Welcome to the current newsletter issue of
Advances in Medicine (AIM)- Take AIM against pain.
Feel free to send me an e-mail with your own thoughts
and experiences. Email: timsams@mypainreliefdoc.com.
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INDEPENDENCE
Independence is one of the most important aspects of
self-management for persistent pain. In ABC's of pain Relief and
Treatment, Chapter 8 discusses The Terrible Truth about Coping
with Pain. The terrible truth is that people cope with pain the
way they have coped with life before pain, though they can
change their coping style. There are seven basic choices that
determine life effectiveness arranged in a hierarchy of
importance: honesty, courage, independence, creativity,
planning, initiative, and perseverance.
A fierce commitment to remaining independent is critical with
persistent pain. A fierce Commitment is not determined by
thoughts or feelings, how you want to be, but by behavior, what
you actually do. Persistent pain makes every single human
activity more difficult; it inexorably pulls dependent
behaviour. Your task is to fight this inevitable decline with
every fiber of your being - as consistent with self-management.
A list of dependent behaviours includes: giving up bill paying
or other "mental" tasks; letting other people schedule your
appointments, drive you, or keep track of medications or other
treatments; "taking each day as it comes;" giving up most or all
household chores; bringing your spouse to all your appointments;
letting a spouse or case manager advocate for you, etc. Ultimately,
dependent behaviour is driven by using your pain to
avoid simple, perhaps unpleasant, tasks.
Chronic pain should negatively affect your closest
relationships, at least initially. When a spouse comments that
their relationship is better since the pain problem developed,
that is a red flag that the spouse is being over-solicitous,
i.e., supportive to the point of enabling and encouraging the
patient's dependency. There is short distance between being
supportive and being enabling a greater level of disability than
is medically warranted.
Daily, I am told by patients, "My spouse doesn't understand my
pain or what I'm going through." Of course not; they can't, and
they never will. Pain is a journey that, one way or another, you
travel alone. The more you fight this existential reality, the
more dependent you will be.
If you can get away with it, why not be dependent and make your
life easier? 1) With every dependent behavior you surrender to
your pain, define yourself, as disabled, and reinforce
dependence as part of your character. This makes the next
independent behavior harder and less likely. You begin to see
yourself as helpless, powerless over the events in your life. 2)
You begin to establish a relationship with your support system
that you are a child. You will be treated like a child in many
other (no pain) ways that you will loathe - financially,
sexually, with decision-making, etc. You will inevitably see
your significant other as controlling; a beast you created. 3)
You lose credibility with your doctors and other providers. They
will not be impressed with the support you are receiving but more
by how little you are doing to help yourself. This will affect
the treatment you get in negative ways. Unless you have severe
brain damage, your family does not need to keep your records,
advocate for you, or schedule your appointments. These behaviors
are red flags to all medical providers.
A fierce commitment to independence is the beginning of
self-management for persistent pain. It is a refusal to
surrender to weakness, and aging, and pain. This commitment
compels you to be proactive, not simply reacting to what the
gods throw at you, but being willing to create your own world,
one that accommodates a certain level of pain and decreased
function.
It is so easy to get wrapped up in your limitations and pain.
Fighting for your spouse to take over chores you can no longer
handle or fighting for the security of disability benefits,
handicapped placards, etc., can compel you to focus on what you
"can't do anymore." Healthy pacing and limit setting may require
that you abandon certain activities and ask for help at times.
This is inevitable and even adaptive.
In the first book I wrote, Stepping Stones: 10 Steps to Seizing
Passion and Purpose, step number two is self reliance -
absolutely required to achieve a sense of purpose and maintain
passion for life. When you hurt all the time, a fierce
commitment to independence is a delicate, uncertain balancing
act between being self reliant as much as possible and getting
reasonable assistance when appropriate. You really shouldn't
grab that twenty-pound bucket of pain off the top shelf at Home
Depot.
Living with persistent pain is a profoundly challenging,
immensely isolating task. The more you pursue the intimacy of
understanding and emotional support, the less time and energy
you have left for proactive independent behavior. You determine
where and when your journey ends. You can get directions and
companionship along the way, but you leave one set of footprints
in the sands of time.
As always, your feedback is welcome as are suggestions for
future newsletter topics.
Good light,
Dr. Tim
My Pain Relief Doc
http://www.mypainreliefdoc.com
Copyright 2006. Dr. Tim Sams and My Pain Relief Doc.
All rights reserved. http://www.mypainreliefdoc.com
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include the entire article, along with the web links
and copyright information. Thanks, Dr. Tim
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