To motivate individuals living with chronic pain to participate actively in rehabilitation programs and recovery, it is essential to tailor the focus of interventions towards activities that are meaningful and relevant in their lives. In a research paper discussing the concept of meaningfulness for patients with chronic pain, Liddiard et al. (2019) propose the following definition of meaningfulness: “that which patients themselves select as being of value, and contributes to their personal sense of identity” (839).
If an activity carries no meaning or significance, it is challenging for patients to push themselves to participate and overcome the barriers of chronic pain. This article will explore ways in which healthcare providers and clients work together to establish joint goals which reflect meaning and purpose to promote chronic pain management.
As a rehabilitation professional, I have been trained to explore goal-setting with clients in a way that reflects both clinical reasoning and the collaborative wishes of the client. Gentle guidance and education are also an important part of the rehabilitation process and creating a therapeutic alliance. Without listening openly to a client’s goals and wishes, the relationship will erode and there will likely be negative health outcomes.
Active, engaged listening skills and validation are important for fostering an understanding of what is meaningful to a client. Exploring not only the physical components of pain, but also the psychological, social, vocational, and spiritual realms of chronic pain may provide therapists with clues as to how best to support clients in their recovery journey.
Value and identity are two words that stand out from the abovementioned definition of meaningfulness. For a patient who was previously a pianist and developed chronic pain or arthritic pain in their hands, it is possible that finding adaptive ways to engage in musical activities may promote recovery. Simply focusing on exercises that strengthen hand muscles or thermal modalities may not provide the same sense of hope and future orientation as incorporating music and creativity into the therapeutic process.
Exploring a client’s sense of loss and the difficulty of transition is also critical for recovery. Having an understanding of how to motivate clients and allow the space to express sadness and grief resulting from chronic pain is a key step towards moving clients towards acceptance. From this place, it is possible to adapt activities, not only for the sake of remaining “busy” or “occupied,” but rather for the purpose of creating and maintaining a life of meaning.
Values are different from goals. Values give us direction, and hope, and guide us towards the goals we would like to achieve. They are what is most important to us. Values exploration can be helpful if it is unclear what a client finds meaningful, or if they are struggling with depressive symptoms that make it challenging for clients to find purpose. Provide clients with a list of values and ask the client to circle their top ten values. Then, have the client narrow their focus to one or two values they would like to address now. Use these values to determine goals and have the client create specific action steps towards these goals. For example, if contributing to the community is a value, the client can create a goal of volunteering once per week at an animal shelter, and set an action step of calling the shelter this week to inquire about volunteering opportunities.
Case examples may be helpful to illustrate how to explore meaning with a client. When listening to a client tell their story, be open to different interpretations of what may be important or meaningful for them, outside of what may be culturally or socially relevant for you. For example, one client expressed that for them, cooking for a large family get-together is something that brings them a sense of belonging and purpose. Every year, the family gathers for a party and this client prides themselves on the delicious food and hospitality that they provide.
Since experiencing chronic low back pain, this client has canceled many dinners over the past few years due to difficulty with lifting, bending, and standing for long periods of time. The client lives with their husband, however, does not want to burden him with the task of hosting, as it is something that is mainly important for her. She cries to the therapist when speaking about her wishes to be able to fulfill this meaningful role this year for the Christmas season. Rather than suggesting the client hold off on hosting this year due to pain, the rehabilitation professional can find ways to enhance the client’s life by creatively exploring ways to make this evening happen, through pain education, modifying tasks and compensatory strategies.
Once a meaningful activity has been identified, it is crucial to engage in realistic goal-setting. A formula for goal-setting which is used in many contexts is that of the “SMART” goal. This stands for Specific, Measurable, Realistic, Attainable, and Timely. It is easy to get caught in a pattern of “I wish I could do…” or “if my pain wasn’t so bad I would…” and set some lofty goals that are not realistic. Using this formula takes away the likelihood of clients creating directionless “New Year’s Resolution” goals that do not come to fruition. Using the SMART formula allows patients to track progress on measurable goals that meet their specific needs and interests in life.
Routine-building is the next step toward establishing a meaningful daily life for individuals with chronic pain. From the values and goals that have been set collaboratively with the rehabilitation professional, it is now time to create a weekly schedule filled with activities that promote recovery and have significance for the individual.
Provide the client with a blank weekly schedule and encourage them to block out specific times that they anticipate would be appropriate for engaging in meaningful activities. Each day should have a balance of self-care, leisure, and productivity, and a specific focus should be placed on the one or two key activities that bring a sense of hope and purpose to the client. Create time-sensitive goals around these activities, encouraging the client to monitor pain symptoms however use pacing techniques to enable activity engagement.
Meaningfulness has a different definition for each person. Listening with a compassionate, attentive ear is the first step towards supporting clients in re-establishing healthy, important, and relevant daily activities. Re-focusing the client’s attention away from pain and tailoring treatment plans that reflect their wishes and goals may be a key step towards treatment adherence and functional recovery goals. We all crave lives of meaning and purpose, and supporting people in finding, exploring, and committing to meaningful action is a rewarding and effective wellness strategy.
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens and New Hyde Park – Long Island. Call the Queens office at (718) 215-1888, or (516) 419-4480 for the Long Island office, to arrange an appointment with our Interventional Pain Management Specialist, Dr. Jeffrey Chacko.
