Written by Karen Tang, General Member
Disclaimer: The insights shared in this blog are not medical advice and thus, should not be taken as such. Please consult a licensed medical professional if you are unsure.
September is Pain Awareness Month, which allows us to reflect on those who live with chronic pain in their day-to-day life.
Personally, I have lived experience with a variety of pain conditions. I have experienced temporary and episodic pain, all the way to chronic pain for years at a time. I am also a Clinical Psychology PhD student, which allows me to apply the evidence-based clinical skills I learned in my schooling to work with clients. I also apply many of these skills to my life to help cope with my own pain!
Evidence-Based Skills from Cognitive Behavioral Therapy (CBT)
Firstly, I will draw from Cognitive Behavioral Therapy (CBT) for pain management. CBT is an evidence-based therapy that can help you cope with a challenge by altering the way you think and behave.
Time-Based Pacing
One of the primary skills I learned was Time-Based Pacing, which is judging when to stop an activity based on time and not pain levels. People living with pain know that the more they do, the more likely they will experience pain. Therefore, some individuals may opt to do less or to do nothing at all, which is not ideal! Doing nothing can actually make pain worse, or exacerbate boredom or depressive symptoms. Pacing is a key management strategy for people with chronic pain, and this has been supported in systematic reviews.
Pacing is a skill that allows you to consistently carry out activities without causing extra pain and is the middle ground between doing nothing and over-exerting yourself. Pacing means you spend just enough time to get the most out of an activity, without pushing yourself so far that you end up in a long of time. Over time, you may find pacing allows you to do more, as you continuously build your capacity and stamina!
To do Time-Based Pacing, you want to establish a starting point or baseline. Firstly, choose an activity to focus on (e.g., sitting, walking, jogging with the dog). Next, measure the length of time you are comfortably able to do this activity—do this on at least three different occasions on both good and bad days. Lastly, you want to take the average of these times, then subtract a fifth.
For example, let’s say I want to try walking. I get the following lengths of time:
Time 1: 10 mins
Time 2: 15 mins
Time 3: 7 mins
My average of those times would be 11 mins. The average time minus (1/5) would be 9 minutes. Therefore, the next time I want to try going for a walk, I will set an alarm and engage in that activity for 9 minutes—no more than that, as I don’t want to experience pain flare-ups!
Ensure you take a break after your time is up! This can mean changing your body position and posture (e.g., gentle stretching exercises, listening to music). Remember, Time-Based Pacing is all about determining when to stop an activity based on time, not pain!
Relaxation Techniques
Another evidence-based skill that is worth mentioning is relaxation techniques. CBT teaches several techniques, including progressive muscle relaxation.
Progressive muscle relaxation (PMR) teaches you to relax your muscles by tensing and relaxing major muscle groups. To do this, you want to tense specific muscle groups in your body by holding that tension for five seconds or whatever feels comfortable, and then release the tension for 10 seconds while noticing how your muscles feel when you relax them. Skip areas that cause pain when you tense. A step-by-step guide to PMR can be accessed here, or feel free to search for a guided video to follow on YouTube! Research seems to indicate that the noticing of tension is the most effective aspect of PMR for chronic pain.
Stay tuned for Part 2, where we will dive into more evidence-based skills using Acceptance and Commitment Therapy (ACT)!
Resources and further reading:
How-to: Time-Based Pacing: https://www.va.gov/PAINMANAGEMENT/Veteran_Public/Veteran_docs/Pacing-formula.pdf
Treatments that Work Series: Managing Chronic Pain Workbook https://academic.oup.com/book/1084