Self-management

Sleep

How can you sleep when you have pain? Sometimes pain keeps us awake, but we are also kept awake by our thoughts, worrying about the past and the future, negative feelings, and restlessness. It’s very common to spend more time resting or napping during the day because of pain and fatigue. That makes it harder to fall asleep at night.

Try to pay attention to how your daytime routine affects your sleep. One of the most effective ways to deal with insomnia, with or without pain, is to limit the amount of time spent in bed. This helps to consolidate your sleep to be more restorative with less time in bed. It’s hard to do because you’ll go to bed feeling very tired and you’ll get up before you want to! I know, ugh! But it works! Read “Goodnight Mind” by Colleen Carney and you’ll be convinced to give it a two-week trial. After that, anytime you start to have sleep difficulty again, you’ll go back to reducing your time spent in bed until you are sleeping well again.

Medications for sleep may help some people for a while, but they aren’t a long-term solution. This is. What if you wake up in the middle of the night and need to get up and move around to relieve stiffness and pain? If you can do that and still fall back to sleep easily when you feel ready, then this is okay. If you can’t fall back to sleep, then you will need to try reducing your time spent in bed.

What should you do when you get up? Find something quiet and relaxing to do so you don’t activate your brain too much. Using the computer or your phone can be too stimulating, and there is evidence that the blue light can shift your sleep patterns. Generally speaking, reading a book or magazine is okay. Maybe it’s a good time to practice meditation and focus on your breathing.

Gentle Movement

“Motion is lotion”

Gentle movement helps your body and brain recover in many ways and is not harmful. If you do some movement and it doesn’t feel right, slow down and pay attention to the sensations you are feeling. Ask yourself, “is this really dangerous?”. Most times, the discomfort comes and goes and is not related to the movement. When you are not fearful of movement, the brain begins to learn a new and valuable lesson.

As a result, with consistent gentle movement, as through walking or doing a set of exercises daily, your body will adapt and will be able over time to do more. If you get too ambitious and on a good day, you overdo it, you will still get a flare up to remind you of your limitations. Try to stay consistent and gentle, but persistent with yourself. This approach will take time, but it works!

Daily Routines

If you work, that tends to dictate your routine. When you cannot work or volunteer, it can be challenging to figure out when and why to do anything in the day. Time slips away from us and nothing much gets accomplished.

Try to keep a consistent daily routine for five days per week, so that you get up and go to bed at similar times. Plan to prepare and eat meals at certain times, then organize everything else that you want to get done around these points in the day.

Keep track of the time of the day that is your “best time” and make use of that time to do what matters most to you. Quite often you’ll notice that there is a lot of time spent resting or recovering. Think of lighter tasks, like sorting and organizing, making lists, doing something creative. These can be used as activities during what used to be your rest times. This can make you more productive, efficient, and it keeps you mentally engaged even when the body is in need of rest. It turns out that you didn’t need to nap! When you use your brain for something productive, fewer neurons are involved in telling you about your pain.

Mindfulness

Mindfulness is moment-by-moment awareness of thoughts, emotions, and sensations without judgement. The focus of attention is often on breathing, but it can also be on other present moment events, such as sounds or other body sensations. Mindfulness practices can take the form of meditations such as the body scan or it can be an informal practice throughout the day, where you notice details of the present moment and your sensations, thoughts and feelings. When taking a shower, pay attention to the temperature and sensation of the water on your skin, and enjoy the present moment. If your mind is anticipating the future, or ruminating on the past, interrupt this for a brief moment to fully experience the shower. It can be as simple as this. Each time you interrupt your automatic brain processes, you are retraining your brain to experience more of the present moment. The body scan meditation is very effective in reducing pain, but if you have chronic pain, you might prefer to start with shorter meditations first.

These are two books that are recommended to help you get started with mindfulness for pain.

“The Mindfulness Solution to Pain” by Dr. Jackie Gardner-Nix (audio downloads available)
“You Are Not Your Pain” by Vidyamala Burch and Danny Penman (includes CD)

At Peace with Pain

(Adapted from Altman,D. (2014). “The Mindfulness Toolbox: 50 Practical Tips, Tools & Handouts for Anxiety, Depression, Stress & Pain”. PESI Publishing and Media: Eau Claire, WI. Pg 186-7).

“With this meditation, may I find peace of mind with my pain through the love, support and comfort of others”.
Recall those persons who it feels good to be around,
Mentally say the following words to yourself:
“May I rest in the very compassion, love and support that these individuals hold for me”.
“May I rest with an abiding peace with my situation, knowing that I am always supported by my benefactors”.
Think about and feel a sense of unity with yourself and your benefactors.
Feel the warm compassionate gaze and loving support of benefactors from your past, present, and even those who you may encounter later today or tomorrow.
Lastly, send these benefactors a blessing that reflects your gratitude and appreciation.

Stress Reduction

Stress makes pain feel worse. Mindfulness might help to manage stress, but sometimes you also should take an honest look at the source of your negative stresses.

There are some positive stresses in life too. This might be what motivates us to get going in the morning and to finish what we start. Sometimes children bring ups and downs with stress, but overall, they are a positive.

If you have a lot of stress, for example from not being able to do certain things for yourself, your family, or you are having money problems, there comes a time when you should think about what you can do to address the stress and make positive changes. There might not be easy solutions for everything but try talking with other people about your stressors with an intention to make changes to make things better.

Write down some of the ideas that come up as you brainstorm together.

Example:

Chuck was feeling guilty about not being able to go on a family outing to the zoo because his severe back pain and numbness in the legs made walking difficult. His wife suggested that they bring along a borrowed wheelchair and use it when needed. His wife was willing to push him if he felt too tired. This took away the barrier to his participation in the outing, and the associated feelings of guilt for letting the family down. Afterwards he reflected that he should have thought of that before. We don’t always think of the possible options when feeling stressed.

Feeling Useful

Having to rely on others is uncomfortable. On the other hand, others will appreciate it when you can be of service to them. Think about what you like to do, what you can do, and do it! Feeling useful helps both you and others. The smallest thing can make a difference.

If someone asks you to do something beyond your ability, you have some choices: politely say no, offer to help do a smaller, more manageable part of the task, or see if you can find someone else who can help. There are a lot of possible choices. These are just a couple of examples to help you get started. Saying no is hard, but its an option. You still might have to look harder for ways that you can feel useful and contribute in a meaningful way to your family, friends, neighbours, and at work.

Asking for Help

Think of someone you know who is good at asking for help and expressing gratitude to others. This can be your model of how to do this difficult task with skill and confidence. How and when should you ask for help? Some will say NEVER! That’s not true, obviously. You can and should ask for help when you need it.

Choose someone who you feel comfortable with, who might even enjoy being of service in some way. When you receive help that you have asked for, how do you feel? Is it difficult for you to accept it or are you able to feel grateful? If you can feel grateful, that’s a positive emotion and it helps reduce your pain. Okay, it might take some practice.

If you need help frequently, then consider asking someone to visit you on a regular basis and include a social component, such as having a friend over for tea with the understanding that they would also give you a little bit of help with some tasks that you cannot do on your own. If you are always relying on a certain family member, or a child, make sure to express your gratitude and be watchful that you are not burning out your main supporter.

Hobbies

Hobbies are an amazing way to feel useful and creative at the same time, and take your mind off pain for a while. With limited time and energy, sometimes these types of diversions are neglected. Think back to what hobbies you used to enjoy or think ahead to the hobbies that you planned to do when you finally had the spare time to pursue it. Where is all the time going?

Consider scheduling a small amount of time for hobbies. Hobbies are a great way to engage your brain in something other than telling you about your pain. Be creative!

Aerobic Activity

Aerobic activity is important to boost your mood and your energy and to help your body to produce its own natural pain killers. You can produce natural pain relief through other ways too, but exercise is something that should be a regular part of your self-management plan. If you are going to do aerobic activity, choose something you enjoy that’s within your physical abilities. Even if you choose something you enjoy, it isn’t always going to be a perfect session every time. We have ups and downs from day to day with pain and fatigue. Just try to be persistent, but flexible with yourself.

The graphic in the link below describes common sense exercise and movement guidelines prepared by Ben Cormack, a well-respected physiotherapist and pain educator. You’ll find many aerobic activity tips that you can relate to.

Read the Common Sense Exercise & Movement Guildelines.