Developing a Plan for Chronic Pain Relief

The experience of chronic pain is more than just the pain itself.  Pain can affect how a participates in life, from physical activities like running and cycling or simply bending over to pick up a grocery bag, to emotional wellbeing and functioning in daily activities like work and social outings.  In turn, mood, physical activity, and social engagement influence the level of pain one experiences.  It makes sense, then, that an optimal pain management plan is multifaceted and tailored to the individual:

    • education,
    • structured exercise,
    • judicious use of medication,
    • meditation and breathing techniques, and
    • psychological or other mental health treatments for developing strategies for thinking about pain as well as for other conditions that are co-occurring with chronic pain (depression, anxiety disorders, PTSD).

The big question is, how does a person experiencing chronic pain get help getting an effective treatment plan together?

Since pain is an internal experience, the experience of pain may be invisible to others, sometimes leaving the person with pain feeling alone and not well understood by others. Additionally, many people with chronic pain find themselves withdrawing from activities resulting in social isolation. Therefore, one of the most important things a person experiencing chronic pain can do is talk to others. Talking to a clinician or other provider can help promote feelings of being understood and start a course for reducing pain to a reasonable level, while maintaining higher levels of functioning, emotional wellbeing, and quality of life. Conversing with friends and family members may also be helpful for reducing feelings of isolation and also in building an “at-home” support team for your pain management plan. Ultimately, you are the expert on your experience of pain, and starting with thoughtful, open communication can be the start to reducing chronic pain’s negative impact on your life.

Click here to see talking points and other ways to prepare for the conversation.

While the majority of people manage mild pain on their own, those experiencing moderate to severe chronic pain—pain that's lasted three months or longer despite a reasonable period of recovery and that interferes with daily activities and work—or an exacerbation of a chronic pain condition, often choose to go to their primary care provider first. On the other hand, with certain kinds of pain conditions, like low back pain, one might seek care from alternative providers such as a physical therapist, chiropractor, massage therapist, or acupuncturist. Other providers that may be able to help with chronic pain include mental health care providers for developing strategies for achieving goals and gaining control over how one thinks of their pain, yoga and Tai Chi practitioners, and nutritionists for dietary guidance.

Findings from a large body of research suggest that a majority of people with chronic pain may achieve adequate pain control and improved physical and emotional functioning through the implementation of an integrated, multimodal pain management plan that supports successfully managing pain while maintaining valued activities. Development of the plan begins with a comprehensive pain assessment that relies most heavily on an information exchange between persons with pain and their providers. It may be that a single visit with a single practitioner isn't going to have a substantial impact, but a series of sessions with one provider, or a team of providers, can make a world of difference. Be sure that your primary care provider or other healthcare providers are aware of the approaches that you either are or have been using so that they can be thinking about how these approaches might best fit into your integrated pain treatment plan.

Try to set specific, measurable, and most importantly, feasible, goals. The goal can be based on thinking about, "Right now, what can I do comfortably? And what would I like to be doing three months from now if I am successful in better managing my pain?" Specifying goals that are meaningful is an important strategy for ensuring an effective plan. It can be as simple (but as invaluable) as wishing to play with your children or grandchildren. Research has shown us that a very large proportion of people engaged in a targeted treatment plan can successfully achieve meaningful goals that help them live a quality life.

Finding a way to keep moving, despite the experience of pain and without threat of further injury, is the basis for a strong pain management plan. It doesn’t need to be strenuous, and it especially should not increase pain. A walking or swimming program can be helpful for many pain conditions. Yoga and Tai Chi, both of which are known to help relieve the pain of osteoarthritis, can help provide relaxation and develop better breathing techniques, as well as in helping to gently stretch and move the body. Another common approach is physical therapy, which can be in a professional setting or at home, with some guidance around structured exercises that target specific pain conditions.

Gathering specific guidance from practitioners, books or other reputable sources can help build a pain management tool kit to include mental relaxation techniques, distraction activities to remove the focus from the pain, and meditation. Early access to Pain Coping Skills Training, which is a cognitive and behavioral approach that involves relaxation, activity pacing, and visual imagery techniques, can help people flip their experience of pain from it controlling them to the individual controlling the pain. The more a person can add skills to their toolbox, the more they can develop a sense of mastery and confidence about their own ability to manage their pain. That feeling of control alone can help decrease the emotional burdens from pain, as well as the physical ones.

The integrated, multimodal approach to pain management has garnered attention and study, including Pain Management Collaboratory’s own pragmatic trials, with much success being noted in VA’s Whole Health Model for overall patient care. Establishing a plan that addresses all aspects of the individual’s experience of pain, along with goal setting and good communication with providers, can be quite powerful in reducing the level of pain experienced. More research needs to be done to find the most effective combinations and durations of therapies, depending on the individual and the type and location(s) of pain being experienced--thus, the importance of studies like the ones being conducted by researchers in the Pain Management Collaboratory.

As much as you are the expert on your own pain, you are also your own best advocate for lessening the level of pain you feel. Sometimes, it takes quite a bit of action and effort on the part of the individual, because one is taking on changing ways of thinking and establishing new habits to make goals achievable and the pain management plan successful. With the proper support, reasonable goals, a multimodal therapeutic approach, and effort, the vast majority of people with chronic pain can lead a high-quality life.