
- •Other titles in the series include:
- •Overcoming chronic pain a self-help manual using Cognitive Behavioral Techniques frances cole, helen macdonald, catherine carus and hazel howden-leach
- •Isbn: 978-1-84119-970-2 eIsbn: 978-1-47210-573-8
- •Table of contents
- •Acknowledgements
- •Foreword
- •Introduction by Peter Cooper Why cognitive behavioral?
- •Introduction
- •Who might benefit from using this book?
- •What does chronic pain mean?
- •What is Cognitive Behavioral Therapy?
- •How can a book help?
- •How can I get the most out of using this book?
- •What do the chapters cover?
- •How do I start using this book?
- •Four case histories
- •Using the person-centred model
- •Maria and the person-centred model
- •How did the model help Maria make changes for the better?
- •How can the person-centred model help you get ready tomake some changes?
- •Getting started
- •Reducing the impact of pain on your daily life
- •How do you or others see these changes occurring?
- •Understanding chronic pain and pain systems
- •Understanding pain
- •Acute and chronic pain
- •What is acute pain?
- •What is chronic pain?
- •Acute and chronic pain systems
- •The acute pain system
- •The chronic pain system
- •Theories of pain The Gate Control Theory of Pain
- •Other theories of pain
- •Frequently asked questions
- •Understanding investigations for pain
- •Blood tests
- •Waiting for tests and results
- •Understanding the roles of healthcare professionals
- •Healthcare professionals
- •What is the role of a physiotherapist?
- •How do physiotherapists work?
- •What is the role of a specialist pain nurse?
- •What is the role of a pain specialist?
- •What is the role of a psychologist?
- •What is the role of a psychiatrist?
- •Talking therapies
- •Cognitive Behavioral Therapy
- •Pain management programmes
- •Understanding medicines and using them better
- •What types of medicines are used to manage chronic pain?
- •How are medicines used? Analgesics
- •Problems with medicines
- •Making better use of medicines
- •Four suggestions for using medications more helpfully
- •Stopping or reducing your medicines
- •Part two Overcoming Chronic Pain
- •Introduction
- •Setting goals
- •What are goals?
- •Informal and formal goals
- •What are smart goals?
- •Setting goals
- •Using a goal ladder
- •Achieving your goals
- •Giving yourself rewards
- •What are rewards?
- •Creating a ‘fun presciption’
- •50 Mg of fun three times a day (at least) For maximum benefit, use imagination!
- •Understanding pacing skills
- •What is pacing?
- •What are the different styles of pacing?
- •What type of pacing style do you use at present?
- •If pain levels are low, do you:
- •If pain levels are high, do you:
- •How to change your pacing style
- •Experimenting
- •Planning
- •Priorities
- •How to deal with barriers to realistic pacing
- •Getting fitter and being more active
- •How being more active can help you manage your pain
- •Trying to get fitter: What does having more pain mean?
- •Why do these types of activity cause aches and pains?
- •Assessing your present activity level
- •Frequently asked questions about increasing physical activity
- •How to get started on a basic exercise programme
- •Strength exercises – do slowly
- •Stretches for flexibility
- •Understanding problem-solving
- •What is problem-solving?
- •The main steps in problem-solving
- •Putting the problem-solving process into practise
- •Problem-solving guide
- •Understanding sleep and sleep problems
- •What sort of sleeping problems can be caused by chronic pain?
- •What kind of sleep pattern do you have at present?
- •How much sleep do you need?
- •How to use a sleep diary
- •How can you change unhelpful sleep habits?
- •Relaxation
- •What is relaxation?
- •How can relaxation help with chronic pain?
- •What can help you relax?
- •How to practise relaxing
- •Time out relaxation
- •What can make it difficult to practise relaxation?
- •Pain, communication and relationships
- •Part 1: communication and sharing concerns How close relationships can be affected by pain
- •How to manage difficulties in relationships
- •How to change behavior
- •How to communicate and share your concerns
- •Part 2: chronic pain and sexual relationships
- •How to deal with sexual problems
- •How to make sexual relationships easier
- •Managing depression, anxiety and anger
- •What moods can occur because of pain?
- •Part 1: managing depression
- •Why do people become depressed with chronic pain?
- •How depression affects people’s thinking
- •What factors can contribute to depression?
- •Unhelpful thinking in depression
- •Using anti-depressants
- •Part 2: managing anxiety
- •What is anxiety?
- •What are the effects of anxiety?
- •How does anxiety affect the body?
- •Anxiety and chronic pain
- •Managing anxiety by dealing with unhelpful thinking
- •Overcoming avoidance
- •Changing unhelpful behaviors
- •Part 3: managing anger
- •How anger affects you and your pain
- •How chronic pain and anger are linked
- •How being angry can affect other people
- •How to manage anger better
- •A coping plan
- •Acceptance
- •What is acceptance?
- •How can acceptance help you manage chronic pain?
- •What is attentional control or mindfulness?
- •1. Reasonable (thinking reasonably)
- •2. Emotional (thinking emotionally)
- •3. Wise (being mindful)
- •Mindfulness skills
- •1. Observing
- •2. Being ‘non-judgemental’
- •3. Focusing on one thing now and being in the present
- •4. Doing what works
- •Mindfulness exercises
- •Maintaining progress and managing setbacks
- •How can you maintain progress?
- •Obstacles to progress
- •What is a setback?
- •How can you manage a setback?
- •Looking to the future and managing work
- •How are new ways of life and new roles possible?
- •How can you use a positive data log?
- •Thinking through work, training and other options
- •How can you stay at work or return to work successfully?
- •Useful information
- •Professional organizations
- •Self-help groups and organizations
- •Books and publications
- •Self-help books
- •Tapes and cDs
- •Useful videos
- •Wordlist
How to get started on a basic exercise programme
Here are some suggestions for a basic exercise programme that will begin to improve your strength and flexibility. Your stamina will improve with any activity that makes your heart beat faster and stronger, e.g. climbing stairs, walking uphill, washing the car, or sweeping the yard. It helps your heart become fitter if it beats faster and you become slightly breathless.
Note: Before thinking about doing these exercises, make sure you read all the sections above.
You will need:
• A chair
• Floor space and a mat or blanket
• Loose, comfortable clothing
• Some time!
HOW DO YOU ‘WARM UP’ AND ‘COOL DOWN’?
A ‘warm up’ means using gentle, relatively slow movements to prepare your body for exercise – for example, walking for 5 minutes, going up and down the stairs a couple of times, or anything that makes you breathe a little faster and gives you a warm feeling.
A ‘cool down’ means using gentle movements or stretches to help the body recover from exercise. An example of a ‘cool down’ may be walking on the spot and letting your arms swing by your sides for 3–5 minutes.
All the exercises overleaf marked with an (S) can be used as stretches.
TIP
Remember that, initially, the warm up may be enough.
Illustrations of the following exercises can be found in the Appendix pages 298–304.
Strength exercises – do slowly
NECK
Starting position: Sit down, face forwards
1 Bring your chin down towards your chest and then up towards the ceiling. (S)
2 Look over to your left shoulder, return to facing forwards, then look over to your right shoulder. (S)
3 Bring your ear down towards the shoulder on the left, and then do the same to the right side. (S)
SHOULDERS AND ARMS
Starting position: Sit or stand, arms down by your sides
4 Bring your shoulders up towards your ears. (S)
5 Push your shoulders down towards the floor. (S)
6 Bring your shoulders forwards to meet each other at the front of your body. (S)
7 Pull your shoulders backwards to meet each other at the back of your body. (S)
8 Lift your arms forwards and up above your head. (S)
9 Lift your arms sideways and up above your head. (S)
10 Place your hands on top of your head and slide them down the back of your head towards the floor. (S)
11 Place your hands on your bottom and slide them up towards your head. (S)
12 With arms down by your side, bring your hands up to touch the front of your shoulders. You may add a small weight, like a can of beans in each hand for any of the arm exercises.
LOWER BACK
Starting position A: Sitting on a chair with legs straight out
13 Let your hands slide down the front of your legs towards your feet.
14 Let your back slouch into a C shape and then sit upright again.
Starting position B: Lying on your back with your knees bent up and feet flat on the floor or bed
15 Keeping your knees together, let them roll from side to side. Keep your shoulders flat on the floor. (S)
16 Place your hands on the front of your thighs and let them slide up towards the tops of your knees, keeping your chin tucked in.
HIPS
Starting position: Standing up and facing forwards
17 Take 3 steps to the left and then 3 steps to the right.
18 Take 3 steps backwards, then 3 steps forwards.
19 Face up a flight of stairs or a step. Step up onto the loweststep, then bring the other foot up onto the same step.
KNEES
Starting position: Sitting in a chair
20 Straighten one leg out, then return and straighten the other. (S)
21 Stand up from a sitting position, trying not to use your hands to help. The lower the chair, the harder it is!
ANKLE
Starting position: Standing up, facing a windowsill or a kitchen work surface
22 Push downwards through your hands into the surface and move up on to tip toes, as if looking over a high fence.
Note: Everybody can become more physically active. However, it may be sensible to inform your doctor that you plan to do more activity. You must tell your doctor that you plan to do more exercise or activity if you have any heart condition, such as severe angina or a previous heart attack, or diabetes, or dizziness or blurred vision when you turn your head.