Customer Reviews

ISBN-13:

9781936693887

Publisher: Bull Publishing Company
Publication date: 05/01/2015
Sold by: Barnes & Noble
Format: eBook
Pages: 340
File size: 7 MB

Sandra M. LeFort, RN, PhD, is a researcher in the school of nursing at Memorial University in Newfoundland, Canada where she teaches in the master’s and doctoral programs. She lives in St. John’s, Newfoundland. Lisa Webster, RN, is the clinical manager of Pain Management Centre at Hamilton General Hospital. She lives in Hamilton, Ontario. Kate Lorig, DrPH, is the director and an associate professor at the Stanford University School of Medicine’s Patient Education Research Center. She lives in Mountain View, California. Halsted Holman, MD, is a professor of medicine at Stanford University School of Medicine. He lives in Stanford, California. David Sobel, MD, MPH, is the director of patient education and health promotion at the Kaiser Permanente Medical Care Program, Northern California Region. He lives in San Jose, California. Diana Laurent, MPH, is a health educator at the Stanford University School of Medicine’s Patient Education Research Center. She lives in Palo Alto, California. Virginia González, MPH, is a health educator at the Stanford University School of Medicine’s Patient Education Research Center. She lives in San Jose, California. Marian Minor, RPT, PhD, is an assistant professor in the department of physical therapy at the University of Missouri. She lives in Columbia, Missouri.

Read an Excerpt

Living a Healthy Life with Chronic Pain

By Sandra LeFort, Lisa Webster

Bull Publishing Company

Copyright © 2015 Bull Publishing Company and The Board of Trustees of the Leland Stanford Junior
All rights reserved.
ISBN: 978-1-936693-88-7

CHAPTER 1

Overview of Self-Management and Pain

Nobody wants chronic pain in their lives. Unfortunately, about 30 percent of people worldwide live with chronic pain conditions, many of which have no identifiable cause. We wrote this book to help people explore healthy ways to manage and live with their chronic pain condition so they can enjoy more fulfilling, satisfying lives.

This may seem like a strange concept. How can you live a healthier, happier life when you are hurting? To answer this, we need to explore what happens with most chronic health problems. Whether it's heart disease, diabetes, depression, or any of a host of others, the conditions that cause chronic pain also cause fatigue, loss of physical strength and endurance, emotional distress, and a sense of helplessness or even hopelessness. A healthy way to live with chronic pain is to work at managing the physical, mental, and emotional problems caused by the condition. The challenge is to learn how to function at your best even with the difficulties pain can present. The goal is to achieve the things you want to do, to get pleasure from life, and to be as healthy as possible. That is what this book is all about. Before we go any further, let's talk about how to use this book. It is not a textbook; in fact you might want to think of it as a workbook rather than as a traditional book. You do not need to read every word in every chapter. Instead, we suggest you read the first two chapters and then scan the table of contents to find the specific information you need. Read the sections that feel most relevant to your situation. Feel free to skip around and to make notes right in the book.

You will not find any miracles or instant cures in these pages. What you will find is hundreds of tips and ideas to make your life easier. This advice is from physicians, psychologists, physical therapists, registered nurses, and other health professionals who specialize in working with people in chronic pain. It also is from people like you who have learned to positively manage their own chronic pain.

Please note that we said "positively manage." If you have chronic pain, there is no way to avoid managing it, but there are different ways to approach it. If you choose to do nothing but sit and watch TV all day, that is one way of managing. If you rely on medication alone to manage your pain, that is another management style. But the management style we advocate in this book is different from these two approaches. This book teaches you to be a positive self-manager by being proactive about your pain and working with your health care professionals. We believe that if you adopt this positive management style, you will live a healthier life.

In this chapter we begin by discussing the importance of being your own self-manager and the self-management skills that will help you successfully live with your chronic pain condition every day. These skills are useful not just for chronic pain management but for the management of any chronic disease condition. This is good news because people often have more than one chronic condition. Learning these key self-management skills will allow you to successfully manage not just a single condition but your entire life. After introducing the basics of self-management, we then go on to define pain and discuss the difference between acute and chronic pain. We also cite the most common problems experienced by people with chronic pain and provide a list of resources so you can learn more about pain.

Understanding Your Role as a Self-Manager

The first responsibility of any chronic pain selfmanager is understanding your condition. This means more than learning about pain and what you can do about it. It also means carefully observing how chronic pain and its treatment affect your physical and mental health and how it affects those around you. With experience, you and your family will become experts at this.

Your second responsibility as a self-manager is communicating your unique situation, experiences, and preferences to your doctor and others on the health care team. They need to know how you are feeling and how the pain is impacting all aspects of your life. In other words, to effectively manage your condition you must be an observant person who communicates openly with his or her health care providers.

When you develop a painful condition, you become more aware of your body. Minor symptoms that you ignored may now cause concerns. For example, you may wonder is this pain in your arm a signal of a heart attack? Is this pain in your leg a sign that you should stop exercising? Is your pain spreading to other parts of your body? Does the pain in your back signify something more serious? There are no simple, reassuring answers to questions like these. Nor is there always a fail-safe way of sorting out serious signals from minor, temporary symptoms that can be ignored.

Even though chronic pain can be unpredictable, it is helpful to be aware of the natural rhythms of your particular condition. Chronic illnesses usually wax and wane in intensity. Symptoms do not follow a steady path. Most times, chronic pain is like that too — although sometimes you may feel as if it's all a downward path and the outlook is bleak. In general, you should check with your doctor if symptoms are unusual or severe. You also should contact your doctor if symptoms occur after you start a new medication or treatment plan.

Throughout this book we give specific examples of what actions to take if you experience certain symptoms. However, you should not rely solely on the information in this book. Partnership with your health care provider is critical. Self-management does not mean going it alone. Get help or advice whenever you are concerned or uncertain.

Think of self-management like this: Both at home and in the business world, managers direct the show. But they don't do everything themselves. Managers work with others, including consultants, to get the job done. What makes them managers is that they are responsible for making decisions and making sure those decisions are carried out.

As the manager of your chronic pain condition, your job is much the same as any other manager. You gather information and work with a consultant or team of consultants consisting of your physician and other health professionals. Once they have given you their best advice, it is up to you to follow through.

In this book, we describe many self-management skills and tools to help you address the problems of living with your condition. We do not expect you to use all of them. Pick and choose. Experiment. Set your own goals. What you do may not be as important as the sense of confidence and control that comes from successfully doing something proactive to deal with your situation.

Whenever we try a new skill, our first attempts may be clumsy, slow, and show few results. When this occurs, it is often easier to return to old ways than to continue trying to master new and sometimes difficult tasks. The best way to master new skills is through practice, perseverance, and thoughtful evaluation of the results. Always keep this in mind as you develop effective self-management skills for your chronic pain condition.

Self-Management Skills

Throughout this book we examine ways of of the essential management skills you need to breaking the cycle of chronic pain illustrated in learn in order to live a healthier, more satisfying Figure 1.2 on page 13 and overcoming feelings life with your chronic pain condition. Table 1.1 of physical and emotional helplessness. A first lists these important skills. step in the right direction is becoming aware of the essential management skills you need to learn in order to live a healthier, more satisfying life with your chronic pain condition. Table 1.1 lists these important skills.

Perhaps the most important skill of all is learning to respond to your chronic pain on an ongoing basis in order to solve the daily problems associated with your condition. After all, you live with your condition 24 hours a day; your health care provider sees you only a tiny fraction of that time. This means that you are primarily responsible or managing your chronic pain. (See Chapters 4 and 5.)

Some of the most successful self-managers are people who think of their chronic pain as a journey or a path along life's way. Sometimes this path is flat and smooth and you can travel along with few problems. At other times the way is rough, and you must slow down to think about your next move or to take a rest.

To negotiate this path one has to use many strategies. Good self-managers are people who have learned three types of skills:

* Skills to deal with chronic pain. Chronic pain, like any health condition, requires that you adapt and do new things to deal with it. These may include practicing relaxation and stress reduction techniques regularly, monitoring your pain levels in order to balance activity with rest, and learning specific exercises and developing a physical activity program. Your condition may mean you may have more frequent interactions with your health care providers. You may need to take medications or treatments on a daily basis. All chronic pain conditions benefit from day-to-day self-management skills.

* Skills to continue a normal life. Chronic pain does not mean that life stops. There are still household tasks that need to get done, friendships to maintain, work to perform (whether you have a job or do volunteer work), and important family relationships to nurture. You just may need to learn new skills or adapt the way you do things in order to maintain the things you need and want to do in your life.

* Skills to deal with emotions. When you are diagnosed as having a chronic pain condition, your future changes. With these changes come changes in plans and changes in emotions. Many of the new emotions are negative. They may include anger ("Why me? It's not fair"), fear ("I am afraid to move my body in case I hurt myself"), depression ("I can't do anything anymore, so what's the use?"), frustration ("No matter what I do, it doesn't make any difference. I can't do what I want to do"), or isolation ("No one understands. No one wants to be around someone who is in pain all the time"). Negotiating the path of chronic pain means learning skills to work with these negative emotions.

Self-management involves using skills to manage the work of living with your pain condition, continuing to take part in normal daily activities, and successfully dealing with your emotions so you can start enjoying a healthier, happier life.

What Is Pain?

Pain is a part of being alive. It is nearly universal, something we all share as human beings. At the same time, it is a most personal, individual, and subjective experience. One person's experience of pain is not the same as another person's. Throughout human history, pain has been regarded as mysterious and unknowable. Because we can't see another person's pain, it seems invisible. But when we feel pain ourselves, it is all too real.

Humans have always tried to understand pain. The ancient Greeks described pain as a "passion of the soul," an emotion like sadness or grief. This idea of pain as an emotion is called the affect theory of pain and this view of pain was prevalent until the seventeenth century.

In 1664, a famous French philosopher and scientist, René Descartes, developed a new concept of pain. He believed that there were special places in the body called pain receptors that sent pain impulses along a pain pathway that went directly to a single pain center in the brain. He also believed that the mind and body were completely separate and that one did not affect the other. According to Descartes, pain was purely physical, and it was a straightforward, simple process. This was called the specificity theory of pain, and it persisted for 300 years.

But it wasn't until the late 1800s that scientists started to use observation and experiments to study pain. Descartes' idea that pain was purely physical just didn't fit the facts. But progress was slow. Then, in 1959, two scientists — Dr. Ronald (MIT) in Cambridge, Massachusetts. Together Melzack from McGill University and Dr. Patrick they developed new ideas about pain that they Wall from Oxford University — set out to unravel called the gate control theory. Their ideas revoluthe puzzle of pain. They met while working tionized pain research. at the Massachusetts Institute of Technology (MIT) in Cambridge, Massachusetts. Together they developed new ideas about pain that they called the gate control theory. Their ideas revolutionized pain research.

New Ideas about Pain

Nerve endings all over our body are sensitive to types of stimuli that can cause us harm and signal danger. Exposure to things like heat, cold, pressure, or chemicals cause particular patterns of nerve or electrical impulses. If the stimuli are strong enough, these nerve impulses travel along the nerves to the spinal cord and up to the brain.

Let's say you just stubbed your toe. Within nanoseconds, the nerve endings in your toe that respond to pressure send a pattern of nerve impulses along the 'nerve highway' — the nerves in your toe, foot, leg, buttock and up to the spinal cord in your back. The spinal cord is like a super highway of nerves that connect to your brain. It's your brain that asks: "How dangerous is this really?" It's only when the brain thinks the pattern of nerve impulses are dangerous that pain is felt. In other words, pain is not in your toe, although it sure feels like that. Pain is produced by your brain to tell you and your body to take action. Because this is so important, it bears repeating: All pain is 100% in the brain.

Melzack and Wall said that there is a transmission station in the spinal cord that influences the flow of nerve impulses to the brain. They called this transmission station a 'gate'. Think of it just like a gate you can open or close to get to your backyard. Two things can happen when nerve impulses from your toe reach the gate:

* If the gate is open, the impulses pass through and continue up the spinal cord to the brain. If the brain senses 'danger', you experience pain.

* If the gate is closed or partially closed, then only some or none of the nerve impulses travel to the brain. The brain might then interpret the signals as a little danger — not enough to worry about — or no danger. So you experience minimal or no pain.

The gate can be opened or closed in a number of ways, including by the brain itself. The brain can send electrical messages down nerve pathways to close the gate and shut out or reduce the flow of nerve impulses to the brain, or send messages that do just the opposite. Many factors can open or close the gate.

Some of these factors arise from our mind. They include our past experience, what we have learned about pain from our culture and social environment, our expectation about what might happen, our beliefs about pain, how much attention we direct towards the pain, and our emotions. For example, positive mood, distraction, and deep relaxed breathing can act to close or partially close the gate while strong emotions like fear, anxiety, and expecting the worst can open the gate.

So research on the gate control theory has explained a lot. It tells us that pain results from many interactions and information exchanges at different levels of our nervous system — in billions of nerve cells, the spinal cord and the brain. Our physical bodies, our feelings and emotions, our thoughts and beliefs and other factors are all involved in the experience of pain. And all pain is produced in the brain. The mind and body are completely connected. They influence each other all the time.

But the story does not stop here. The gate control theory mostly explained what is happening when nerve impulses travel to the spinal cord. But what is going on within the brain itself? Answers are coming from several sources: advanced brain imaging studies, studies of the link between pain and genetics, research into the immune system and our response to stress, and Dr. Melzack's latest neuromatrix theory of pain.

It turns out that at least seven (and probably more) areas of the brain are active when we experience pain. Some of these brain regions control our emotions, our thinking (or cognitive function), and the processing of body sensations. These body sensations include stimuli that might cause us to feel pain as well as things like light touch, vision, hearing, and other body sensations. These areas of the brain are connected to each other through a complex widespread network of nerve cells and neurochemicals. Dr. Melzack called this network a 'neuromatrix'. The purpose of the neuromatrix is to organize the huge amount of information coming into the brain so that we experience our body as a single unified whole. How this network gets developed in the first place is mostly due to our genetics. But after that, many things affect how the network changes to influence how we experience our body.

(Continues...)

Excerpted from Living a Healthy Life with Chronic Pain by Sandra LeFort, Lisa Webster. Copyright © 2015 Bull Publishing Company and The Board of Trustees of the Leland Stanford Junior. Excerpted by permission of Bull Publishing Company.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Front Cover,
Title Page,
Copyright Page,
Dedication,
Acknowledgments,
Contents,
Disclaimer,
1 Overview of Self-Management and Pain,
2 Becoming an Active Self-Manager,
3 Finding Resources,
4 Understanding and Managing Common Symptoms and Problems,
5 Using Your Mind to Manage Pain Symptoms,
6 Pacing: Balancing Activity and Rest,
7 Exercise and Physical Activity for Every Body,
8 Exercising for Flexibility, Balance, and Strength,
9 Exercising for Endurance and Fitness: Moderate to Vigorous Physical Activity,
10 Communicating with Family and Friends,
11 Communicating with Your Health Care Professionals,
12 Sex and Intimacy,
13 Healthy Eating,
14 Healthy Weight Management,
15 Managing Your Medicines,
16 Medicines and Treatments for Chronic Pain,
17 Making Treatment Decisions,
18 Managing Specific Chronic Pain Conditions,
19 Managing Angina Pain, Coronary Artery Disease, and Related Conditions,
20 Planning for the Future: Fears and Reality,
Appendix: Helpful Hints for Everyday Living,
Index,
Back Cover,

Living a Healthy Life with Chronic Pain

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