July 16th, 2009

Pain Management Class #9

Pain Management Class #9

In today's pain management class, after a review of all the previous topics we've covered over the course of the classes, we looked at how to handle a pain flare.

Pain flares are inevitable. Even if we diligently practice the deep breathing relaxation response, pace ourselves perfectly, observe excellent sleep habits, stop ourselves from getting caught up in cognitive distortions about our circumstances, set and maintain healthy boundaries and clearly communicate our needs and wishes, we are still going to have pain flares from time to time. There is no way to avoid them. So we need to formulate a strategy ahead of time for how to handle them, before we are in the middle of one and getting overwhelmed.

The goals for a pain flare coping plan are to decrease the intensity of the flare, to decrease the duration of the flare, and to increase the time between flares. This is best achieved by using a combination of the deep breathing relaxation exercises, cognitive restructuring and physical conditioning. Often the basic plan will need to be modified in some fashion, to account for different kinds of flares or different circumstances surrounding any particular flare.

The plan needs to be in writing, to help us remember the details of it in the heat of the moment when we are distracted by the pain and the accompanying emotions. And it needs to be specific, the way a building's fire exit plan is specific. You never see a building's fire exit plan signs say just "In Case Of Fire, Get Out." Instead, they have a map of the premises and specific instructions of how to get out. And our pain flare coping plan needs to be just as specific to be useful.

Our plan needs to include being aware of our thought process, including any negative thoughts -- they need to be addressed head-on in order to employ any necessary cognitive restructuring to get through the flare. It needs to include deep breathing, to help the relaxation response kick in and start reducing the pain. It needs to include a pacing strategy to figure out how to accommodate for the flare. It needs to include any physical therapy exercises or stretches that might help mitigate the pain.

There should be multiple hard copies of our plan, to be sure of having a copy at hand wherever we may be when a flare might strike -- at work, in purse or wallet, on the fridge, in the nightstand, etc. Significant others and family members should have copies as well.

This was the final session of the pain management program. I learned a lot from it. Probably the most useful thing for me will turn out to be the deep breathing exercises, because almost everything else we covered in the classes built upon that foundation. And the deep breathing is simple and easy to do, but it can achieve some pretty impressive results all on its own, without any drugs or special equipment or anything else. So even if I might forget the formula for how to make an "I statement" or all 10 sleep hygiene recommendations, I won't forget how to breathe in, count for 5, hold for 1, breathe out for 5, hold for 1, etc., etc. *takes long, deep breath* *feels more relaxed already*

rtfMRI Scan #6

rtfMRI Scan #6

Yesterday I had my sixth and final rtfMRI scan in the chronic pain treatment study, and this time I alternated between using the successful strategies for increasing and decreasing my pain found during the previous scans (the affective strategy, using the feelings of anger, discouragement and frustration for increasing the pain, and the evaluative strategy of thinking about a day when I had little to no pain for decreasing the pain) with the new coping strategy, where I thought about how bad things would get if my pain just got worse and worse every day until I was completely disabled by it to increase the pain, and then thought about how good things would get if my pain went away little by little every day until it was gone completely for good to decrease the pain.

This was another strategy that seemed really abstract to me, and I felt really detached from it while practicing it at home.  There was some overlap with the sensory and affective strategies, because while thinking about how bad and how good things could get for me, a lot of emotions and physical feelings came up.  I found out that some people do better if the sensory and affective strategies are placed in a specific context or scenario, so some overlap is natural in the evaluative and coping strategies, and it wasn't like I was doing them wrong or anything like that (which had been a minor concern of mine).

So after 8 scans yesterday, the winning strategies for me are the affective for increasing my pain and the evaluative for decreasing my pain.  Whoop-de-doo. 

Boy, am I glad that's all over.  I was getting really tired of practicing those strategies.  I was getting really tired of lying in the scanner for 45 minutes, thinking about one particular strategy for 60 seconds at a time and then switching at the drop of a hat to a different one for 60 seconds, and then back again, and so on (my brain fog doesn't make it easy for me to concentrate the way the study required).  I was also getting tired of all the paperwork to fill out before and after each scan.  I know it's all necesary for the study, but nevertheless it became tiresome.  I've reached my burn-out point with it all.

There is still some homework to do, but it involves keeping a simple pain diary for one week, and then I have my first follow-up appointment.  There is a second follow-up in 2 months and a final follow-up in 6 months.  And then I'm free to live my life, strategy-free if I so choose.  Whoop-de-doo.