Managing Pain

Pain Scale for FM & MPS

Very Important: This is the pain level that is experienced AFTER taking the daily medication prescribed by your doctor.

0 ~ Pain free

1~ Very minor annoyance -mild aches to some parts of the body. No pain medication needed.

2 ~ Minor annoyance- dull aches to some parts of the body. No pain medication needed.

3 ~ Annoying enough to be distracting. Over-the-Counter pain relievers (such as Naproxen Sodium, Acetamonophen, or topical treatments such as Absorbine or Arthritis Pain relieving rubs) take care of it.

4 ~ Can be ignored if you are really involved in your work, but still distracting. Over-the-Counter pain relievers remove pain for 3-4 hours.

5 ~ Can't be ignored for more than 30 minutes. Over-the-Counter pain relievers help somewhat (bring pain level from 5 to a 3 or 4) with pain for 3-4 hours.

6 ~ Can't be ignored for any length of time, but you can still go to work and participate in social activities. Stronger painkillers (such as Ultram) relieve pain for 3-4 hours.

7 ~ Makes it difficult to concentrate, interferes with sleep. You can still function with effort. Stronger painkillers (such as Ultram) are only partially effective. (Stronger pain killers bring pain from a 7 to 4-6.)

8 ~ Physical activity severely limited. You can read and converse with effort. Stronger pain killers (such as Ultram) are not effective. (Narcotic pain killers do bring this pain down to a level 3 or lower.)

9 ~ Non functional for all practical purposes. Cannot concentrate. Physical activity halted. Panic sets in. (Narcotic Pain killers bring the pain level from 9 to the 4-6 level.)

10 ~ Totally nonfunctional. Unable to speak. Crying our or moaning uncontrollably - near delirium.

About Pain

The good news is ... YOU already have the power within you to reduce your pain.

DISCOVER on this web site……………….. The many wonderful ways of managing and reducing pain yourself, which will free up your energies for enjoyment and fun, putting you back in control.

AND/OR

GO ON……………. A Pain Management Course at a local hospital (ask your doctor for details of your nearest Course).

Even though we can’t promise you a cure, the ideas and methods on this web site will show you how to reduce and manage pain in a natural way. We aim to improve your lifestyle and well-being through information and support.

All of the methods suggested on this web site can be used
alongside conventional medicine.
They will enhance the effect of any treatment you may be having.

The Pain Gate

Pain levels vary from time to time throughout each day. The Gate Control Theory of Pain (Melzack and Wall) does much to explain why this happens. The theory uses the idea of a gate, which can be open to allow pain messages through, or shut to stop pain messages being passed to the brain. The gate also opens and closes in response to messages sent from the brain.

Activities That Can Open the ‘Pain Gate’ and Increase Pain
Overdoing activities	Depression
Poor Posture	Indecision
Poor Diet	Stress
Tension	Tiredness
Concentrating on the pain.	Anxiety
Small quantities of stimulants, such as tea, coffee and alcohol.	Fear
Activities That Can Close The 'Pain Gate' and Reduce Pain
Hypnosis	Exercise
Massage	Laughing
Pacing your activities	TENS machines
Being enthusiastic	Meditation
Having a positive attitude	Visualization
Rubbing the area that hurts	Feeling joyful
Distracting your attention from the pain	Good posture
Even certain foods are said to have the potential to reduce pain	Relaxation

How do I talk with my doctor or nurse about pain?

1. Speak up! Tell your doctor or nurse that you're in pain. It is not a sign of personal weakness to tell them about your pain. Pain is a common medical problem that requires urgent attention. So don't be embarrassed or afraid to talk about it.

2. Tell your doctor or nurse where it hurts. Do you have pain in one place or several places? Does the pain seem to move around?

3. Describe how much your pain hurts. On a scale from 0 to 10, zero means no pain at all and 10 means the worst pain you can imagine. In the past week, what was the highest level of pain you felt? When did you feel it? What were you doing at the time? When did it hurt the least? How bad does it hurt right now?

04. Describe what makes your pain better or worse. Is the pain always there, or does it go away sometimes? Does the pain get worse when you move in certain ways? Do other things make it better or worse?

5. Describe what your pain feels like. Use specific words like sharp, stabbing, dull, aching, burning, shock-like, tingling, throbbing, deep, pressing, etc.

6. Explain how the pain affects your daily life. Can you sleep? Work? Exercise? Are you able to do activities with family and friends? Can you concentrate on tasks? How is your mood? Are you sad? Irritable? Depressed? Do you feel unable to cope?

7. Tell your doctor or nurse about past treatments for pain. Describe any medical treatments you've had such as medication or surgery, and mention other approaches you've tried. Have you done massage, yoga or meditation? Applied heat or cold to the painful areas? Exercised? Taken over-the-counter medications, or supplements such as vitamins, minerals, and herbal remedies? Tried other treatments? Explain what worked and what didn't.

Tip: Write down your questions for the doctor or nurse before an appointment. People often get nervous and forget to ask all their questions. Take notes so you can review them later. If possible, bring along a family member or friend to provide support, help take notes, and remind you of what was said.

Flare-up Plan

At flare-up time you need a plan of action already in place
so you will know what to do.

If you haven't already started learning some Survival Skills,
such as diaphragmatic breathing or relaxation, etc.
- check them out and begin today.

Your Flare-up Plan

1. Firstly - don't panic!

2. STOP what you're doing and take charge of the situation.

3. Tell yourself, ‘STOP all those negative thoughts. I am in charge here. I know what to do. I can cope with this situation with my Flare-up Plan.’

4. Your breath is the key to pain relief. Slow, regular breathing from the abdomen is calming and relaxing. It helps to release tension and pain.

Try the Pain Reliever below, and during the routine, remember to breathe slowly and deeply into your abdomen and, as you breathe out, imagine all the pain flows out with your breath. Pain Reliever STOP what you're doing - bring your attention to your body.

Check round your body for tension.

Breathe in healing energy.

Breathe out tension and pain.

Enjoy the feelings of peace and of being in control...and smile on the out breath.

Focus on the positive aspects of how to help yourself.

Change negative thoughts into positive thoughts.

Acknowledge that you may feel bad, but you know it will pass and you can cope.

Repeat affirmations - read or make affirmation cards. Use them hourly.

Be patient.

Stop battling.

Accept the situation and allow it to take its course.

Go with it…………..drift through time…………..time heals.

Prioritize your tasks.

Pace yourself.

Break up tasks into small segments.

Rest in between.

Cut down activities until the flare-up settles.

Be kind to yourself.

Say ‘no’ to any excessive demands upon you until you are feeling better.

Make time for extra relaxation, visualization and/or meditation sessions.

Find suitable tapes.

Talk yourself through the situation and identify your fears.

Write them down and rationalize them.

Talk it over with someone else - talk to your friends at Pain SUPPORT.

Only go to bed if absolutely necessary and if the pain is so severe that you just can't stay up.

Lie down for no longer than 18-24 hours.

Bed rest weakens muscle strength rapidly (you lose about 1% of total muscle strength a day), leaving you weaker when you get up, able to do less and more likely to make the pain flare up again faster.

If you do decide to go to bed for 24 hours, keep yourself mobile with gentle stretching exercises.

Have hot baths if they help to ease the pain.

Use alternate hot and cold ice packs on the painful area if you find it helpful.

Always cover the packs with a towel so you don't burn your skin.

Try 3 minutes with the packs alternately, about 3 times in all.

Finish with a cold pack if there is inflammation.

Don't use cold packs for longer than 20 minutes at a time.

If it is your back that hurts, try taking the pressure off by resting face down on the floor with your arms by your sides.

Lie like this for as long as is comfortable and until the pain subsides a little.

AND/OR

Lie on the floor with your bottom near a chair.

Put your legs on the seat of the chair so your thighs are at a right angle with your body to relieve the pressure on your lower back.

Avoid resting too much and keep as active as you can.

However, don't be proud - accept any offers of help from family and friends for tasks that increase the pain or that you can't do for the moment.

Begin a gentle exercise regime as soon as you can.

Try to stay involved in the day to day activities in your household.

If you feel like crying - cry.

If you feel angry, release the emotion by shouting your feelings
into a pillow and thumping it.

Try not to focus on the pain or talk about the pain constantly.

Focus on what you CAN do and
not on what you can't do.

S - M - I - L - E ………………. Even if you don’t feel like smiling,
when you deliberately place a smile on your lips
you will pass messages of peace and calm around your body.

TALK to your friends.

After the Flare-up has Settled

Review the flare-up as you come out of it to learn what you can from it.

Find out what you need to adjust or alter to avoid a flare-up in the future.

Make notes of ways of dealing with future flare-ups.

There always will be flare-ups, they are, unfortunately, a fact of life.

Now you know how to deal with them.

Emotions

When you have pain it’s common to sometimes be
overwhelmed with negative feelings - anger, fear, resentment, etc.

It’s perfectly normal to have both positive and negative feelings.
There's nothing wrong with having negative feelings.

However, it’s important to be able to express
those feelings in a constructive way...

Feelings that are not expressed stay inside, causing tension and further pain, they give us no peace.

Learn to respond to situations, not react emotionally.

Remember, it isn’t the other person or situation that upsets you - you upset yourself - you make yourself angry, anxious or upset. It’s not someone else’s fault. Realizing this gives you more control. You can’t change other people, you can only change yourself.

Heightened emotions cause the Stress Response which produces adrenaline and increased pain. (see the Stress page)

Other ways to Deal with Emotions

1. Your thoughts create your feelings. Change your thoughts and you change your feelings. Concentrate on the positive aspects of your life. Think happy thoughts and you will be happy.

2. Write your emotion on paper. Pour your anger, frustration, anxiety on to the paper. Don’t read what you have written. Destroy the paper safely when you have exhausted your emotion in the writing.

3. Imagine all the unwanted emotional energy flowing out of you down your arm and into a stone. Now throw the imaginary stone far away from you into a river where it will be washed clean of the unwanted feelings. Enjoy the relief.

4. Brush off all the unwanted emotional energy but flicking your hands all around your face, head and as much of your body that you can reach. When you’ve flicked away the negative energy, soothe yourself as though you are stroking ruffled feathers or fur. Start at the top and work down. Enjoy the calmer feelings you now have.

5. Let out all the emotion with a sound. Take a deep breath and make an ‘aaaaahhhhhhhhhh……..’ sound with your mouth wide open. Continue with the sound until your breath has gone. Feel the vibrations throughout your body. Repeat three times.

6. Ground yourself by letting your feet sink deep into the ground beneath you. Connect with the earth - be like an oak tree, anchored into the earth itself. Feel secure, calm and safe, like the oak, as storms break all around you.

7. If you feel like crying - cry. If you feel angry - beat up a pillow.

8. Change a negative mood as quickly as you can with a positive action.

Foster Positive Emotions

Be aware of any fleeting feeling of pleasure - maximize it, and treasure it.

At the end of each day ‘treasure your pleasures’ - write down all the little happy or pleasing events from the day, however small.

Make sure you actively enjoy an activity at least once a day. Ask yourself every day, ‘What am I going to do to enjoy today?’

Indulge your senses. Enjoy favorite food, drink, sights, fragrances and touch sensations.

Be compassionate towards yourself - and others.

Talk about your feelings -
with family, friends, counselor, doctor, self-help groups, etc.

Pain Patient's Bill of Rights

You have a right to:

Have your pain prevented or controlled adequately.

Have your pain and pain medication history taken.

Ask how much pain to expect and how long it might last.

Have your pain questions answered freely.

Develop a pain plan with your doctor.

Know what medication, treatment, or anesthesia will be given.

Know the risks, benefits, and side effects of treatment.

Know what alternative pain treatments may be available.

Sign a statement of informed consent before any treatment.

Be believed when you say you have pain.

Have your pain assessed on an individual basis.

Have your pain assessed using the 0=no pain/10=worst pain scale.

Ask for changes in treatments if your pain persists.

Compassionate and sympathetic care.

Receive pain medication on a timely basis.

Refuse treatment without prejudice from your doctor.

Seek a second opinion or request a pain care specialist.

Your records upon request.

Include family in decision making.

Remind those who care for you that pain management is part of your diagnostic, medical, or surgical care.

- 1992 Jane Cowles, Ph.D. -