Being grateful won’t make pain disappear but can make it much easier to live with by
releasing suffering, changing perspective, and boosting mood.
 
Ways to practice/build gratefulness:

• Say thank you
• Make a list of things/people you are grateful for
• Journal your blessings
• Start and end each day with a grateful thought
• Write thank-you letters
• Look for the good in everyone and everything
• Stop whining and complaining
• Give compliments
• Smile – share the joy
• List your strengths/positive qualities
• Volunteer – help others
• Hang out with other people with similar beliefs – avoid negative people

Before I begin, let me clarify I’m not a trained clinician nor a pain expert.  I share my experience as a pain patient (I tapered off opioids while attending the Mayo Pain Rehabilitation Center – it’s an expectation when you start the program) and my research.  My treatment approach may or may not be right for everyone else. I don’t mean to dismiss anyone’s beliefs or experience. If opioids work for you, so be it. Treatment is a decision between patient and doctor.  
 
Opioids are a hot topic.  In the 1990s, they became the quickest and least expensive treatment option for chronic pain.  Then came the opioid crisis and a hard push to reduce opioid use.  More recently, there is a movement to de-stigmatize opioids.
 
Bottom line for me
While opioids are appropriate for acute pain, there’s no quick fix for chronic pain.  While some chronic pain patients report short-term improvement with opioids, there is a question of when do the risks exceed the rewards.

• There aren’t any conclusive long-term studies showing the effectiveness of opioids in relieving pain or restoring function.
• Observational studies have found that treatment with long term opioid therapy is associated with poor pain outcomes, greater functional impairment, and lower return to work rates.
• Extended use of opioids can make people more sensitive to pain – a condition called hyperalgesia – and lead to the chronification of pain.
• Higher opioids doses have been tied to more health care utilization.
• Opioid use come with risks:
  • Side effects – including drowsiness, dizziness, nausea, vomiting, and constipation
  • Tolerance – needing more of the drug over time to get the same benefit 
  • Dependence – not being able to stop the medicine without severe symptoms
  • Addiction – compulsively seeking out the drug
  • Other complications – including anxiety, depression, and respiratory failure

 
It isn’t fair to ask chronic pain patients to lower or stop opioids with little or no tapering and no alternative treatments.  If the decision is to reduce or stop opioid therapy, tapering should be done with oversight and alternative treatment.  Chronic pain patients shouldn’t be expected to abruptly stop opioid therapy.
 
If used, opioids should be prescribed at the safest lowest dose and be used as part of a comprehensive pain management plan, including non-opioid medicines and non-biomedical therapies like ACT, CBT, relaxation training, exercise, and other coping strategies. 
 
More research is needed about all sorts of pain treatment.
 
Sources
Barnett, M. L. (2020). Opioid Prescribing in the Midst of Crisis — Myths and Realities. New England Journal of Medicine, 382(12), 1086-1088. doi:10.1056/nejmp1914257 https://www.nejm.org/action/showPdf?articleTools=true&fbclid=IwAR0k_gaCI6MDzN8r-N33UwWqyIC8IqmPEjRwdnzl3LGbO2UAbHLFHIBw880&downloadfile=showPdf&doi=10.1056/NEJMp1914257&loaded=true
 
Busse JW, Wang L, Kamaleldin M, et al. Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. JAMA. 2018;320(23):2448–2460. doi:10.1001/jama.2018.18472 https://jamanetwork.com/journals/jama/fullarticle/2718795
 
Chou R, Deyo R, Devine B, Hansen R, Sullivan S, Jarvik JG, Blazina I, Dana T, Bougatsos C, Turner J. The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain. Evidence Report/Technology Assessment No. 218. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2012-00014-I.) AHRQ Publication No. 14-E005-EF. Rockville, MD: Agency for Healthcare Research and Quality; September 2014. https://doi.org/10.23970/AHRQEPCERTA218. https://effectivehealthcare.ahrq.gov/products/chronic-pain-opioid-treatment/research
 
Morasco BJ, Yarborough BJ, Smith NX, et al. Higher Prescription Opioid Dose is Associated With Worse Patient-Reported Pain Outcomes and More Health Care Utilization. J Pain. 2017;18(4):437-445.doi:10.1016/j.jpain.2016.12.004 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376359/

Khomula EV, Araldi D, Bonet IJM, Levine JD. Opioid-Induced Hyperalgesic Priming in Single Nociceptors. J Neurosci. 2021 Jan 6;41(1):31-46. doi: 10.1523/JNEUROSCI.2160-20.2020. Epub 2020 Nov 17. PMID: 33203743; PMCID: PMC7786210.
Stannard C. Where now for opioids in chronic pain? Drug and Therapeutics Bulletin 2018;56:118-122. https://dtb.bmj.com/content/56/10/118
 
Turner JA, Shortreed SM, Saunders KW, LeResche L, Von Korff M. Association of levels of opioid use with pain and activity interference among patients initiating chronic opioid therapy: a longitudinal study. Pain. 2016;157(4):849-857. doi:10.1097/j.pain.0000000000000452 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939796/

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".

[Updated: 10/14/21 with new research link.]

​People with chronic pain often do too much when they’re having good days and not
enough when they’re having bad days.
 
Pacing/moderation has become a common tool for people living with 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.  

Pain doesn't mean harm. It's the result of an overly-protective system trying to protect itself. Our bodies become over-sensitized. 
 
Pacing should instead be used to gradually increase what we can do, despite the pain. 
 
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
• 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
• 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

Pain patient neuroscience education improves movement, lowers pain ratings, decreases disability, and reduces catastrophization.

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