mayo Clinic when I attended their Pain Rehabilitation Center in 2018 nor is it recommended by the International Association for the Study of Pain.

A new systematic review and meta-analysis published November 28, 2022, in the Journal of the American Medical Association, suggests cannabis is no better at relieving pain than a placebo. 

I have found I don’t need medicine or supplements to manage my chronic pain. Of course, your experience may differ. I know mine did earlier in my pain journey. My relief came by changing how I think about, feel about, and behave around my pain with pain rehabilitation using self-management.
 
Learn more
  • Cannabis is no better than a placebo for treating pain – new research
  • Cannabinoid Non-technical Summary 2021 (International Association for the Study of Pain)
  • Cannabis for chronic pain: New research questions its effectiveness
  • International Review finds lack of evidence to endorse clinical use of medical cannabis for pain
  • Cannabis For Smart Consumers: What The Industry Does Not Want You To Know.
  • Beware of supplements (my blog post)
  • We Have a Chronic Pain Problem, Not a Prescription Opioid Problem
  • The power of the placebo effect

Do you have back pain?

7/3/2022

 
Updated 1/28/2023

Back pain can be scary, especially when an MRI finds something abnormal. While they can seem scary, structural findings on a diagnostic scan don’t always equate with pain or are the cause of the pain.

Abnormal MRI findings are normal in people without pain, especially as age increases. Over 50% of 30-year-olds with no pain show signs of disk degeneration increasing up to 80% at age 50 (
Brinjikji, et al, 2015).

And although chronic back pain is a common medical complaint, no specific cause is found in up to 85% of cases with central sensitization as a potential contributing factor (Sanzarello, et al, 2016) along with fear of pain and activity as maintaining factors.

Check out these back facts from OSullivan, et al, 2020:
  1. Persistent back pain can be scary, but it’s rarely dangerous
    Persistent back pain can be distressing and disabling, but it’s rarely life- threatening and you are very unlikely to end up in a wheelchair.
  2. Getting older is not a cause of back pain
    Although it is a widespread belief and concern that getting older causes or worsens back pain., research does not support this, and evidence-based treatments can help at any age.
  3. Persistent back pain is rarely associated with serious tissue damage
    Backs are strong. If you had an injury, tissue healing occurs within three months, so if pain persists past this time, it usually means there are other contributing factors. A lot of back pain begins with no injury or with simple, everyday movement. These occasions may relate to stress, tension, fatigue, inactivity or unaccustomed activity which make the back sensitive to movement and loading.
  4. Scans rarely show the cause of back pain
    Scans are only helpful in a minority of people. Lots of scary -sounding things can be reported on scans such as disc bulges, degeneration, protrusions, arthritis, etc. Unfortunately, the reports don’t say that these findings are very common in people without back pain and that they don’t predict how much pain you feel or how disabled you are. Scans can also change, and most disc prolapses shrink over time.
  5. Pain with exercise and movement doesn’t mean you are doing harm
    When pain persists, it is common that the spine and surrounding muscles become really sensitive to touch and movement. The pain you feel during movement and activities reflect how sensitive your structures are – not how damaged you are. So it’s safe and normal to feel some pain when you start to move and exercise. This usually settles down with time as you get more active. In fact, exercise and movement are one of the most effective ways to help treat back pain.
  6. Back pain is not caused by poor posture
    How we sit, stand and bend does not cause back pain even though these activities may be painful. A variety of postures are healthy for the back. It is safe to relax during everyday tasks such as sitting, bending, and lifting with a round back – in fact, it’s more efficient!
  7. Back pain is not caused by a ‘weak core’
    Weak ‘core’ muscles do not cause back pain, in fact people with back pain often tense their ‘core’ muscles as a protective response. This is like clenching your fist after you’ve sprained your wrist. Being strong is important when you need the muscles to switch on, but being tense all the time isn’t helpful. Learning to relax the ‘core’ muscles during everyday tasks can be helpful.
  8. Backs do not wear out with everyday loading and bending
    The same way lifting weights makes muscles stronger, moving and loading make the back stronger and healthier. So, the activities, like running, twisting, bending and lifting, are safe if you start gradually and practice regularly.
  9. Pain flare-ups don’t mean you are damaging yourself
    While the pain flare-ups can be very painful and scary, they are not usually related to tissue damage. The common triggers are things like poor sleep, stress, tension, worries, low mood, inactivity or unaccustomed activity. Controlling these factors can help prevent exacerbations, and if you have a pain flare-up, instead of treating it like an injury, try to stay calm, relax and keep moving up.
  10. Injections, surgery, and strong drugs usually aren’t a cure
    Spine injections surgery and strong drugs like opioids aren’t very effective for persistent back pain in the long term. They come to risks and can have unhelpful side effects. Finding low-risk ways to put you in control of your pain is the key.
 
Learn more
  • Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations (sourced in article)
  • Central sensitization in chronic low back pain: A narrative review (sourced in article)
  • Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis
  • Back to basics: 10 facts every person should know about back pain (sourced in article)
  • 10 Facts every person should know about back pain. Presented by patients (4:15)
  • Patient Stories Behind the 10 Back Pain Facts Every Person Should Know (9:40)
  • Making Sense of Disabling Back Pain - Peter O’Sullivan Koadlow Lecture 2021 (1:30:29)
  • The Empowered Beyond Pain Podcast (includes several discussions about back pain and back pain myths/facts)
  • Communicating with people seeking help for lower back pain (a quiz for providers but also beneficial for patients)
  • Pain-Related Fear, Disability, and the Fear-Avoidance Model of Chronic Pain
  • Your Back Is Not Out of Alignment
  • Low Back Pain​
  • Central Sensitization Syndrome (CSS) - Dr. Christopher Sletten (22:19) 
  • 3 orthopaedic surgeries that might be doing patients (and their pockets) more harm than good
  • DIM SIM Therapy 

My thoughts about opioid therapy

6/22/2022

 
My most recent article published in Practical Pain Management "We Have a Chronic Pain Problem, Not a Prescription Opioid Problem" explored the efficacy and safety of opioids for chronic pain as well as the need for more pain rehabilitation programs.

Below is some of the original content I submitted that didn't make the published version of the article which helps provide some additional context.


The rise of prescription opioids
In the 1990s and the next two decades, opioid prescriptions became the quickest and least expensive treatment option for chronic noncancer pain.

Their rise in popularity was due to a mix of factors, including:
  • Good intentions to improve pain management.
  • Pain is positioned as the 5th vital sign with a focus on pain intensity.
  • Aggressive, if not, fraudulent pharmaceutical company marketing.
  • incentives based on patient satisfaction.
  • The desire for a quick and easy fix.
  • The structure of our healthcare system and insurance reimbursement.
  • A reduction of interdisciplinary pain rehabilitation programs.

With the increase in opioid use came an increase in opioid use disorders and opioid deaths.  Then came a hard push to reduce opioid prescriptions following the 2016 Centers for Disease Control (CDC) guidelines for prescribing opioids.

The 2016 CDC guidelines indirectly led to many chronic pain patients being forced to lower their medicine doses or to stop them completely. Often with little or no tapering and no alternative treatments offered or covered by insurance. Pushing patients to undergo invasive procedures like injections or surgery. And labeling patients as “addicts” for wanting pain relief. Which all led to increased tension between patients and providers, more patient suffering, illegal drug use, or, even worse, suicide.  

Opioid users don’t know what they don’t know – “try it, you may like it”
Unfortunately, there isn’t a crystal ball when it comes to pain treatment. There's no way of knowing how a patient will respond to any specific type of therapy. And tapering can be hard. Chronic pain patients can be weary of tapering opioids for fear of increased pain and the general fear of the unknown. 
 
Patients need to accept the possibility of worse pain and other symptoms during a taper. It’s also important for providers to remember to treat the entire person in pain and not just manage the taper.
 
Transitioning to self-management built around pain rehabilitation takes time. It’s a marathon, not a sprint, and requires work from both the provider and the patient. It’s like the old joke “How do you get to Carnegie Hall? Practice, practice, practice.”
 
Opioid treatment is a decision between the provider and patient
The use of opioids is a shared provider-patient decision based on risk and reward including the history and needs of the patient and should be applied on a case-by-case basis.
 
If the decision is to reduce or stop opioid therapy, tapering should be done with education about the benefits of opioid reduction and provider oversight. If the decision is to use opioids, they should be prescribed at the safest lowest dose. Either decision should include pain rehabilitation and self-management strategies.

Read my blog post about pain rehabilitation
Find pain rehabilitation programs and self-management resources

Read about my experience at the 3-week Mayo Clinic Pain Rehabilitation Center

Learn more about opioids, pain management, and the Compass Opioid Stewardship Program
Listen to my Compass Opioid Stewardship program interview

Personal note
My chronic pain recovery started after I accepted the pain and stopped doctor-shopping to find pain relief and a medical cure (many praises for the Mayo Pain Rehabilitation Center). Through pain rehabilitation, I learned how to self-manage my condition. This process led me to stop the use of medicines including opioids, benzodiazepines, anticonvulsants, muscle relaxers, amphetamines, beta-blockers, antidepressants, and over-the-counter analgesics as well as other passive interventions like supplements and injections for my pain.

Read my published articles. Hear my story.

6/16/2022

 
  • We Have a Chronic Pain Problem, Not a Prescription Opioid Problem
  • A Letter to Pain Providers: 10 Do and Don’t Tips from a Chronic Pain Patient 
  • Are You Missing Two-Thirds of Your Potential Pain Treatment Plan? 
  • Five things I wish I knew earlier in my journey with chronic pain 
  • Hopping Off the Pain Merry-go-round
  • My Time at the Mayo Clinic Pain Rehabilitation Center 
  • Stop Whining and More No-Nonsense Tips from a Chronic Pain Champion​​ ​
  • Compass Opioid Stewardship - Learning to Champion Chronic Pain

Be kind to yourself

6/15/2022

 
There's still a core you despite the pain.

What you can do
  • Write down your positive qualities and accomplishments – what’s good about you. Sometimes we can be own worst critics.
  • Balance expectations.
  • It’s okay to not be perfect – everything doesn’t have to be in place.
  • Say “no” if you need to.
  • Accept help.
  • Forgive yourself (sometimes we are our own worse critics).
  • Eat healthy.
  • Sleep better with these tips.
  • Talk with your loved ones about your needs and challenges without complaining. We don’t want sympathy, we want understanding.
  • Reward yourself and celebrate your successes, no matter how small.
  • Check out these helpful self-compassion exercises and practices from Dr. Kristin Neff.
  • Read this article "The Role of Self-Compassion in Chronic Illness Care".
Picture

Beware of supplements

6/13/2022

 
Updated 1/2/2023

Did you know?
  • Supplements aren’t regulated by the FDA.
  • China is the main supplier of supplement ingredients.
  • More than 50% of U.S. adults take supplements.
  • Products labeled natural aren’t necessarily safer.

Editor’s note: This article was written based on my experience and what I have researched about the topic.  Everyone is different. The decision to use supplements should be a decision between the doctor and the patient.
 
As part of the multi-day Mayo Clinic fibromyalgia program I attended in 2016, I met with a pharmacist to review the long list of prescription medicines, over-the-counter medicines, and supplements I was taking at the time. My medicine cabinet looked like a GNC store.
 
I was instructed to bring the actual bottles with me to the appointment, so I packed the bottles into a gym bag (yes, I was taking a lot of medicines and supplements) and went to see her.
 
I was surprised as she read each bottle, making comments and recommendations about each pill – including product quality, labeling issues, ingredient safety, and dosing.  
 
When the appointment ended, my medicine and supplement list was much shorter with her recommending stopping most of the supplements and my gym bag much lighter – throwing away the pills was going to stop taking. I kept only one supplement - Vitamin D.
 
Limited oversight
Unlike prescription or over-the-counter drugs, which must be approved by the Federal Drug Agency (FDA) before they can be marketed, the FDA doesn’t review supplements for safety and effectiveness before they are sold.
 
We don’t know where the products are made, how they are made, what is in them, and if the dosage is appropriate.
 
Safety is left up to the manufacturers and distributors of the supplements.  
 
Bottom line
You assume all risk when using supplements.  While some may be valuable, many aren’t and some may even be harmful.
 
Learn more
  • American Roulette — Contaminated Dietary Supplements
  • Natural supplements can be dangerously contaminated, or not even have the specified ingredients
  • Hundreds of Dietary Supplements Are Tainted with Prescription Drugs
  • Dr. Pieter Cohen Explains Dietary Supplements and Regulations
  • What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD
Picture

Stop the pain talk

6/9/2022

 
Do you talk about your pain or complain about it? What do you do if other people ask you about your pain?

Pain talk is a maladaptive pain behavior – worsening symptoms by adding more attention to the pain.
We can't move forward if we're constantly reminding ourselves of the pain or if we 're surrounded by negativity.

I choose not to talk about my chronic pain to myself or with others, including my doctors (unless there is a new symptom that need acute treatment).

Learn more​
  • Should You Stop Talking About Your Pain? (Dr. Evan Parks)
  • Reducing Pain Talk: Coping with Pain Series (Institute for Chronic Pain)
Picture

cognitive behavioral therapy for pain

6/5/2022

 
Our thoughts, emotions, and behaviors can make pain worse or more manageable.

We can change pain and retrain our overprotective pain systems by changing how we think, feel, and behave using a form of biopsychosocial treatment called Cognitive Behavioral Therapy (CBT).

CBT reprograms our minds and bodies to help us feel safe and confident in our ability to manage pain and do the things we enjoy — improving the body’s natural pain relief mechanisms, increasing function, and breaking the chronic pain cycle.

.CBT is based on the core principles that our thoughts, emotions, and behaviors interact together with the pain; that we can become trapped in unhelpful thoughts, emotions, and behaviors; and that we can modify our thoughts, emotions, and behaviors to make our experience more manageable. 

It's what changed my pain experience and my life by giving me tools to:
  • Accept the pain and live in the present.
  • Identify, challenge, and change unhelpful negative thoughts and behaviors.
  • Actively self-manage the pain.

Best yet, CBT is a do -it-yourself therapy. You can use it anytime. You don’t need help from anyone once you learn it. And there are no negative side effects.

Learn more and do more
  • What is CBT?  (McGovern Medical School)
  • ​A Magical Cure for Pain? No – it’s just Cognitive Behavioral Therapy (Dr. Rachel Zoffness)
  • Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach​ (WebMD)
  • Brief Cognitive Behavioral Therapy for Chronic Pain: Patient Guidebook (Department of Veteran's Affairs)
  • How To Use CBT Thought Records To Change The Way You Feel
  • How to recognize and tame your cognitive distortions​
  • 15 Cognitive Distortions To Blame for Negative Thinking
  • Cognitive Restructuring Worksheet (University of Washington)
  • Replacement Thought Examples
  • The Pain Management Workbook (Dr. Rachel Zoffness)
Picture
Image courtesy of McGovern Medical School

Don't count spoons...Recharge!

5/29/2022

 
INSTEAD OF STARTING YOUR DAY WITH A LIMITED NUMBER OF SPOONS, YOU HAVE THE ABILITY TO SELF-CHARGE THROUGHOUT THE DAY TO BOOST ENERGY AND IMPROVE MOOD.
​

Christine Miserandino's spoon theory has become popular with people with chronic pain. It assumes people with chronic pain have only so much emotional and physical energy each day to do the things they want to do.

You start each day with a finite number of spoons. Each spoon represents a unit of energy. As you use up your energy, you take away a spoon. 

While it's a helpful concept to help explain to friends and family who don’t experience chronic pain what it’s like to live with pain, the spoon theory is commonly used by chronic pain patients to plan their days so they don't over-extend themselves.

The problem with the theory: there isn't a way to add more spoons (energy) or to make each spoon last longer than expected.

Therefore, it can be self-limiting - focusing on what we can’t do instead of the things we can and leading us to avoid activities that could make us feel worse but may very well help us in terms of giving us more energy and improving our mood. For instance, we may choose to save spoons by not joining our friends for lunch or going on a much-needed walk.

Recent research "demonstrated that on mornings when patients catastrophized more than usual about their pain in the day ahead, they spent more time in sedentary behavior and engaged in fewer minutes of moderate to vigorous physical activity that day. Cross-day lagged analyses further showed that the effect of morning pain catastrophizing on subsequent sedentary behavior extended to the next day. More time spent in sedentary behavior, in turn, contributed to greater pain catastrophizing the next morning" (Zhaoyang et al 2020). 

Who wants to wake up each day thinking you're limited in what you can do? I tend to see things more positively. 

We have more control over our pain, energy, and mood than we think. 

Another idea: Think of your day like a battery system in a car.

If you don't use a car or if you leave on a car's lights or radio without the engine running, the car battery will eventually run out of energy. But if you drive the car, the alternator will recharge the battery as you drive.
​
Just like a car's battery system, we can add more energy to our days by doing things like:
  • Changing how we think about pain to not be so afraid of it and minimize the suffering
  • Doing self-help activities like deep breathing, tai chi, mindfulness, yoga, and muscle relaxation
  • Playing games and doing hobbies
  • Laughing - Watch a funny movie or TV show and give yourself permission to be silly
  • Getting outside for a walk and enjoying nature
  • Listening to music - Music has an analgesic effect to help us feel better
  • Modifying activities, like using good body posture, to make things easier, not harder
  • Spending time with people who don't drain our energy with pain talk, negativity, and complaints
  • Being grateful - Focusing on what you have, not what you’ve lost

Check out 50 ways to live well, despite chronic pain. 

Note: This is just another tool to add to your chronic pain toolbox. If the spoon theory or another approach works for you, please continue using it. 

PACING ISN’T AN EXCUSE TO AVOID ACTIVITY AND PAIN

5/28/2022

 
People with chronic pain often do too much when they’re having good days and not enough when they’re having bad days.

Chronic pain can cause us to overprotect ourselves. Our natural reaction to pain is to avoid activities that worsen our discomfort or increase our perceived risk of further damage. When we become overly fearful and stop doing things in anticipation of pain, we can make things worse.

Inactivity reduces our functional ability and decreases our strength and stamina. It also prevents us from getting involved in the social, leisure, and work activities we enjoy.
 
Pacing/moderation has become a common tool for people living with chronic pain to help provide them with balance. It includes setting time limits, slowing down (start low, go slow), breaking up tasks, and taking frequent short breaks.
 
But be careful not to let pacing become an excuse for not being active or avoiding pain. Doing so can add more focus to the pain, worsen symptoms, and reduce physical stamina.

Pacing should instead be used to gradually increase what we can do, despite the pain. Stay consistent with your activity. 
 
The difference is in the goal and execution. Keep moving forward.
 
Learn more and do more
  • Activity pacing: moving beyond taking breaks and slowing down
  • The role of avoidance, pacing, and other activity patterns in chronic pain
  • Activity Pacing
  • Pacing and Goal Setting
  • Tools for recovery – Boom or bust vs pacing
  • Pacing For Pain
  • Chronic pain self-management: Pacing and goal setting
  • Goal Setting for Pain Rehabilitation​
  • Pacing – how to manage your pain and stay active
  • What Goals Have You Set Recently? 
  • Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain
  • Activity Pacing is Associated With Better and Worse Symptoms for Patients With Long-term Conditions​
Picture
Picture
Cooper, Booker and Spanswick, 2003

Resilience is important

5/22/2022

 
I just watched a great TEDx Talk from Dr. Trung Ngo about resilience that everyone who lives with chronic pain or treats chronic pain should watch.  

He talks about how there are three types of people:
  1. Those who are victims
  2. Those who are catastrophizers
  3. Those who are resilient

I can identify with all three types during my personal journey with pain. Early in my journey, I was the victim. It was the surgeon's fault for my pain. I was set on making that doctor pay for his mistake and make my pain go away.

As the pain continued, I became the catastrophizer. It quickly became gloom and doom. I become fearful of the pain. I worried about all the terrible things that might happen because of the pain. And I worried about my future and the future of my family. 

Fortunately, my mindset changed to resiliency. Many thanks to the Mayo Clinic Pain Rehabilitation Center for helping me transition to that stage.

How to be resilient
According to Dr. Ngo, the keys to being resilient:
  • Be interdependent
  • Prioritize your own well-being
  • Let go
  • Take ownership

 Learn more
  • 10 Habits of Highly Resilient People
  • How to Build Resilience and Boost Your Mental Health

* Ojala, T., Häkkinen, A., Karppinen, J., Sipilä, K., Suutama, T., & Piirainen, A. (2014). Chronic pain affects the whole person – a phenomenological study. Disability and Rehabilitation, 37(4), 363–371. doi: 10.3109/09638288.2014.923522

Take control

4/28/2022

 
Picture
I love this metaphor about who's driving the car - you or your pain.

Things you can control - Focus on these
  • Understanding how pain works
  • Changing how you think and feel about pain, and how you respond to it
  • Accepting the pain
  • Not being afraid of the pain
  • Being aware of what you listen to, read, and watch to avoid negativity and drama
  • Being kind to yourself and others
  • Taking active responsibility for your care
  • Not verbally expressing or complaining about the pain
  • Not wallowing in the pain
  • Not placing blame for the pain
  • Staying away from people who only want to complain about pain
  • Not sharing your pain with others
  • Reducing stress
  • Eating right
  • Moving more and increasing your activity level
  • Moderating what you do
  • Modifying what you do
  • Being grateful – focus on what you have, not what you’ve lost
  • Developing better sleep habits
  • Preparing for a flare in advance so it doesn’t overwhelm you
 
Things you can’t control - Don’t focus on these
  • Pain
  • Imaging test results
  • Past medical interventions
  • Past painful experiences
  • What other people say or do
  • Weather
  • Cultural and family norms
  • Socio-economic background
  • Demographics (sex, age, ethnicity, etc.)
  • Genetic make-up

We can’t treat chronic pain like acute pain

4/19/2022

 
Picture
If biomedical treatments like medicines, rest, supplements, ice, heat, injections, and physical therapy didn’t resolve pain when it was acute, is it reasonable to expect using only the same treatments to change our symptoms when the pain becomes chronic?

It's not.

We must change the paradigm. Pain is more than a biomedical condition. We need to treat both mind and body. As Dr. Rachel Zoffness reminds us, " Because pain is biopsychosocial, treatment must be, too."

Comprehensive pain treatment that addresses the biopsychosocial aspects of a person's pain experience is not only more clinically effective than conventional medical treatment by itself, it’s also more cost-efficient.

Acute pain vs. chronic pain
There are two types of pain: acute and chronic.

Acute pain is the body’s normal response to tissue damage or injury. The pain matches the damage and treatment works - lasting less than three months.  

Chronic pain is an abnormal response, becomes its own disease/condition, and doesn’t improve over time.  It can happen long after an injury or illness heals. Treatments don’t always work or stop working and symptoms can change and grow over time.

The longer we have pain, the less likely it is related to tissue damage or injury and the better our bodies can become at creating it and turning up the pain volume. It’s a process known as central sensitization. 

Sensitization can happen in all chronic pain conditions, no matter the underlying cause, including fibromyalgia, whiplash, shoulder pain, neuropathic pain, chronic fatigue syndrome, non-cardiac chest pain, irritable bowel syndrome, temporomandibular disorders, post-surgical pain, complex regional pain syndrome, low back pain, osteoarthritis, pelvic pain, and headache.

This 22-minute video from Dr. Sletten with the Mayo Clinic Pain Rehabilitation Center (PRC) does an awesome job explaining pain and sensitization, why traditional medical treatments don’t always work for chronic pain, and their approach at the PRC. I encourage you to watch it.

Learn more
  • We Have a Chronic Pain Problem, Not a Prescription Opioid Problem (my article)
  • Are You Missing Two-Thirds of Your Potential Pain Treatment Plan? (My article) 
  • Central Sensitization Syndrome (CSS) - Dr. Christopher Sletten (22:19) 
  • Central sensitization: implications for the diagnosis and treatment of pain
  • The Truth About Managing Chronic Pain (w/Dr. Rachel Zoffness) - ZDoggMD (1:39)
  • Neuroplasticity​

Picture

video: CENTRAL SENSITIZATION SYNDROME

4/15/2022

 
This is an excellent video from Dr. Christopher Sletten, Clinical Director of the Jacksonville, Florida Mayo Clinic Pain Rehabilitation Center (PRC) that is part of the FEATURED content in my Chronic Pain Champions - No Whining Allowed support group. (The Rochester, Minnesota Mayo PRC is the program I attended.)

Dr. Sletten explains:
  • The differences between acute and chronic pain.
  • Why treatment must be different for chronic pain.
  • How and why central sensitization happens.
  • Why symptoms can change and grow along with the development of more and different triggers for the symptoms.
  • Why traditional medical non-traditional medical physical treatments stop working.
  • Pain isn’t a psychological disorder.
  • The four targets of treatment at the PRC (physical, emotional, behavioral, and chemical).
  • The concept of pain behaviors and how ice, medication, injections, etc. reinforce the pain – adding fuel to the fire.
  • How the PRC can help conditions that are beyond musculoskeletal like POTS and long-COVID.

Find links to the Mayo Clinic PRC and other programs.
Read about my experience at the Mayo PRC.
Picture

23 tips to get the best treatment

3/29/2022

 
My article originally published December 30, 2019 in National Pain Report.
Chronic pain appointments can be difficult for both doctors and patients. 

For patients, doctor visits can be intimidating and create anxiety.  We want validation of our pain, empathy, answers, and support.  
 
For doctors, chronic pain patients can be more challenging to treat than other patients.  We can be demanding of their time, attention, and patience.
 
While they genuinely want to help, doctors often have limited training (typically only 11 hours of pain education in medical school); limited time (typically only 15-20 minutes per appointment); limited options due to government, health system, and insurance guidelines; and limited internal resources to treat chronic pain patients.
 
So how do you make the most of your appointment time and get the best treatment when you visit the doctor?
 
Below are 23 suggestions to help maximize the patient-doctor experience (thanks to the many ideas provided by members of the Chronic Pain Champions – No Whining Allowed Facebook support group):
 
 
In general

  1. Don’t bring any bad experiences you may have had with other doctors in the past to your appointment.  You don’t want to muddy a new doctor relationship.
  2. Go with a stated purpose but don’t go with any pre-conceived expectation about getting a certain treatment or continuing a specific treatment, like opioid therapy, or a specific diagnostic test, like an MRI.  Unfortunately, there isn’t an easy answer for chronic pain.  It’s not like prescribing an antibiotic that will cure an infection.  Most chronic pain doesn’t have a cure.  You may not be able to be fixed.
  3. Let your doctor determine the best course of action.  That is why you’re there.  To get the help you need, not necessarily the help you think you need.  Be open to any suggested treatment recommendations.
  4. Ask your doctor about arranging recurrent appointments (quarterly, etc.) just for pain management as well as scheduling extra time, if needed, for those appointments.
  5. If you’re seeing the doctor about other medical conditions unrelated to your regular chronic pain, don’t talk about pain.  Keep it for your regular pain visits.
 
 
Before the appointment

  1. Make a prioritized list of topics/questions you want to cover at the appointment.  That way you won’t forget things and you’ll stay on topic.  You might also want to practice going over the list and what you want to say to help capitalize on your discussion time at the appointment. 
  2. Draft an alphabetical list of medications (including over-the-counter medications/supplements).  Include the medication name, the dose (such as 5MG), how many pills you take and how often you take them, as well as the name of the doctor who prescribed them.  Include any allergies on this list.  Download this free template.
  3. Put together a medical summary of major health events, medical conditions, surgeries, and special treatments related to your pain condition.  Make it easy to read and keep it short, one- or two-pages so the doctor can get a quick snapshot of your history. Download this free template.
  4. Arrange for a family member or other trusted support person to go with you to the appointment to be a second set of ears and take notes.
 
 
At the appointment

  1. Arrive early with your insurance card and payment method.
  2. Bring your prescription list.  Give this list to the nurse at the beginning of each appointment to help them reconcile your medicines.
  3. Bring copies of your prioritized list of topics you want to cover at the appointment.  Share with your doctor and support person at the beginning of your visit. 
  4. If visiting a new provider, also bring your medical summary and any relevant x rays, CT scans, MRIs, ultrasounds along with their radiological reports.
  5. If you heard something you think might be helpful in your diagnosis or treatment, take time before your appointment to look at evidence-based scientific research that may support it (try searching on Google Scholar) and bring a copy of the research with you to share with your doctor. Be prepared to talk about it.  Don’t say you Googled some information.
  6. Stay non-emotional, calm, and factual.  No drama, whining or catastrophizing about the pain.  And don’t get angry or be rude.  
  7. Talk to your doctor about what is happening in your life and how your chronic pain is affecting it.  Pain isn’t just a number on a pain chart.  It’s a biological, psychological, and social experience.  Talk about your emotions, your ability to work, your relationships, and your ability to do daily activities.
  8. Be specific when describing your pain symptoms.  Tell the doctor when the pain started and how it started, what kind of pain you’ve been feeling (aching, dull, throbbing, sharp, burning, radiating, pins and needles, electrical, numb, etc.),  how often you experience the pain, where the pain is located (lower back, head, etc.), what you’ve done to help reduce the pain (ice, heat, analgesics, etc.), and how successful those treatments have been.
  9. Talk to your doctor about treatment goals.  Once pain becomes chronic, the goal of treatment is often increasing functional ability and quality of life, not pain elimination.
  10. Talk to the doctor about the psychosocial components of pain and recommended treatment.  Opioid pain medicines and other medical interventions aren’t always the best or only treatment options.  Explore comprehensive multidisciplinary pain management and rehabilitation.  Ask about other treatments.  If there isn’t a cure, how can you manage the pain?
  11. Clarify and confirm.  Ask questions if you don’t understand something.  Repeat what you heard to make sure you heard it correctly.
  12. Be respectful.  Listen to what the doctor says and do what they recommend, even if they may involve behavioral changes or other treatments you may have already tried or don’t think are valuable.  If you want them to listen and respond to you, you need to do the same to them.
  13. Be patient as a patient.  It may take several doctor visits and/or different treatments before you recognize improvement.
  14. Be grateful.  Thank the doctor.
 
 
Bottom line
To get the best treatment from your doctor, be prepared, calm, engaged, insightful, and open to self-care.  It’s harder for doctors to treat patients who are negative or expect the doctor to fix all their problems.
 
I hope you find these tips helpful.

Beware of supplements

3/19/2022

 
Updated 12/30/22

Did you know?
  • The FDA doesn't regulate supplements.
  • China is the main supplier of supplement ingredients.
  • Products labeled natural aren’t necessarily safer.
  • Some CBD products are being marketed with unproven medical claims and are of unknown quality.

Editor’s note: This article was written based on my experience and what I have researched about the topic.  Everyone is different. The decision to use supplements should be a decision between doctor and patient.
 
As part of the week-long Mayo Clinic fibromyalgia program I attended in 2016, I met with a pharmacist to review the lengthy list of prescription medicines, over-the-counter medicines, and supplements I was taking at the time. My medicine cabinet looked like a GNC store.
 
I was instructed to bring the actual bottles with me to the appointment, so I packed the bottles into a gym bag (yes, I was taking a lot of medicines and supplements) and went to see her.
 
I was surprised as she read each bottle, making comments and recommendations about each pill – including product quality, labeling issues, ingredient safety, and dosing.  
 
When the appointment ended, my medicine and supplement list was much shorter with her recommending stopping most of the supplements and my gym bag much lighter – throwing away the pills I was going to stop taking.
 
Limited oversight
Unlike prescription or over-the-counter drugs, which must be approved by the Federal Drug Agency (FDA) before they can be marketed, the FDA doesn’t review supplements for safety and effectiveness before they are sold.
 
We don’t know where the products are made, how they are made, what is in them, and if the dosage is appropriate.
 
Safety is left up to the manufacturers and distributors of the supplements.  
 
Bottom line
You assume all risks when using supplements.  While some may be valuable, many aren’t.
 
Learn more
  • Dietary Supplements: What You Need to Know
  • American Roulette — Contaminated Dietary Supplements
  • Natural supplements can be dangerously contaminated, or not even have the specified ingredients
  • Hundreds of Dietary Supplements Are Tainted with Prescription Drugs
  • Dr. Pieter Cohen Explains Dietary Supplements and Regulations
  • What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD
  • Cannabis is no better than a placebo for treating pain – new research
  • Cannabis For Smart Consumers: What The Industry Does Not Want You To Know​
  • Labeling Accuracy of Cannabidiol Extracts Sold Online
  • Medical Cannibis for Chronic Pain (my blog post)

what goals have you set recently?

3/12/2022

 
Chronic pain can make it easy to feel overwhelmed, reduce our activity levels, and become isolated.  Goals help restore a sense of order, build self-efficacy and sense of control, improve mood, and provide direction by helping with planning daily activities.
 
One of the tools we learned at the Mayo Clinic Pain Rehabilitation Center was goal setting to help us plan our days and keep us on track. We set goals each day. They didn't have to be massive, but they had to be SMART - specific, measurable, achievable, relevant, and time-bound.
​
  • Specific – What do you want to do?  What action will you take?
  • Measurable – How will you track progress and know when you’ve reached the finish line.
  • Achievable – Is it something you can do? Do you have the necessary skills and resources?
  • Relevant – Why is it important to you?
  • Time-bound – When do you want to accomplish it?

Some SMART goal examples:
  • Increase my step count by end of week to 5,000 steps a day.
  • Do deep breathing for three minutes three times each day for the next week.
  • Read three articles about cognitive behavioral therapy by end of the week.
  • Plan a social event to visit in-person with friends and family this week.
  • Lose 4 to 8 pounds of weight in the next 30 days.
  • Volunteer 10 hours a week at the community center for the next month.
 
Did you notice none of the goal examples included pain reduction?
Our focus should be on reducing stress, improving our quality of life and increasing functional ability and activity, not pain reduction. Focusing on pain reduction is an easy trap to fall into - leading to frustration and depression.  Just as the homepage of my website says - we can live well, despite the pain. 

Celebrate!
While it's natural to celebrate big goals, be sure to celebrate milestones along the way, as well as smaller victories. These celebrations keep us motivated along the way and help instill confidence.

Resource
  • Goal Setting for Pain Rehabilitation​

Hurt doesn't always mean harm

3/10/2022

 
Pain is the body’s alarm system.  It’s designed to protect us from danger just like a home security system or a smoke detector.  It’s the body’s normal response to acute tissue damage or injury and heals in normally 3-6 months.
 
But what happens when pain doesn’t go away?
 
Once pain persists beyond the normal healing time, it becomes chronic - losing its warning function and becomes its own disease/condition.  It’s an abnormal response (with or without obvious pathology). 
 
Although all pain hurts, not all pain indicates damage. We know what to expect from our pain by the very nature of it being chronic or ongoing.  It’s not like getting burnt, twisting an ankle, or getting stung by a bee that needs protection until the injury has heals.  Of course, any unexpected new pain should be investigated.
 
Learn more
  • Central Sensitization Syndrome (CSS) (22:19)
  • Understanding pain & what to do about it in less than 5 minutes (5:00)
  • A Tale of Two Nails
  • How your brain creates pain – and what we can do about it
  • Tame the Beast – It's time to rethink persistent pain (5:00)
  • Are You Missing Two-Thirds of Your Potential Pain Treatment Plan?
  • The Truth About Managing Chronic Pain (w/Dr. Rachel Zoffness) - ZDoggMD (1:39)
  • Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability
  • Fear-Avoidance Beliefs and Chronic Pain

calm the mind. calm the body.

3/1/2022

 
Pain, stress, and tension are closely related. Muscles tighten and put pressure on nerves resulting in even more pain.

It’s possible to activate your body’s natural relaxation response to help reduce the tension using mind-body tools like:
  • Deep breathing (also called diaphragmatic breathing, abdominal breathing, and belly breathing) – easy to learn and can be done anywhere.
  • Yoga and tai chi – can be modified, if needed, to accommodate individual needs, like chair yoga or tai-chi chih (a simplified version of tai chi).
  • Mindfulness and meditation – require you to redirect your attention.
  • Passive muscle relaxation – mentally relax your muscles from head to toe.
  • Progressive muscle relaxation – actively tense and relax your muscles from head to toe.

Helpful videos
  • Deep Breathing Exercises for Beginners
  • Breathe to Heal | Max Strom | TEDxCapeMay (18:32)
  • Mindfulness
  • ​Passive Muscle Relaxation to Manage Anxiety and Stress (12:40)
  • Progressive Muscle Relaxation to Manage Anxiety and Stress (15:00)
  • ​Tai Chi Chih - Joy Through Movement (50:08)
  • Yoga For Chronic Pain | Yoga With Adriene (25:33)

Free Apps
  • Bellybio
  • Breath2Relax
  • Mindfulness Bell
  • ​The Breathing App
 
FIND MORE TOOLS AND APPS
 

Pain rehabilitation works

2/15/2022

 
Pain rehabilitation goes beyond medicine and medical interventions – and crosses different disciplines. It doesn’t just focus on removing the pain.  It focuses on the patient and how they can play a role in their own pain management - giving them control over the pain instead of letting the pain control them..
 
It’s a proven approach based on the biopsychosocial model of medicine – benefiting patients while reducing costs and reliance on the medical system.  
 
In addition to their general efficacy, these types of programs using interdisciplinary chronic pain rehabilitation can be effective at weaning patients off opioid therapy with long-term improvements in pain, mood, and function.
 
I was fortunate to be able to attend the 3-week interdisciplinary Mayo Clinic Pain Rehabilitation Center – not just once, but twice.  It was both a game-changer and lifesaver for me.  I highly recommend the program to anyone interested in taking an active role in managing their own care.  Read about my Mayo experience in this article.
 
More programs like this are needed to shift the current reliance on biomedical therapy towards a greater reliance on provider-supported patient self-management and true biopsychosocial treatment. .
 
Availability is important but so is accessibility. These programs aren't cheap, and insurance can be hesitant the pay the price tag. What payors need to remember is that these programs are cost-effective with a 68% reduction in medical cost spending.
 
Find links to programs in the U.S. and around the globe.

 
What to look for in a program
A pain rehabilitation program should focus on you as a person, not just your pain.  

Interdisciplinary pain rehabilitation programs that take place in the same facility with health care providers working together with open communication and shared objectives are the gold standard of comprehensive care outperforming medical pain services and less coordinated multidisciplinary programs.
 
A comprehensive pain rehabilitation program typically includes:
  • Medication management – To find the right combination of medicines and taper/stop any unnecessary medications along with better monitoring of patients who are prescribed opioids.
  • Pain education – To help patients better understand the purpose of pain and how best to respond to it – reducing any fears that pain is a symptom of a serious health issue, and that activity will cause more damage.
  • Lifestyle changes – To improve diet and sleep.
  • Psychosocial intervention – To change self-limiting thoughts and provide coping skills using acceptance commitment therapy and cognitive behavioral therapy.
  • Physical therapy/exercise – To build strength and endurance.
  • Occupational therapy – To modify and moderate daily life activities.
  • Relaxation training – To reduce stress on the mind and body – easing the pain experience.
  • Family therapy – To teach loved ones how to help/not help those in pain – encouraging self-efficacy and reducing pain behavior.
 
Learn more about pain rehabilitation
  • Patient Perspective: We Have a Chronic Pain Problem
  • What is a Chronic Pain Rehabilitation Program?
  • On Can't and Able
  • Interdisciplinary Rehabilitation Programs in Chronic Pain Management
  • Interdisciplinary Chronic Pain Management: Past, Present, and Future
  • Focused Review of Interdisciplinary Pain Rehabilitation Programs for Chronic Pain Management
  • Interdisciplinary Chronic Pain Management: International Perspectives
  • Interdisciplinary Chronic Pain Management: Overview and Lessons from the Public Sector
  • Economic Analysis of a Comprehensive Pain Rehabilitation Program: A Collaboration Between Florida Blue and Mayo Clinic Florida
  • Chronic pain affects the whole person – a phenomenological study
  • IASP Pain Management Center – a series of chapters
  • The Resurrection of Interdisciplinary Pain Rehabilitation: Outcomes Across a Veterans Affairs Collaborative
  • A Call for Saving Interdisciplinary Pain Management
  • Evaluation of an interdisciplinary chronic pain program and predictors of readiness for change
  • Predicting Readiness to Attend an Interdisciplinary Pain Management Program: What’s better for Clinical Decision-Making? Clinical Judgment or a Patient Self- Report Questionnaire?
 
Learn more about the Mayo Clinic Pain Rehabilitation Center (PRC)
  • Program information
  • My experience at the PRC
  • Dr. Christopher Sletten explains pain, central sensitization syndrome, and what they do at the PRC (22:19)
  • Dr. Jeannie Sperry explains how the PRC can help those suffering with chronic pain (9:44)
Picture

WE CAN LEARN A LOT FROM A PRO GOLFER

1/22/2022

 
Pro golfers use visualization when they play. They picture the precise shot they want to hit before taking the club back – the trajectory, shape, roll and finish. This puts a positive image in the mind; the body then makes the motions needed to turn the image into reality.

We can do the same with our pain.

We can visualize a different way to view our pain and respond to it. We can visualize living well despite the pain. And we can visualize the pain leaving our bodies or the pain taking a smaller role in our lives.

Try these exercises
  • Audio Meditation - Visualize your Pain​ (9:54)
  • Guided Imagery for Pain Relief (9:55)
  • Guided Imagery Practice For Pain (9:43)

Find links to these and other self-management tools.
<<Previous

    Author

    Tom Bowen is a chronic pain patient who turned into an advocate, educator, and collaborator.

    Categories

    All
    Cognitive Behavioral Therapy
    Featured Resource
    Forgiveness/Gratitude
    General
    Goal Setting
    Moderation/pacing
    Opioids
    Pain Behavior
    Pain Management
    Pain Rehabilitation
    Supplements
    Understand Pain

    Archives

    January 2023
    November 2022
    August 2022
    July 2022
    June 2022
    May 2022
    April 2022
    March 2022
    February 2022
    January 2022

Powered by Create your own unique website with customizable templates.
  • Home
  • Pain truths
  • Pain Quiz
  • Free e-book
  • Support Group
  • Resources
  • Education
  • Blog
  • Think Positive
  • Tinnitus
  • About
  • Connect