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Living well with chronic pain

Treat Chronic Pain as an Ongoing Experiment

Improving your experience of pain through understanding it.

Chronic pain is often accompanied by a frustrating level of uncertainty and many vexing questions: Why did I have such a great day yesterday, but hurt like the dickens today? Is there a medication or combination of medications that will relieve my symptoms? What about exercise? Can I develop a realistic fitness program that helps? How about other strategies to feel better? What can I do to increase my good days and good moments? In a nutshell, how can I gain greater control over how I feel?

Understanding the patterns and determinants of your well-being is key to living well with chronic pain. The more unpredictable your pain, the more challenging it is. Not knowing how to improve generates feelings of helplessness. Uncertainty about how your body may respond in a given situation--whether, for example, you will experience a pain flare-up or reprieve if you venture out with friends--makes planning risky, even frightening.

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Donning the hat of a scientist can relieve this uncertainty and provide answers.

Treating each day as an experiment also transforms your daily narrative. Even your most wrecked moments become productive when they contribute essential data to your quest for improvement. How you respond provides useful information--when your efforts make things better, you have a course to follow; when they worsen, you have grounds for other tactics. Distress is much easier to tolerate when it holds the potential for improvement.

Self-research can be simple. (That's a good thing, because starting an extensive project makes little sense when you feel depleted with pain.) As both researcher and research subject, you have easy access to all relevant data. Anything you experience or try counts as data as long as you record it. Here's how:

1) Select a data tracking method that you find easy to use, even when you don't feel well. The most comprehensive tracking system is worthless if you don't use it.

2) Track at least one daily measure of well-being (such as your pain level, happiness, or success in coping) as well as specific strategies that you would like to evaluate (such as changes in medication dosages, sleep strategies, exercise, pacing, self-talk, or anything else you do to try to soothe your body and mind). This allows you to identify how what you do affects how you feel.

3) Adapt your tracking tool and behavior according to your findings. As you hone in on an effective strategy, continue to re-test it, refining your behavior and testing again. This ensures progress and increases confidence in effectiveness.

Having data on what actually helps (and hurts) is crucial for living well with chronic pain because, unfortunately, acting from intuition or common sense sometimes worsens symptoms. Take "activity" for example. Being exhausted with pain may seem like a logical reason to lie down. But while resting can be restorative--it can also intensify suffering. Through empirical testing, you can learn precisely when you profit from engaging in activity, or certain types of activity, and when activities will likely result in a pain flare-up. You may discover, for example, that you benefit from forcing yourself to get up each morning, regardless of how you feel, and that scheduling short meditative breaks every two hours keeps your pain at bay, increases your stamina, and improves your mood. By treating each decision as a potential source of data, you can continue to refine your understanding of what helps most.

The goal of experimentation is not pain-free living, but rendering your body's reactions predictable. Self-knowledge reduces the extent to which we feel like victims of the vicissitudes of random factors. This knowledge can allow you to build behaviors into your life that increase your comfort, energy, and fulfillment. It also lets you decide when something feels worth the pain. When pain is "planned," you can likewise plan recuperative measures and avoid the suffering that comes from the shock and disappointment of unexpected pain.

For more information on using experiments to improve life with chronic pain, see my forthcoming book and companion website, with its free, customizable tracking tool.

Deborah Barrett, Ph.D., MSW, LCSW is a clinical associate professor in the School of Social Work at the University of North Carolina at Chapel Hill.

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