Coping and Chronic Pain / Jan 15, 2009 Meeting Review

Presented by Dr. Burgess, Ph.D. to
AZ Syringo Chiari Support Group Jan. 15, 2009

What is Behavioral Medicine?
• Addresses the psychological aspects of illness and health promotion including:
• Stresses associated with illness
• Health behavior and lifestyle change
• Preexisting difficulties with stress and coping
• Promoting wellbeing

Overview of Chronic Pain
• Types of Pain
o Acute vs. Chronic
o Intermittent vs. Continuous
o Progressive vs. Stable
• Pain-Mood connection
o Suffering
o Tension
o Rate pain and mood

Pacing or Walking the Sword’s Edge
• Balancing Up-time and Down-time
o Overexertion vs. Deconditioning
o Engaging in positive activities
• Think Ahead and Plan!!!
• Use Pain Ratings as a Tool

Goals
• Set goals for yourself
o Important
o Time limited
o Specific
o Realistic
o Measurable
o positive
o Large enough with small intervening steps

Rewards
• Importance of rewards or
• Training ourselves is far more like training a dog than we would like to think
• What to use
o Both big and small things
• Things that appeal to each sense
• Thoughts
• People
• Places

Guiding Thoughts and Images
• Examples of guiding thoughts:
o I want to go back to enjoying life
o I can balance my pain and activity level
o I am worth the effort. I am going to do it!
o I CAN do this!
• Examples of guiding images:
o I picture myself enjoying (insert activity)
o I picture myself interacting with my children and grandchildren.
o I see myself feeling really proud of what I have accomplished.
o
Additional relaxation techniques
• Diaphragm breathing
• Guided imagery
• Progressive Muscle Relaxation

Sticking to a Plan
• Write down all the reasons you wanted to accomplish your goal.
• Take credit for your success and hard work. Continue to reward yourself often!
• Plan for people, places, and events that might trip you up.
• Keep your thinking POSITIVE
• Plan ways in advance for you to deal with difficult situations.
• Find new ways to cope with stress.
• If you do slip-up, get right back with your program. Give yourself lots of praise for doing that.

Take Control of Your Thinking
1. What have I been thinking or telling myself
o For example I will never be able to lose weight
2. Is this thought sensible, realistic, or am I making something out of nothing? Is there real evidence for thinking this way?
o For example is it really true that I can never enjoy life?
3. Is it helpful or healthy for me to be thinking this way?
o For example: Is it helpful for me to think. I can never enjoy life?
4. What positive thoughts can I use to replace my negative thinking?
o For example: There are other activities that I can use to enjoy myself.

STOP
• Sometimes, we need help dealing with temptation.
1. Yell STOP!! Either aloud or silently to yourself.
2. Take 5 slow, deep breaths. Relax
3. List 3 bad things that are likely to happen if you give in to your impulse.
4. Quickly think of something you can do instead, and do it!!!

Five Column Technique
Situation / Emotions / Automatic Thoughts / Alternative / Thoughts / Outcome

Who?
What?
Where?
When? Rate each mood 0-10

Identifying Automatic Thoughts
• What was going through my mind right then?
• What does this say or mean about me? My life? My future?
• What am I afraid might happen?
• What is the worst thing that could happen if this is true?
• What does this mean about how other people feel or think about me?
• What does this mean about other people in general?
• What images or memories do I have about this situation?

Questions to Generate / Alternative Thoughts
1. What is the evidence that these thoughts are not 100% true?
2. Is there an alternative explanation?
3. Have I had any experiences that show this thought is not completely true all the time?
4. Even if this were true, what/s the worst that could happen? If that happened, how would I cope?
5. If someone I love or care about had this thought, what would I tell them?
6. When I am not feeling down, how might I think about this situation differently?
7. When I have felt this way in the past, what did I think about that made me think about this differently?
8. Am I blaming myself for something that I don’t have complete control over?
9. Are there small things that contradict my thoughts that I might be discounting as not important?
10. Five years from now, looking back at this situation, will I think about it differently?
11. Are there any strengths or positives in me or the situation that I am ignoring?

Enlisting Others
• Ask key people who you know will be positive and supportive.
• Share your concerns and struggles with your key supporters.
o Even if a support person fails to ask how you are doing, go ahead and tell them! This starts the conversation and provides the opportunity to get some encouragement.
• Tell your key supporters what they can do to help.
o Be specific. For example: Ask me how I am doing, and then listen. Don’t reward me for pain behaviors.
• Let them know that their support is extremely meaningful!
• Give back in return. Reward your support people with your attention and your support for them.
•
Enlisting Others part II: Dealing with problems
• Pain management requires lots of changes, and sometimes this can cause relationship problems.
• Try to understand each other.
o Change can be difficult for both of you.
• Realize that your partner may not know how to support you.
o Ask for help, and actually tell them what they can do to assist you. Be patient, change takes time.
• Practice being assertive.
o This means saying no firmly and repeatedly, or whatever else you need to say to maintain your personal program of pain control and physical activity.
• Remember that this is about you.

Recommended books:
The relaxation and stress reduction workbook
Managing pain before it manages you