Chronic Pain Management Strategies

Chances are if you are reading this, you are dealing with chronic pain. The presence of this pain has taken a toll on your on your lifestyle, your relationships, your job performance, your self image and your self esteem. It may have become difficult to enjoy life at all under these circumstances. At The Fibromyalgia Circle of Hope, the goal is to help others regain some control in your life, to feel less of a victim of your circumstances and to limit the impact of chronic pain on your sense of well being. Trying together to learn more effective ways of coping with pain. It is often difficult to find hope during periods of suffering, and in a system that may have left you feeling down. While we cannot cure our pain, we can try to reduce it so that we can increase more good days in our lives.

PHYSICAL MANAGEMENT OF PAIN 

The focus is on the specific attention given to your body movements. Slow and steady is the key! Beginning with what you can do without causing pain. A slow and steady manner to a comfortable maximum from which you can continue on a daily basis.

PURPOSE 

1) To promote sense of well-being, physically and mentally.

2) Can increase the ability to cope with stress and tension.

3) Increase muscle strength that leads to less joint pain and increases the muscle. The muscle will then require less oxygen and therefore you exert less effort.

4) Muscle activity facilitates the release of endorphins.

How to maintain Physical Fitness

1)Gear exercise schedule into your personal daily routine.

2) Balance activity and rest.

3) Plan ahead for daily activities.

4) Learn to set priorities.

GENERAL GUIDELINES

Proper Breathing Technique :  Breathing should be slow and controlled. DO NOT hold your breath while exercising. This can cause increase in blood pressure, dizziness or lightheadedness.

Warm Up and Stretching :

Warming up allows the heart to adapt to performing exercises by allowing a gradual increase in heart rate and facilitates a shift of blood from the trunk to the working muscles of arms and legs. Proper Stretching is important to maintain flexibility and minimize injury with exercise. Stretches should be comfortable. You should not feel you are straining . Stretches should be static and held for 10-30 seconds. NO BOUNCING. Stretches can be done throughout the day.

COOLING DOWN: Cooling down gradually decreases the heart rate after exercise and allows redistribution of blood to the trunk, preventing blood from pooling in your hands and feet which can lead to a decrease in blood pressure. Cooling down should last 5-10 minutes. 

EXERCISE: I know how hard it can be to exercise or walk when when in pain. Start SLOW.  Just 5 minutes of moving or stretching can make a difference!

Avoid overdoing. If you experience additional pain while doing any exercise, stop and talk to your health care provider. Only follow the number of recommended repetitions to avoid overdoing. 

Stretching

1) Reduces muscle tension and makes the body feel more relaxed.

2) Increases flexibility (range of motions)

3) Prevents injuries such as muscle strains.

4) Makes strenuous activities easier as it prepares the muscles for work.

5) Develops body awareness.

6) Promotes circulation after sitting or standing for prolonged period of time.

Guidelines for Proper Stretching

• Ease gently and slowly into the stretch and release it gradually afterwards.
• Keep breathing. Do not hold your breath.
• Stop where you feel a good sensation of stretch. Do not force it. As the muscle slowly releases, you may increase the stretch. 
• Do not bounce.
• Hold upper body stretches 15 seconds, lower body stretches for 30 seconds.
• Repeat each stretch twice.

Flexibility Tips

Warm up before you stretch by:

• Take a warm bath or walk briskly in place for 2-3 minutes.

Stretch to the point of mild discomfort  

• Hold for 10-20 seconds, slowly release.
• Repeat 3-5  times

Breath normally while stretching.

• Inhale at the beginning of exercise.
• Exhale while you hold the stretch.

DO :                                             

•  Wear loose clothing.
•  Take pain medication 1/2 hour before you stretch. Dosage and frequency as prescribed.
•  Stretch often.

DON'T : 

• Bounce when you stretch, this can hurt muscles.
• Stretch to the point of pain, if it hurts, ease up.
• Stretch right after meal.
• Hold you breath while you stretch.
• Stretch without warming up.

WALKING

Benefits: 

• Improve endurance, strength and well being.
• Improves the body's efficiency in utilizing oxygen during exertion.
• Lowers the resting heart rate and blood pressure 
• Increases efficiency of the heart and lungs. 
• Improves circulation to the body, including muscles, tendons and ligaments.
• Enhances lubrication of joints, flexibility and strength. Stiffness and lack of strength aggravates existing pain.
• Burns excess calories

( It is important to wait 1 to 2 hrs. after eating before starting your program. This allows time for your body to digest the food and increase blood flow to your arms and legs.)

Beginning your walking program:

• Do pre-walking stretches, two for arms and two for legs. (The distance and speed that you walk will depend on your present level of exercise and general activity. It is better to start off slowly.)
• Now assess how you feel. Are you fatigued or short of breath? If you are, then you have gone too far. There is a difference between being tired after the walk and feeling fatigued. Being tired is OK but feeling fatigued is not.
• The next day, assess how your muscles feel. If they are sore, only walk half as far as the day before. It is still recommended that you continue activity even if you are a little sore.
• If your muscles are not sore you can walk a little longer, perhaps 5 minutes more. 

Continue at least 3 times a week and if possible more often. You may increase your distance and time only id you do not have any undue fatigue or pain following your walk.

Remember: You do not have to walk 30 minutes the first week or even the first month. Your body will benefit just by starting a regular routine of walking.

TIPS FOR GETTING A GOOD NIGHT'S SLEEP 

Sleep/Wake Routine:

• Decide on a regular time to go to bed and a regular time to get up. Try to get up at the same time every morning, regardless of what day of the week it is or when you went to the night before. This helps your body establish a regular sleep/wake cycle. Eventually it ill help you feel sleepy at the same time each night.
• Avoid daytime naps, which tend to fragment sleep at night. If you must nap, keep it to no more than 20 minutes.

Sleep Environment:

• make sure your sleeping conditions, including your bed, are as comfortable as possible. Keep your bedroom as quiet and as dark as possible. Ideal room temperature for sleeping is usually about 65 F.
• If you are sharing your bed with a snoring or restless partner, make temporary sleeping arrangements until you re-establish a satisfactory sleeping pattern.
• Reserve your bed for sleep and sex only.

Pre-Bedtime Routine:

• Avoid too much mental stimulation during the hour or so before bedtime. Don't finish your office work or discuss family finances with your spouse, for example. Instead, consider reading, watching a relaxing TV program, taking a warm bath, listening to  calming music, or, if you're hungry, eating a light snack.

If you're a bedtime "worrier", try using another time of day to outline problems and possible solutions.

EXERCISE:

• Try to get some exercise daily, such as walking or gentle stretching. It can help reduce stress-related insomnia. Avoid exercise within 2 hrs. of bedtime, as a stimulation makes it difficult to fall asleep.

Sleep-Disturbing Substances:

• Avoid eating a lot or drinking a lot of liquids before going to bed.
• Avoid chocolate ( it has caffeine) or any foods that upset your stomach.
• Avoid alcohol after dinner. When it wears off during the night, it may cause periods of wakefulness.
• Cut back on caffeine-containing beverages ( coffee, tea, soft drinks)
• and medicines( some pain relievers, such as Midol and Excedrin also contain caffeine). Avoid caffeine- containing products completely within 6 hrs, of bedtime. Some people may need to eliminate caffeine entirely.
• IF YOU CAN"T FALL ASLEEP:
• Do not force yourself to stay in bed, worrying about getting to sleep. After a half hour or so get up and pursue some relaxing activity until you feel sleepy.

REMEMBER THAT IT MAY TAKE 2-4 WKS.OF FOLLOWING THESE SUGGESTIONS BEFORE YOU NOTICE ANY IMPROVEMENT IN YOUR SLEEP. IF YOU STILL HAVE DIFFICULTY SLEEPING AFTER THAT PERIOD OF TIME CONSIDEPAIN CHARTS:   

PAIN CHARTS:

PAIN SENSATION- The actual feeling of the pain you are experiencing.

 (stabbing, throbbing, aching. burning, tightness)

0 -  No Pain. Pain free

1- 4  Functional. The pain is present. It does not get in the way. No effecton my daily activities and my life.

5- 7  Uncomfortable. Hard to move, cannot concentrate. Impacting my abilities. Affects my daily activities and my life.

8- 9  Severe. Not able to leave my home. Unable to do anything. I am in Bed. High Effect on my daily activities and my life.

10  Unbearable. Out of Control, Overwhelmed. Cannot tolerate the excruciating sensation. Seeking Immediate Attention ( Urgent care/ Emergency Room.

PHYSICAL IMPAIRMENT-  How much does the pain impact your physical abilities?

0 -  Fully Functional. Highly productive, able to work, able to exercise regularly. Attending social activities regularly, maximum physical functioning. PAIN DOES NOT IMPACT FUNCTIONING AT ALL.

1- 2 Highly Functional. Able to work, part-time to full time, can accomplish more than one physical task, attending to responsibilities around the house. Basic social activities, stretching, basic exercises, regularly PAIN IMPACTS FUNCTIONING VERY LITTLE.

3- 4 Functional. Able to perform light household activities, worlk out of the house , laundry, do dishes, simple errands. PAIN IMPACTS FUNCTIONING AT TIMES. 

5-  7 Somewhat Functional. Able to independently perform basic activities of daily living (preparing simple meal, making the bed, getting the mail) PAIN IMPACTS FUNCTIONING MOST OF THE TIME.

8- 9  Non-Functional Able to go to the bathroom on your own, perform basic grooming/bathing with some assistance. In bed most hours of the day, bedridden. PAIN IMPACTS FUNCTIONING ALL OF THE TIME.

10  Completely Disabled. Hospitalized, Care Facility. Completely dependent on others to assist with any functional mobility. ( going to the bathroom, grooming, basic needs)

EMOTIONAL DISTRESS- The current negative emotions you are experiencing ( anger, frustration, depression, sad, irritated)

0 -  No distress.

1-  4 Functional. The distress is present. It does not get in the way. No effect on my daily activities and my life.

5-  7 Uncomfortable. Hard to think, cannot concentrate. Impacting my abilities. Affects my daily activities and my life. 

8-  9 Severe. Not able to leave my home. Unable to do anything: I am in bed. High effect on my daily activities and my life.

10  Unbearable. Out of control, Overwhelmed. Cannot tolerate the excruciating feelings. Seeking Immediate Attention. ( Urgent Care/ Emergency Room)

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