Now imagine that instead of being an actor, you are a person in pain.
The “director” is someone trying to help you. It could be a health care
provider, family member, or simply an acquaintance who read something on the
internet. Whoever it is, they are well-meaning and have something they want to
share with you. No matter how much they know about pain, you are the one who is
living with it every day. Unless they understand your unique set of
circumstances, their suggestions may not work for you. They may seem frustrated
with you, because their attempts to be helpful are not resulting in an
improvement of your situation. At the same time, you may feel frustrated with
them because it seems like they simply do not understand.
Now let’s look at the word “stage” a little differently. Instead of
thinking of a stage as a platform for acting out a play, let’s think of the
other kind of “stage,” a point in a process. Just like it is essential for a
director to understand the set and available props, anyone who intends to help
someone in pain needs to understand where the person is, and what their
strengths and challenges are.
When it comes to managing chronic pain, self-management is often an
essential component. But simply giving people a one-size-fits-all list of steps
to take may not be effective. This type of approach will likely result in
a similar scenario to the one described above with the actor and the director.
The clinician and person in pain will become increasingly frustrated with each
other, and the intended goals will not be achieved. Clinicians can sometimes
assume people will follow every single recommendation and it can be a source of
tension for both parties. There can be a multitude of reasons for this
disconnect, such as the information clients have previously been given about
their pain, their stress level, their responsibilities (looking after children,
keeping a job, etc), and their beliefs and values.
The clinician needs to start by understanding where the client is. One
model that can be useful is the stages of change. Today we’ll make some
suggestions about how we believe the stages of change apply to lifestyle
changes that people want to make, such as pain self-management strategies.
Please note, there is no right or wrong stage to be in. Telling someone they
are in the wrong stage of change would be like telling someone they’re in the
wrong stage of grief after a loss. Everyone deals with challenges in their own
individual way, and it may change over time.
Precontemplation: “I don’t have any control over this.”
In terms of coping with chronic pain, a person in this stage is looking
for someone or something outside of themselves (a medication, a new doctor, a
new treatment, etc.) to make their pain go away. This might mean they feel
completely helpless and that their pain is out of their control.
- If you are in this stage
- If you are reading this
blog, you are probably not in this stage. Unless someone suggested you
read the blog, in which case, thanks for checking it out.
- If you want to help someone
in this stage
- Support them as they look
for answers.
- Express that you believe
them and how pain is affecting their life.
- Let them know you’ll be
there for them along their journey.
- Note: If you give a lot of
suggestions about self-management to a person in this stage, it may not
go over well. This is like the actor and director we described above. You
may end up feeling frustrated that they are not taking your suggestions,
and they may end up feeling like you don’t understand their situation. If
you do give them suggestions, it may work best to frame it as something
to keep in the back of their mind.
Contemplation: "Maybe I can have some control
over this.”
In the world of pain, a person in this stage may be dissatisfied with
the symptom relief they experience from their current treatment, and they may
be looking for more options. They may begin to feel that there could be
something they can do about their pain, but they are not yet confident that change
will make a difference.
- If you are in this stage
- Look to reliable sources of
information and support. This may include your health care providers,
support groups, books, and other sources. (We like to think of ourselves
as one of these reliable sources!)
- It may be helpful to make
notes or jot down ideas that seem interesting to you
- Try not to get overwhelmed
by all the different perspectives out there
- If you want to help someone
in this stage
- Recognize that their
interest in change may rise or fall, and that’s okay
- Try not to overwhelm them
with too many different suggestions
- Try to encourage them
without pushing
- Remember that this is their
journey.
Preparation: “This is how I’m going to try and take
control.”
A person in this stage is formulating a specific plan.
- If you are in this stage
- Decide on one small,
sustainable change that you want to start with
- When deciding what change
to make, consider what changes might take the least effort and/or have
the most reward
- Eliminate barriers that
would stand in the way of achieving your goal
- If you want to help someone
in this stage
- Identify the positive
results that this change would bring about
- Express that you believe in
them, and their ability to carry out the change
Action: “I am taking control now.”
A person in this stage is carrying out their plan.
- If you are in this stage
- Don’t be afraid to start
very small. Walking for two minutes more than you have been is a huge
step in itself.
- Don’t be too hard on
yourself if it doesn’t work some days
- If you want to help someone
in this stage
- Encourage them on rough
days
- Make the change along with
them, if you’re a family member or friend
- Help them celebrate their
accomplishments - both the small successes and the big ones
Maintenance: “I have tools and resources that I can use to help
manage my pain”
- If you are in this stage
- Recognize that there will
be ups and downs
- Keep learning and trying
new strategies to add to your “tool belt”
- Celebrate how far you’ve
come
We purposely put these steps in a circle because although they are a logical progression, they are not necessarily linear. People may move backwards, forwards, or sideways depending on what’s going on in their lives. What may feel like a set-back may just be part of the journey. Remember that just like the actor and the director at the beginning of this post, the person in pain and someone who wants to help them will both find the experience more rewarding if they are on the same stage.