By: Dr. J. Douglas Salmon, Jr.
*Adapted with permission from Multi-Health Systems & Dr. J. Douglas Salmon, Jr. from Rehabilitation Education and Coping Pamphlet Series Pain is one of the most diffi- cult symptoms with which to cope when one has experienced injury or illness. While the origin of pain is usually very real and results from a specific physical problem, one’s thoughts and feelings (such as anger, irritation, depression, and nervousness) tend to feed off of one another to complicate and prolong the recovery process. There are two main reasons that thoughts and feelings play such an important role in the recovery process.
First, feelings such as anger, fear, frustration, irritability, anxiety, and depression often bring about changes in the body such as increased muscle tension and poor posture, which can increase the pain experi- enced. These feelings are often brought on by negative thoughts about the overall situation. For instance, a person who believes that his or her condition or pain is “impossible to overcome,” and that it prevents him or her from doing “all that is meaningful in life” is likely to become anxious and depressed and may experi- ence worse pain and physical symptoms. By contrast, a person is likely to move forward more quickly and to better endure his or her symptoms when he or she accepts the situation and takes on a more positive attitude by think- ing, “I can overcome this,” “there are still many things I can do, a despite my pain,” or “this is an important learning experience.”
Positive Coping Strategies * Educate yourself. It is critical that you understand your symp- toms best as you possibly can so that you may have your fears addressed and have a more real- istic understanding of your pain and other symptoms. * For chronic “soft tissue” pain, use appropriate muscle strengthening, muscle stretching and general conditioning tech- niques as prescribed by your doc- tor or therapist. * Identify emotional road- blocks such as family problems, financial difficulties, workplace concerns, medication overuse, alcohol/substance use, anger control difficulties, loneliness, anxiety, and depression.
* Deal with emotional prob- lems as well as the physical ones. Seek professional help when nec- essary and talk to people who will listen and be helpful whenever possible. * Maintain and gradually increase your general activity level. Talk with your doctor or therapist about the safety of any activity that you are concerned could aggravate your injury. * Prevent muscle tension build-up. Muscular relaxation techniques, gentle muscle stretching (as indicated by phys- iotherapist), and other tension control strategies (e.g., change in posture, rubbing, self-massage) are critical in helping prevent muscle tension build-up during the day. Do these exercises once every 30 to 60 minutes each day.
* Keep your mind and body active. Distracting yourself from pain and other symptoms by keeping involved in things that you enjoy helps lessen the impact of pain and ward off anxiety, depression, and irritability. Increasing Your Activity Level Before you reject an activity because of pain or other symp- toms, carefully evaluate the activ- ities that interest you most. Use a goal-setting table and start by fill- ing in the “Can’t Do” column with any activities that you feel you are unable to do. Next, carefully think about whether or not it is really true that you cannot do this activ- ity. Perhaps you could do it by performing it a different way, by allowing yourself more time to do it, by accepting a less “perfect” performance from yourself, by permitting others to help you, or by determining if you would enjoy doing only a specific part of the activity. You may want to ask for someone else’s opinion, or a doc- tor’s or therapist’s advice about other ways that you can continue to get enjoyment out of an activi- ty on your “Can’t Do” list. Careful examination and evaluation of these activities may allow you to move an activity from the “Can’t Do” category into the “Maybe Do” or “Can Do” category.
Next, think of some other activities that you think you may be able to do, and place them in the “Maybe Do” category. Go through the same exercise of try- ing to figure out a way that you can do each of these activities by changing the way you used to do it, using special devices or aids, or perhaps revising high expecta- tions and doing the activity for enjoyment rather than to win. Again, ask for the help of family, friends, and professionals to iden- tify ways that you can continue to enjoy this activity while ensuring your safety. Finally, develop your “Can Do” list. This list should be a combina- tion of things that you have now moved from other lists as well as other activities. You can begin this list by identifying activities that perhaps you used to do but stopped doing because you became too busy with other things.
The list should include things that you’ve always wanted to try doing, and things that you already enjoy doing. You should also consider activities related to your “Maybe Do” or “Can’t Do” lists. For example, if you can no longer play baseball you might want to begin coaching a little league team, or go and watch some games. Selecting Goals, Pacing Activities, and Rewarding Your Efforts It is important that you select realistic, attainable goals that you can maintain and that will help motivate you to increase your activity level. You may begin by focusing on gradually doing more of the activities on your “Can Do” list. If your goals are set too high and you don’t achieve them, you may become both frustrated and disappointed, which may discour- age you from engaging in that activity in the future.
It is best to choose a goal that you know you can reach even on you worst day, and then stick to that goal for a good week or two (at least 6 times) before you increase the goal. For example, you may start to walk once around the block at first, because, although you can walk further on most days, you probably couldn’t do so on your worst day. This keeps you active even on your worst day and ensures that you’ll reach your goal, feel good about it, and keep up the good work the next day. Then, when you’re ready to increase your goal, make it a rel- atively small increase again one that you know you’ll be able to accomplish even on your worst day. Never increase your goal by more than about 10-15% of your previous target. And always make certain that you have achieved your goal several times in a row (and during several bad days) before setting the target higher. Finally, reward yourself well for your efforts on a daily or weekly basis, or based upon reaching various goals. A daily reward might include some small food treat or leisure activity. Treating yourself to a movie, a favourite magazine, some new clothes, or calling a friend long distance are examples of ways in which you might reward yourself once you’ve reached each new goal.