The Pain Toolkit - NHS

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The Pain Toolkit .is for people who live withpersistent painA persistent pain problem can bedifficult to understand and manageon an everyday basis.The Pain Toolkit is a simpleinformation booklet that couldprovide you with some handy tipsand skills to support you along theway to manage your pain. It is not meant to be the lastword in pain self-managementbut a handy guide to help youget started - all you need to beis willing to read it and take onboard some of thesuggestions.Good luck!Pete Moorepetemoore2@yahoo.co.ukwww.paintoolkit.orgPete Moore who has persistent pain, asthmaand osteoarthritis, has put these tools togetherwith the help of friends, family and health careprofessionals.Special acknowledgement to the BradfordPain Rehabilitation Programme team andNHS Kirklees.If you require further copies of this title visit:www.orderline.dh.gov.uk and quote 403298/PainToolkit Tel:0300 123 1002 Fax:01623 724 524Minicom: 0300 1230 1003 (8am-6pm, Monday to Friday))70k Oct 10

The Persistent Pain CyclePersistent PainTime offwork,moneyworries,relationshipconcernsBeing less activeLoss of fitness,weak musclesand jointstiffnessSometimes the arrows canalso go anti clockwise aswell. For example - time offwork can lead to negativethinking fear of the future can lead to stress, fear etcNegativethinking,fear of thefuture,depression/moodswingsCreate ‘no go’lists of thingsyou cannot doSleep problems/tiredness/fatigueWeight gain/lossStress/fear/anxiety/anger/frustrationDo you feel trapped in a persistent pain cycle?If so, ask yourself these three questions1.2.3.Do you do more on good days and less on bad days?Are you an over achiever – doing more than you haveto?Are you a people pleaser? Do you have a problemsaying NO to others when you are asked to do things?Could you see yourself in the persistent pain cycle and didyou recognise yourself in the three questions above? If youdid, then this Pain Toolkit could be for you, so please readon.22

Persistent pain (sometimes called chronic or long-term)is:- Pain that continues for 3 months or more and may notrespond to standard medical treatment. It can be disablingand frustrating for many people to manage. It can also affectrelationships with your family, friends and work colleagues.Sometimes people with persistent painare told by healthcare professionals afterassessment:“I am afraid you have a chronic or longterm pain problem. You will have tolearn to live with it.”To date, your healthcare professionals may have done all thatthey can to help you and may have used many of the toolsavailable in their toolkit. However there are so many thingsthat you can do to help self-manage your pain with thesupport of your health care professional, family, friends andwork colleagues. All you need is to be willing to ask for help.Have you become a ‘can’t do’ person?A ‘can’t do’ person is someone who has tried to carry out ortake part in everyday tasks such as going to work, doing thehouse work, gardening, playing a sport, taking holidays, goingto the cinema, eating out or taking part in family activities buthas stopped or given them up because of their pain. Whenthis happens it is usual for your confidence levels to reduce.Is this ringing any bells? If youhave reached this point you need tostop and take action. By taking on board and practisingthe tools in the Pain Toolkit youcould become a ‘can do’ personagain but it could take time soplease be patient with yourself.33

So is persistent pain a problem in the UK?The short answer is yes, so you are not on your own.Here are some alarming facts from the Chronic Pain PolicyCoalition www.paincoalition.org.uk Persistent pain affects 7.8 million people of all ages inevery parliamentary constituency of the UK. 70% orpeople with persistent pain are under 60 years oldWhy do I need to manage my pain? After all I see myhealth care professional and aren’t they supposed todo that for me?Many people with persistent pain see their health careprofessional for treatment, help and support. But have youactually estimated just how many hours during the courseof a year you spend with your health care professional?It has been said that people with health conditions(including pain) may spend less than 3 hours a year onaverage in contact with a health care professional. For theremaining 8,733 hours of the year they are on their own.So the need to learn pain self- management skills andincorporate them in their everyday activities is veryimportant.So as you can see, the need tobecome more involved in your ownpain self-management is bothnecessary and important. It iscertainly not all up to your doctoror health care professional tomanage your pain. You have toplay a vital part as well - it is allabout teamwork.44

Your next question may be “Well, how can I becomemore involved and how do I get started?Using different skills and tools can be helpful. It is like amotor mechanic who has many tools in his/her toolbox torepair and maintain cars. People with pain also need aselection of tools to help them successfully self-manage it.You may not need to use all the tools suggested in thetoolkit, but like any good motor mechanic it is best to havea variety of tools at the ready to use when and if they areneeded.Self-managing persistent pain is not as hard as you maythink—so let’s get started and look at the first tool in yournew pain self-management toolkit. 55

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Coping or self-managing?Coping with persistent pain can be like playing a game ofsnakes and ladders - a game of luck. Being an overachiever you can tend to do more on good days (climb theladder) and on bad days, do less and return to bed. (This islike sliding down the snake). Self-managing is takingpositive, planned action which can reduce the ‘luck’ elementin pain self-management.88

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Examples of pacing your daily activitiesIroningAs an alternative to doing a large amount inall one go, do smaller amounts frequently.Instead of doing the whole washing load ofironing at once, spread it over a period ofdays.e.g. have two or three piles. an urgent pile a not so urgent pile, and. ‘I can do that at the end of the week’ pile.ShoppingInstead of doing one large weekly shop cut it down to afew trips to the shops per week. Divide your shoppinginto more bags, so that you are not lifting and carryingheavy bags. Remember to ask staff to help carry theshopping and put it in your car; remembering to getsomeone (family or a neighbour) at home to lift and carryyour shopping into the home. Or consider Internetshopping, and then you just have to pack the items awayonce they have been delivered to your home.These are just a couple of examples. There may bemany other every day activities that you need to thinkthrough before you tackle them.If you stop and think about what you intendto do BEFORE you do it, then there is lessof a chance that you will have a set backand in turn increase your condition.Remember pacing is ‘taking a breakbefore you need it’ and spreading outyour activities.1212

Having a set-back planIt is not realistic to think thatyou will never have a setback ever again. Rememberif you are an over achiever; itis easy to forget to paceyourself and in turn you mayexperience a set-back.Don’t forget to stretchbefore and after mostphysical activities to avoid aset-back!So the first thing not to do ispanic, but many people do.It is best to have a set-backplan ready if one occurs.Set backs are usually caused by doing too much –overdoing it, pressure from others, or just forgetting youhave a pain problem. Don’t get annoyed with yourself, it iscommon to occasionally have set-backs.If you are not sure how to prepare a set-back plan askyour GP or health care professional for help.Prioritise your responsibilities.Pace yourself. Break up tasks into smaller portions. Restin between. Reduce your activities until the set-backsettles. Be kind to yourself. Say ‘NO’ to any unnecessarydemands put upon you until you are feeling healthier.And . don’t be to proud or scared to ASK for help!Taking your medicationFollow or ask the advice of your GP or Pharmacist aboutmedication and when you need to take it. If you have totake regular medication think of ways toremind you to take it. Many people justsimply forget. Use post it notes, a timer orget someone to remind you.1313

Please remember that taking medication if you havemusculoskeletal pain (back, leg, arm, neck etc) may maskthe pain and encourage you to do more.For musculoskeletal pain (back, leg, arm, neck etc)Apply heat and/or ice in a way that makes you mostcomfortable. To relieve initial pain, you could apply icepacks wrapped in damp towels for 5 minutes every hour forthe first one or two days. Always make sure you have acloth of some type between your skin and the ice, toprevent burning the skin and causing an ice burn. It is notrecommended that you lie on an ice pack. (People withrheumatic problems may prefer to use heat rather than ice).Again, if you are not sure, seek advice from your GP orhealth care professional.Take it easy.Briefly cutback on normal activities, lie down for a shortwhile and relax but not for too long. Bed rest weakensmuscle strength rapidly, you lose about 1% of total musclestrength a day if you become inactive - remember keepingactive and mobile can actually speed your recovery.Try to start moving gentlyRemember to pace yourself. Begin gentle stretching andmovement as soon as possible to regain normalsuppleness. Keeping active may seem alien to you, but inpain self-management terms, learning to live with apersistent pain is a skill to be learned.Don’t be put off – it does work!Relaxation.Using relaxation is another good way ofmanaging a set-back. Also accept thesituation and that you are experiencing aset-back, and just as it came, it will go.1414

15 reasons why stretching and exercising(don’t forget swimming) is good for you Helps to improve and maintain goodoverall health Increases strong cardiovascular system– heart lungs and blood vessels Increases muscle strength Improves flexibility Increases endurance and stamina Increases natural pain killers (called endorphins) in thebodies nervous system which help control pain. Helps with weight control Helps to improve quality of sleep Helps balance and co-ordination Reduces fatigue and increases energy Reduces muscular tension, stress and depression Helps combat depression and anxiety Helps maintain a positive outlook Helps to prevent constipation Can be sociableDrinking waterWater is essential for a healthy life so drinking plenty ofwater is important for everyone. It’s even more important ifyou are taking part in physical exercise, so make sure youkeep properly hydrated before, during and after exercising.1515

Usefulresourcesandchoices in the UK?Sois persistentpaina problemto help youThe short answer is yes, so you are not on your own.Self-management programmes(SMP’s)Hereare some alarming facts from the Chronic Pain PolicyThese arerun in the community by highly trained tutorsCoalitionwww.paincoalition.org.ukwho also have persistent health conditions themselveshave learnedbecomeself-managers.SMP’s but Persistentpaintoaffects7.8goodmillionpeople of all agesinare everyrun byparliamentaryArthritis Carecalled ChallengingArthritisconstituencyof the UK.70% orwww.arthritiscare.org.ukandarethe underExpertpeople with persistent pain60Patientsyears oldProgramme www.expertpatients.co.uk TalkingHealth www.talkinghealth.org is a Network ofindependentconsultants,andWhydo I needfreelanceto managemy pain?organisationsAfter all I seemyindividualssupportive of theof values tohealthcare professionalanddevelopmentaren’t they supposedlayme?led self-management and empowermentdobased,that fortraining for people living with long-term conditions, andthe healthcare entpain see theirthathealthcarethem. RememberSMP’s helpcan provideyou withprofessionalfor treatment,and support.Butmanyhave youself-managementtools,you hourshave todo thework.actuallyestimated justhowbutmanyduringthecourseof a year you spend with your health care professional?NHS Pain Management Programmes (PMP’S)aresaidin someareas. YourGP ca

Dr Frances Cole is a GP and Pain Rehabilitation Specialist and Cognitive Behavioural Therapist in West Yorkshire UK. She is a member of the British Pain Society and co-author of the self help guide “Overcoming Chronic Pain”. Pete Moore Dr Frances Cole Special thanks also to:- Dr Patrick Hill, Neil Berry, Dr Franz

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