
- •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 can acceptance help you manage chronic pain?
Many people are familiar with the ‘serenity prayer’, often used by people with long-term health problems and difficult life situations:
. . . Grant me the serenity to
Accept the things I cannot change,
Courage to change the things I can,
And the wisdom to know the difference.
Acceptance is about finding ways of living with the things that you ‘cannot change’.
This chapter is about getting used to what is left when you have done all that you can to change and manage better. It is also about grieving and coming to terms with the losses the pain has caused for you and others in your life, now and in the future. This can be one of the biggest challenges: accepting the idea that some pain may be there, however much you stick to your pain management plan.
Some people find that it helps to tell themselves: ‘I cannot avoid pain but I do not have to suffer.’ Changing your outlook on yourself and your future can be hard work and takes time. Spiritual beliefs can be helpful. For example, some spiritual teachings suggest that humans can experience ‘inner healing’ without necessarily being ‘cured’ of their illness or pain.
Having chronic pain can give you an opportunity to look again at what life means to you. It can be about finding new and hopeful meaning in your life situation. Events that may seem negative can also be seen as openings for growth, interest or new understanding.
HOW DID STEVE RESPOND TO THE IDEA OF ACCEPTANCE?
At first, Steve did not expect acceptance to help, because he believed it wouldn’t change anything, especially the things he had lost in his life.
Steve had used other chapters to challenge some unhelpful thoughts, such as: ‘I am useless’ and ‘It’s not fair’. He had made some changes. For instance, he had spent some time with his partner, Nicole, looking at the household budget and working out how they could manage on a lower income. He had also managed to start pacing himself, and was getting a little more active.
However, he still had a lot of pain most days of the week. He realized that, however hard he tried, there was still going to be some pain. At times he was angry about it, but mostly sad.
He talked over the meaning of the pain with his best friend, Paul. His friend helped him to look at the possibilities that he had because he was at home. He came up with a list. (This took quite a long time!)
• I was ‘there’ for my mother when she had her heart attack.
• I can use a digital camera and I’ve got some great shots of the family.
• I could do some different training in electrical work and be better qualified.
• I am learning how to cook things on a low budget.
• I have met some lovely, caring people in the local self-help group.
• I have learned how to send emails.
• I have developed a website.
• I’ve been reading more. I never had time for it before and it helps with the forms and letters.
• I’m closer to my partner, Nicole. I’ve learned to talk about how I feel without blaming anyone.
• I’ve learned that I can be more patient and listen to other people more.
Steve was surprised at how many possibilities or benefits he came up with. He said it didn’t make up for not being like he used to be. However he did find that he felt better and less frustrated when he thought about the benefits.
Now think about the opportunities that you have had, or could have, since having chronic pain. They can be small things, not just major ones. Talk it over with someone if it helps. This isn’t about ‘making up for the pain’. It is about seeing opportunities or chances, even though your life situation is not what you might have planned or expected.
Try to write down at least five opportunities in your notebook.