This handbook is written for people with chronic pain. It is aimed primarily at those of you who have experienced frustration and discouragement as you have worked your way through the maize of medical diagnostic and treatment alternatives. Perhaps adding to your frustration, you may have received all kinds of advice from well meaning family and friends.
Chronic pain, like many other chronic physical conditions, does not fit neatly into our current technologically-driven, drug-oriented medical culture. According to the dominant medical culture, doctor and patient alike want the quick fix, the cure that will enable you to forget your body and return to your former way of living. You may think "if only I can find the right specialist, receive the correct diagnosis, or be given the right pill, injection, surgery or other procedure, then I can be relieved of this pain once and for all." Even though this hasn't happened yet, there is always hope. Recently, I read an article in the newspaper with the provocative title, "Pain study leaps forward: Research points toward cure for chronic sufferers." The article referred to a study by a VA medical researcher published in the journal Science (11/19/99) about the injection of a neurotoxin into certain spinal cord nerve cells which blocked chronic pain in laboratory rats for 200 days with no side effects. Anyone with chronic pain reading this article can readily fanaticize, "wouldn't it be just great to get an injection and be pain free for that period of time!" Although the results of this study undoubtedly advance our understanding of chronic pain and offer hope, several questions still remain. Will the procedure work with humans? Will it work with many types of chronic pain or just a few pain conditions? What are the risks? Will there truly be no adverse side effects? Although these questions can only be answered with further research, you are left trying to deal with today's pain.
Unfortunately, disappointment is the negative flip side to hope in medical technology. How many times have you seen a new doctor, been offered a new medication, or tried a different treatment procedure which stirred your hope that this would be the answer, only to have your hopes dashed when it didn't work? For some, the repeated cycle of hope and later disappointment eventually leads to a downward spiral into feelings of depression, discouragement, and hopelessness. For others, the issue of blame enters into the doctor - patient interaction. Some chronic pain patients blame their doctors for the doctor's seeming failure to understand or take their pain complaints seriously. Doctors can also be blamed by patients for their unwillingness to use the proper medical technology (e.g., run enough diagnostic tests or use strong enough drugs), or for their basic incompetence in dealing with chronic pain. Likewise, some doctors blame their patients for not responding to pills and other medical procedures. The patient is thought to be exaggerating the pain, or perhaps it is all in their head. Perhaps the patient doesn't really want to get better and is just using the pain to get sympathy, prescribed pain medications, or disability compensation. Frustration, confusion, anger, blame, disappointment and discouragement are common byproducts when medical technology goes awry in treating chronic pain.
In our Chronic Pain Management Program we pursue a different approach to chronic pain. This approach, which is discussed throughout the patient handbook you are now reading, is called self-management and represents an alternative or supplement to medical management. Unlike medical management, which relies solely on healthcare professionals, prescribed drugs, and passive medical procedures, self-management places responsibility for day-to-day pain management back on you. It requires you to acknowledge and reclaim ownership of your own body and to pursue healthy means of managing your pain. While not opposed to medical management, self-management aims at creating a healthier balance between self-reliance and dependence on professionals.
With self-management we also strive for a healthy balance between constructive problem solving and realistic acceptance. Reasonable attempts to find and fix the source of the pain condition or find ways to decrease disability are pursued. However, many find the goals of being totally pain free or free of any physical impairment to be unrealistic. This is where healthy acceptance comes into play. Acceptance, which is discussed further in Chapter 8, does not mean taking a defeatist attitude. Rather, we work at accepting the fact that illness, pain, physical breakdown and ultimate death are inevitable parts of human existence. At the same time, we also work at doing whatever we can to keep the pain at a manageable level and live life to the fullest.
Pain self-management, as discussed in our program and this book, is based on a holistic view of health and illness. Rather than the common tendency to view the body and mind as separate entities, we believe that body and mind are intertwined and operate together as a unified whole. Chronic pain ultimately involves not only the body, but also mind and spirit. Although we sometimes use fancy hybrid words to describe this viewpoint such as biopsychosocial, or even bio-psycho-social-spiritual, the important point is that our focus is on you as a whole person. This means that, rather than trying to identify and fix malfunctioning body parts, we are interested in how chronic pain has impacted your entire life. Consequently, you will find chapters in this handbook dealing with topics such as pain and depression, anger, family relationships, sexual functioning, and sleep difficulties. Because body and mind are intertwined together, it makes sense that what goes on in your body can affect your mind, and what goes on in your mind can affect your body. This also means that psychological treatment techniques can have an impact on your physical condition, just as physical techniques can affect you mentally and emotionally. Along with this holistic approach, we believe that chronic pain must be approached from a number of different angles. No single health care professional has all the answers to chronic pain. No single type of medication, injection, surgical procedure, or other technique is the answer to all chronic pain.
In our self-management program, we use both physical and psychological pain coping techniques. However, the physical techniques we emphasize most strongly are those which you can learn to do on your own rather than those which require going to a professional. Although physical therapy, chiropractic manipulation, or acupuncture may be of value, they all require going to a trained professional. Since these passive physical procedures, when they do work, typically have temporary effects, you are stuck with having to return again and again to the professional. Self-management approaches, on the other hand, are meant to be implemented by you in your own natural environment. Self-management is aimed helping you develop and maintain a sense of personal control, dignity, and self-respect, often despite having chronic pain and disability.
Self-management approaches to chronic pain are also meant to be flexible and adaptable to individual needs. In this Handbook we will cover a number of topics and self-management techniques. Not all of them will apply to you. An important part of the self-management process is to carefully and honestly assess your own situation, and then derive your own personally relevant goals. For example, some of you may decide that you need to be less sedentary and become more physically active. Others of you may need to find ways to slow down and give your body more rest breaks through healthy use of relaxation techniques. What works for one person may not work for another. Ultimately, you should use your own experience as your guide. That’s what self-management is about.
Richard W. Hanson, Ph.D.