How to manage difficulties in relationships

In Chapter 2 (‘Understanding Chronic Pain and Pain Systems’), pain was described as an individual, ‘subjective’ experience. This means that no one can know exactly what your pain experience is like. However, you can tell others what body sensations you are feeling, such as pressure or tightness. You can also share how the pain makes you feel in terms of your mood, such as fed up, worried and so on.

People will see how you behave and try to understand these actions. For instance, you might grit your teeth, limp, rub the painful area, withdraw to bed, moan, or be snappy and short-tempered. These are ‘pain behaviors’, which communicate something to those around you. People can be very sympathetic and supportive, especially in the short term (for example, if you fall and hurt your arm and have elbow pain for several weeks).

In the long term, all but the most ‘saintly’ can run out of sympathy or patience with persisting pain. This is when a different approach can help. People close to you need to understand what you are trying to achieve. Otherwise, they can sometimes jump to the wrong conclusions, which can be unhelpful. It helps to explain clearly how you plan to manage your day or week and your pain.

Then they can:

•   Encourage you, and help to reward your efforts (see Chapter 7).

•   Help you to stick at it when the going gets tough.

•   Remind you to ‘pace’ yourself and your activities (see Chapter 8).

•   Learn to avoid being over-protective towards you.

•   Stop doing things for you that you could do yourself, given time and encouragement.

•   Learn to encourage you for trying to stick to your plan.

If you are close to someone who wants to help, have a talk about what your goals are. Talk about the helpful ways to achieve them (see Chapter 6).

Write in your notebook what goals you are trying to achieve that you would like to share with (name).

How to change behavior

It’s well known that if children are rewarded for an action they are more likely to repeat it. Think about this in relation to yourself. If you are rewarded for a particular behavior, you are also more likely to do that behavior again. Unfortunately, this principle applies to unhelpful as well as helpful behaviors.

Let’s take an example:

Imagine that you want to get out to the local shop to buy bread and a newspaper. You have chronic pain, which makes you stiff and tired in the morning. Someone who loves you will always offer to do it for you if you tell them that the pain is bad today.

What are the results?

•   You get the paper and the bread every day.

•   You do not get encouragement to do it for yourself.

•   You feel more ‘dependent’ on someone else.

•   Your self-esteem is lower, you don’t feel ‘in control’, you lose confidence.

•   What else might you lose?

The end result is that you are ‘rewarded’ for saying that you are in pain. The long-term effect on your feelings, pain and behavior is not always helpful.

Let’s imagine a different scene:

You want to get the bread and the paper from the shop every day. You have chronic pain and you are very stiff in a morning so it is hard to get started. You set yourself a pacing baseline. You plan it so that you can get to the shop if you rest on the bench for two minutes on the way there and again on the way back. Someone who loves you will always offer to do it for you if you say that the pain is bad today. You explain to them that it would help to have a reward, such as a cup of tea, when you get back from the shop. It would also help if they said ‘well done’ or ‘thanks!’ to you, so focusing on your achievements despite the pain and stiffness. You ask them to encourage you to go, especially when you don’t feel like it, or you are having a bad day.

What are the results?

•   You get the bread and the paper every day.

•   You get the satisfaction of achieving it yourself, using your own plan and your pacing skills.

•   You get a ‘reward’, which helps you to improve things.

•   Your loved one gets to see you working through the problem and knows what will really help you.

•   You feel more independent and more in control, and you gain confidence.

•   You are managing your pain better.

Furthermore . . .

Your family, or the people close to you, now understand that you are not doing any further harm by starting to exercise and getting active. And you are not ‘slacking’ when you slow down, pace yourself, take a break before the job is finished and give yourself a reward for trying.

It is more helpful to be allowed to do things at your own pace, rather than have someone else do them for you. They can then help you with things that you really can’t manage, such as heavy lifting.