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.
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• 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​

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) - Dr. Christopher Sletten (22:19) 
• Understanding pain & what to do about it in less than 5 minutes - VA (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 - Lorimer Mosely (5:00)
• Are You Missing Two-Thirds of Your Potential Pain Treatment Plan?  (my article)
• The Truth About Managing Chronic Pain (w/Dr. Rachel Zoffness) - ZDoggMD (1:39:10) ​
• 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

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
 

Updated 3/1/24

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 while reducing fear of exercise and activity.
• 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

• Not all pain management facilities are the same (my blog post)
• Patient Perspective: We Have a Chronic Pain Problem (my article)
• 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?
• Has your doctor referred you to pain management but you’re unsure where to go and what to expect?
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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)

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.

I was recently honored to be a guest on the Compass Opioid Stewardship Program podcast hosted by Dr. Rachael Duncan, PharmD. and Dr. Don Stader.

I'm so grateful for the opportunity and blessed to be able to share my story with clinicians. I'm also thankful for the generosity of Dr. Stader. You'll find out what he offered me at the end of the podcast. It brought me to tears.

You can listen to the podcast episode on Apple, Spotify, and Libsyn via the links below:

• Apple
• Spotify
• Libsyn

Check out the entire podcast series. 

Learn more about the Compass Opioid Stewardship Program.
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