Dealing with chronic pain is an individual process. There is no ‘one size fits all’ approach with how to manage each person and their issues, but this article will attempt to provide some broad guidelines with how to approach managing your pain and moving towards a pain-free life.
The messages inside this article may be more or less relevant to your particular situation depending on your circumstances, but hopefully there is some valuable information contained within for you to learn, reflect upon and action.
Working with a trusted practitioner, having a discussion with each other to learn, understand and create a plan together is the most beneficial route. Empowering yourself with knowledge, gaining a mutual understanding with your practitioner and learning actionable skills that are relevant to your experience and your life can be devised as a team to suit your situation. As the captain of your own ship who has been navigating these waters on your own, seeking external help can be of great assistance to facilitate your own healing journey.
Identifying and exploring your beliefs around pain
Initially, we want to be sure that a person is starting with the right information and the right messages about what is appropriate for their situation. Oversimplification of conditions, outdated information, societal messages, misinterpretation of findings, implicit bias and other contributing factors can lead a person to having unhelpful beliefs about their body or condition. Working with a practitioner who is up to date with current information is the most likely way to be able to get the correct information you need to know about your situation and how to construct a plan if you are unsure.
How thoroughly can you potentially explore a new movement if you think it may be dangerous? Will your progression be as quick as possible if you think you should stop well short of a tolerable threshold? What does your pain mean to you when it arises? Exploring beliefs around your interpretation, causes, control, timeline and actions in response to your pain all help to construct a plan.
Example: If you believe osteoarthritis is a ‘wear and tear’ injury due to its representation in society, you may avoid or limit physical activity as you believe it to be detrimental to the health of the joint. However, being physically active has been shown to be effective at increasing range of movement, decreasing perception of stiffness, increasing strength, increasing functional capacity and decreasing pain. You may need guidance in identifying and establishing a baseline of physical activity though, especially if you have been inactive for a prolonged period of time.
Education around contributors to pain
We have an extended article elsewhere on the site which deals with identifying contributors to pain. Often, we can get fixated on a solely structural cause of pain in our bodies and ignore other addressable contributors which can decrease and resolve our pain symptoms.
Example: You have been dealing with persistent low back pain. You are extremely guarded with movement after receiving an MRI and seeing that you have degenerative discs and a disc bulge. You are advised to stop gardening (an activity that you enjoy), avoid flexing forward and to rest. The pain persists so you see a physical therapist who advises you to work on strengthening your core to increase your core stability. This along with phrases such as 'slipped disc' makes you feel as if your spine is in danger of further damage and increased pain unless you do the right thing constantly. Relationships become strained as you feel like you are a burden or expected to do things beyond your capabilities because you do not have a visible injury and you are a personality who puts other people before yourself consistently. These previously listed elements (biological, psychological, social factors) have contributed to your pain experience.
Establishing strategies
Once an individual’s contributors to pain have been established, establishing strategies and a plan to address these factors and implementing it is the next step. These will look different for each individual.
Example: You receive education that although your scan might not be perfect, the changes inside your spine are normal for a person your age and you can be pain free with degenerative discs and disc bulges present. Your spine is actually a resilient and strong structure, and although it may currently be sensitive to certain movements such as flexion, it is still completely safe to flex your spine and engage in activities you love such as gardening. It is explained that by being over-protective of your spine, the muscles around it are extremely stiff, limited in movement and have actually become more sensitive to certain movements. You receive education about interpreting what pain is telling you in certain situations and you begin an exercise program that is tailored to de-sensitising yourself to movements and activities that you fear are aggravating. You are given permission to start activities you love again at a slightly reduced volume and encouraged to participate in daily life. You are also given instruction in how to manage anxiety around movement and given exercises that you perform daily to re-enforce confidence in your abilities.
Exercise is beneficial to all individuals
Regardless of underlying diagnosis or condition, exercise is beneficial to all individuals. However, the ‘dosage’ of exercise and the prescription will need to be tailored and progressed at a rate that is suitable for each person. For some people, this may take the form of a simple walking program and some low intensity exercise with a focus on relaxation, decreasing sympathetic nervous system output and de-sensitisation to movement. For other people, this may involve reducing the load of a barbell back squat in the gym before building back up at an appropriate rate and monitoring for symptom onset. Generally, an exercise program should look to improve function directly related to a person’s goals, diminish movement based fears and build resilience and self-belief.
Re-engaging in meaningful activity
Often, chronic pain can start to limit our engagement with activities that we love. We might feel unable to participate or uncertain if an activity is appropriate for us. Having something meaningful to progress towards is important for a number of reasons: it can provide us with motivation to exercise, bring joy into our lives, help us to express ourselves, decrease anxiety, promote healthy behaviours, encourage social engagement and encourage us to move our body in new ways.
Progress is usually not linear
Management of flare-ups, continual review of programming, stress contributors and steadying the course. When dealing with pain, progress is usually not linear. There will be ups and downs along the way and there will most likely not be one distinct moment where the pain is resolved, but a gradual progression of small wins that accumulate and our capacity to engage in our lives increases.
This article has been written by Atkins Health. For more information on their programs and services, please visit their
website.