MOVEMENT AND ACTIVITY
Setting goals
Setting goals for each day such as what you want to achieve and tasks you want to complete. These can be simple things like brushing your teeth or taking a shower or more complex goals such as reaching a target at work. This study explains that “Focusing on a specific problem, establishing realistic objectives, and developing an action plan for attaining those objectives are beneficial steps in managing chronic illness”.
You can adapt the goals to suit your progress, your symptoms, and your lifestyle. It’s important that you set realistic goals that don’t put too much pressure on yourself. It can even help to write them down on paper or set them as a memo on your phone so that you can tick each goal off as you achieve them.
Pros
- Give a sense of achievement
- Helps with motivation
- Builds confidence
- Keeps days organized
- Realistic goals can prevent over-pressuring yourself or causing flares
- Encourages functioning
- Gives a sense of empowerment
- Can be anything big or small to suit the individual
Cons
- Setting goals too high could knock confidence and make things feel unachievable.
Breaking things down
If there’s an activity that you find particularly difficult, you can break it down into bite-sized pieces so it’s more manageable. For example, going shopping can be broken down into getting dressed and ready to leave the house, transport to the shop, walking around the shop, and so on. Learn to tackle each aspect of this activity one at a time, planning where you might need help or need to take rests. Plan to take supplies with you just like with exercises, such as painkillers or mobility devices.
Pros
- Bite-size tasks are more achievable
- Promotes long-term success
- Builds confidence
Cons
Breaking things down can take more time
Pacing activity
Activities can be built up to and increased gradually. We have a habit of trying to ‘make the most of low-pain days, trying to get everything done while our pain is low. This can make our symptoms flare and send us right back to not being able to function. This is known as the boom-bust cycle.
Pacing activity can help to avoid flares. It’s also important that you take regular breaks, even if you feel that you don’t need them, to give your body a chance to recuperate. This study explains that “The aims of activity pacing include to reduce over-activity–underactivity cycling (fluctuating between high and low levels of activity) in order to improve overall function and reduce the likelihood of exacerbating symptoms”
You can start pacing by choosing an activity that you find tough but not impossible; it’s better to start off with something more manageable. You can figure out your baseline, which is what you will work from, by figuring out how long you can do this activity without causing a flare. Then reduce this amount by 20% and you have your baseline!
Do the activity in accordance with your baseline every day for a week. The next week you can increase that activity by a couple of minutes and so on until you are building up your tolerance and ability. As you gradually increase your activity, you are learning that this activity doesn’t need to be feared and your brain is learning that it doesn’t need to send out pain messages in response to that activity. You can then incorporate this method into other activities throughout your day.
Pros
- Prevents flares
- Increases level of functioning
- Builds self-esteem
- Helps to retrain the brain away from pain
- Helps you prioritize tasks that are most important to you
Cons
- Breaking down activities can take longer
- It can be frustrating to learn not to try to do everything at once on low-pain days
Utilizing mobility devices
Often people can view using a mobility device as ‘giving in’ or find it embarrassing, but using a mobility device is doing the exact opposite of giving up. It’s using every single available resource to ensure that you are being as mobile and active as possible, and that’s something to be proud of not ashamed of. For example, if using a walking stick helps me to be able to walk more with less pain, then that is a positive thing.
Pros
- Increases mobility
- Allows you to increase daily functioning
- Makes life easier
- Increases confidence
- Allows you to perform tasks you might not otherwise be able to
Cons
- Mobility devices can be expensive
- Using mobility aids can be hard to come to terms with
- If used incorrectly, can become a ‘crutch’
Wear comfortable clothes and footwear
Just as you adjust your environment at work and at home to optimize your level of functioning, you can also adjust your clothing to make things easier for yourself. Wearing comfortable clothes makes a big difference, especially if you experience allodynia. Allodynia means that things that shouldn’t be painful can cause pain or discomfort, such as the feeling of clothes scratching against your skin.
I experience allodynia as a symptom of fibromyalgia, so choosing clothes with softer materials that are baggier and more comfortable, makes me so much more comfortable and therefore makes me more inclined to move around and be active.
Choosing footwear that is comfortable and supportive is essential especially when you’re trying to exercise. Flat shoes with grips can help you with balance and good footwear can provide extra support.
Pros
- Making functioning as comfortable as possible
- Increasing functioning
- Reducing pain
- Giving your body appropriate support
Cons
- Clothes and footwear can be expensive
- Adjusting your wardrobe to comfortable clothes can be hard on self-image
Occupational Therapy
An occupational therapist may come to your home or to your workplace to help you make adjustments to the environment. Sometimes they will provide equipment to make things easier. Typically, they will talk to you in-depth about your routine and which aspects of activity you find hard, helping you find ways to make things more manageable.
Pros
- Helps you to adjust your environment
- Can increase functioning
- Can aid in reducing pain
- Can increase confidence in daily activities
Cons
- Can sometimes be embarrassing and time-consuming to have to make adjustments to your environment
Coping with a flare
Unfortunately, even if you do all that you can, sometimes flares do happen. When they do, learning how to deal with them effectively can lessen their impact and make them easier to cope with.
- Utilize your painkillers, medications, and topical creams - Painkillers and prescribed medications can help to reduce your pain slightly and offer some relief. Topical creams can provide some comfort by interrupting pain signals.
- Use the heat and cold we mentioned previously - Heat can help ease pain and make you more comfortable. Cold in painful areas can aid in reducing inflammation and pain.
- Allow yourself the time to rest without feeling guilty - While being active is important, if you’re flaring, allowing yourself time to rest is important.
- Realize it’s ok to feel negative - You don’t always have to maintain a positive attitude; flaring can be emotionally draining as well as physical. Negative feelings are completely valid. Allow yourself to feel these emotions but only for a short time. When you’re ready, pick yourself up and keep going.
- Ask for help - During a flare your level of functioning may be lower so ensure that you are reaching out for help. It’s a great idea to talk to someone you trust about what sort of help you might need during a flare, giving them practical advice so that they are prepared when you reach out.
- Distract yourself - One of the most helpful things you can do, even though it is much easier said than done, is to distract yourself as much as possible. Watch a movie that keeps your mind occupied, put on some loud music that cheers you up, or try and do some crafts. Whatever it is that brings you some joy and keeps your mind busy is useful. You could even make a ‘flare playlist’ on your phone if you have music apps, so you have it ready to just press play when you need it.
- Have supplies ready - When you’re flaring it’s unlikely that you’re going to want to cook meals or go out shopping. Always having some frozen meals or long-life snacks in the cupboard that you can just grab when you need them to ensure you are eating can be helpful. Sometimes it can be tough to think clearly about who you might want to call for help or what distraction techniques you could use. The last thing you want is to be searching for something you need. Preparing a ‘happy box’ in advance can make a difference. You could put anything into the box that is going to help you with relaxation and distraction, for example, your favorite movie, craft supplies, or a game to play. Keeping an emergency list of numbers at the hand of loved ones or medical professionals can be valuable. The more prepared you are the better!
- Practice relaxation - Even though it’s hard when your symptoms are at their worst, trying to practice relaxation techniques like mindfulness meditation and breathing exercises can really calm you, making you emotionally more prepared to deal with the flare.
SELF-CARE
Heat and cold treatments
Heat or cold on affected areas can be effective in relieving pain; sometimes alternating between the two can be helpful. You can use hot water bottles or microwaveable rice bags and heating pads. If you want a bit of extra comfort you can get teddies that go in the microwave which also smell like lavender; this can be very calming.
Ice packs or cloths dipped in ice water can be used as cooling options. You can also buy heat or cool pads which can either be applied to clothes or directly to the skin; effects typically last for a few hours.
Pros
- Easily accessible supplies
- Can reduce pain
- Can help you fall asleep
Cons
- Only works short term
- Must be careful of heat and cold burns if using for long periods of time
- Can be tough to reach some areas of the body if you’re alone
Splints and supports
Your medical professional may provide specific splints or supports that you can wear either daily or during exercise which can help to support joints, especially if you have a diagnosis like osteoarthritis within which joints may need extra help. You can also seek these supports out online or in pharmacies if you feel that they could be useful for you.
Pros
- Can provide extra support
- Reduces pressure on joints
- Can ease pain
- Can reduce inflammation
Cons
- A wide range of choices can be confusing
- The appearance of splints can influence self-esteem
- Typically need guidance from a medical professional
- Can typically only be used for short periods of time.
Transcutaneous Electrical Nerve Stimulation (TENS)
TENS machines can sound scary but really it’s just small machines with sticky pads which you are instructed to put on various areas of your body. The machine sends small electrical signals which interrupt the pain signals in your nerves to bring some relief from pain.
This type of treatment isn’t painful, but you may feel a small sensation that you soon become accustomed to. Usually your doctor or specialist will show you how to use a TENS machine, and you will usually be permitted to take it home with you to integrate into your daily pain management.
Pros
- Isn’t painful
- Can reduce pain
- Fairly easily accessed through doctor
Cons
- Only provides relief for as long as you are actively using the machine.
Educating yourself on pain science
The more you learn about chronic pain, the more prepared you will be to tackle it. Understanding the science behind how the body processes pain, can give you the ability to see why and how various self-help techniques and professional treatments work. This knowledge can give you the confidence to tackle your pain in new ways.
Pros
- Knowledge of what is happening in your body
- Understanding that chronic pain doesn’t mean damage
- Giving a sense of empowerment and confidence
Cons
- Some aspects can be difficult to understand
Finding purpose
In some cases, chronic pain can make you feel worthless. It can reduce your level of functioning until you feel that you are just surviving rather than thriving. Finding a purpose in your life is so important, especially if you aren’t working. This could be things as simple as hobbies that you enjoy or adopting a pet, or more complex purposes such as getting back to work.
Pros
- Gives motivation
- Increases confidence
- Gives a sense of determination
- Brings more joy into day-to-day life
Cons
- Can be difficult if you are not working
Maintaining a healthy diet
Giving your body the fuel it needs to function optimally becomes even more important when you have extra health challenges like chronic pain. Ensuring that you are limiting junk food and focusing on eating in a healthy way can provide your body with the right nutrients to function optimally.
Pros
- Providing your body with the fuel it needs to function
- Increases energy
- Maintains weight
- Good for mental health
- Good for general health
- Boosts immune system
- Strengthens body
Cons
- It can be hard to cook and plan meals when you live with a chronic illness
A good sleep routine
Ensuring that you are sleeping well is vital for overall health. When your body is working against chronic pain and the fatigue that so often comes along with it, rest becomes even more important.
Pain can often keep you awake at night so trying to relax and reduce pain before bed can be beneficial. Fatigue can be like a veil, tricking you into thinking your body is tired enough to sleep. It’s often easier said than done but here are some tips to help you engage in a good sleep routine:
- Trying to go to sleep around the same time every night and wake up at the same time each day can help your body clock to get back on track.
- Keep active during the day to tire your body out in a healthy way. When our bodies are inactive for long periods of time, even if we’re fatigued, the lack of activity can lead to restlessness at night.
- Try not to nap during the day. I know this is easier said than done; sometimes when my fibromyalgia is flaring, I can’t keep my eyes open and so a nap is needed to continue functioning for the rest of the day. In this case, trying to minimize the amount of time you are napping can help your body to feel more tired at night.
- Take your medications close to the time you go to sleep, especially if they have sedative side effects so that you can make the most of them.
- Make your bedroom comforting and relaxing: keep the lighting dim, ensure you have comfortable bedding, and surround yourself with things that calm you.
- Use all techniques at hand to reduce your pain before bed, such as heat pads, painkillers, or topical creams.
- Use relaxation techniques to wind down before bed such as listening to audiobooks or calming music to help you unwind. Meditation can be really useful here. Body scan meditations can really help your body to fully unwind for sleep. This involves you going through each area of your body and tensing each muscle then relaxing it fully. You can find guided body scan meditations online or through an app like ours (download links in the banner above).
One thing that I’ve found really useful to reduce frustration when I simply can’t sleep, is to understand that even if I’m not sleeping lying calmly and resting in bed is still allowing my body time to recuperate and re-energize. Once I realized this, I found that I was drifting off to sleep more often because I didn’t feel so much pressure.
Pros
- Helps daily functioning
- Fights fatigue and increases energy
- Promotes strong immune system
- Improves cognitive functioning
- Good for general psychical health
- Good for mental health
Cons
- It can be hard to get to sleep when you are in chronic pain
Reducing stress
Stress feeds into the stress and pain cycle, increasing pain and worsening accompanying symptoms as this study explains: “Pain and stress are two distinguished yet overlapping processes presenting multiple conceptual and physiological overlaps”
Reducing stress in your life as much as possible can help to reduce your chronic pain. Try to talk about things that are on your mind with someone you trust; sometimes sharing your worries can help you to see the way forward and lighten your load. Surround yourself with people who will encourage you and add to your life in positive ways. Practicing self-care can help you to lower stress levels.
Pros
- Helps to break the stress and pain cycle
- Reduces chronic pain symptoms
- Helps mental health
- Keeps the body functioning properly
Cons
- Breaking the stress and pain cycle can be difficult.
Setting boundaries with others
When you live with chronic pain, you often cancel plans at the last moment because of a flare-up in symptoms. Sometimes you can harbor a sense of guilt when you are not able to keep up with things around the house, daily chores, or a regular social life with your friends. While it’s important that we do maintain social connections, it’s also vital that we do not push ourselves too much, subsequently causing a flare through a sense of obligation or a need to please others.
Setting clear boundaries with loved ones and being assertive with saying ‘no’ if you feel that something is too much can be tough emotionally but is so beneficial. You have a right to put your own health first. Remember that the word ‘no’ is a sentence within itself; you do not have to explain yourself unless you feel comfortable doing so.
Encourage loved ones to educate themselves; send them links to articles that give them a deeper insight into your condition or have open conversations with them so that they understand that when you say no, it’s not because you don’t love them, it’s because you love yourself.
Pros
- Preventing flares
- Maintaining stronger connections with loved ones
- Feeling more understood by those in your life
Cons
- Loved ones can find it difficult to understand why you need to set boundaries
- It can be hard to say ‘no’ to those you care about
Monitoring your symptoms
Keeping track of your symptoms, whether it be writing them down, keeping notes on your phone, or using a monitoring app, can allow you to see useful patterns. This helps you to keep medical professionals up-to-date, allowing them to see your condition in a clearer light.
Knowledge is power, and the more you learn about the ebbs and flows of your illness, the more you can counteract it and adapt your life to work around it.
Pros
- Allows you to see patterns in your symptoms
- Helps you to identify and tackle things that trigger flares
- Aids medical professionals with diagnosis and treatment
- Helps you to utilize low-pain days without causing flares
Cons
- Being very aware of your pain could contribute to pain hypervigilance.
Keeping a journal
Journaling can help you with monitoring your symptoms, but it can also be an emotional outlet. Sometimes it can be tough to talk to others about what we are going through, especially because we may not want to upset loved ones. Having a place where you can vent without feeling the need to filter your feelings can be freeing and cathartic.
Pros
- Can help with monitoring symptoms
- Helps to express emotions and feelings
- Reduces stress
- Can be good for mental health
- Can express creativity
- Promotes cognitive health
Cons
- Can be tough to keep up regularly due to fatigue/other priorities
Writing notes and reminders
Often with chronic pain comes issues with cognition and memory; for me ‘fibro fog’ can make it tough to remember little things. One of the ways I tackle this is to set alarms and reminders on my phone. You could also leave post-it notes around the house or make lists of anything that you need to remember.
Pros
- Can help you to set goals for the day
- Tackles cognitive symptoms practically
- Helps you to be independent without asking for reminders from others
- Reminds you of appointments, medication, etc
Cons
- Writing things down can remind you that you struggle cognitively, can be emotionally tough to accept
Adjusting your environment to set you up for success
It’s important that your environment is conducive to keeping your pain levels as low and managed as possible. You can adjust things to make life easier for you, like adding support bars to help you get in and out of the shower like my example.
Having a mattress topper or a new mattress that is specifically designed for support, depending on your resources, can ensure that you are optimizing your comfort and increasing your chances for a restful night’s sleep.
Adding things like stools to your living room so that you can raise your feet up can be helpful to reduce swelling and provide extra comfort. Keeping things that you use regularly within your reach can be helpful.
It’s about what works for you and your routine. Take a look at your living environment and think about what would make things easier for you in your daily routine. While it’s important to keep active to tackle chronic pain and prevent deconditioning, it's also about increasing your level of functioning. If you can make some actions easier for yourself, then it saves your energy for other activities, increasing your functioning rather than reducing it.
Pros
- Makes daily tasks easier
- Increases functioning
- Promotes independence
- Encourages healthy behaviors
Cons
- Can be hard coming to terms with needing to adjust your environment
- Can be expensive to make adjustments
Being open and clear at work
If you work, it’s important that you are open and honest with your employers and colleagues about your condition and be assertive yet professional about what you might need. If you need guidance you may be able to arrange for an occupational therapist to come to the workplace; they can advise and advocate for adaptations or accommodations that could make things easier for you. Just as with daily tasks at home, it’s about optimizing your level of functioning without causing a flare in your symptoms.
Pros
- Increasing your level of functioning at work
- Allowing you to keep working despite your pain
- Maintains a good relationship with your employer
- Gives you emotional support at work
Cons
- Stigma means that not all employers and colleagues will be as understanding as you might like.
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.
