The Seven Realms Chart of Risk and Protective Factors to Prevent Chronic Pain

Realm Protective Factors Risk Factors Actions to follow Actions to avoidPrevents Pain Leads to Pain Reduce risk of chronic pain increases risk of chronic pain

B Balanced Relaxed Posture Tense unbalanced posture Good posture–head up, shoulders back, tongue up, sit up Shoulder slouching, Forward head, teeth clench, Lift at waist

Body Full Range of Motion Tense tight muscles Stretching exercise (Yoga, Pilates, Warm-up) No stretching or overstretchingPhysical Endurance Poor conditioning Condition exercise (running, walking, swimming) Too much inactivity, sitting, and lying down in daySomatic Strength Weak muscles and joints strengthening exercise (weights, resistance, push-ups) Too much, too fast, too painful

Relaxed muscles and joints Co-morbids/ obesity Practice relaxation and deep breathing daily Sustained tensing, repetitive strain of muslesGenetic protective factors Genetic risk (pain, hypermobility) Manage weight, co-morbid conditions Manage co-morbid conditionsModeration to prevent injury Acute injury Move, Exercise, NSAID, Diagnose (MEND) Inactivity after acute injury (except fractures/tears)

L Healing pain-reducing diet Pain enhancing diet Follow healthy diet pyramid (diet handout) Fat, sugar, processed food, meatsLifestyle Activity Level Inactivity/ sitting Stay up and busy all day Dietary pain triggers (caffeine, sensitivities, stimulants)Actions Good sleep Poor sleep Good sleep routine every night (SLEEP handout) Excessive resting, sitting, lying downBehaviors Pacing Hurrying, rushed Stay calm, leave early for appointments, schedule modestly over-scheduling, leave late, hurrying

variation in lifestyle Repetitive strain take breaks, stretch, alter movements Work activities with sustained tensing/ repeated strainLow risk behaviors High risk behaviors drive defensively, wear seat belts, helmets, Risky driving, biking, lifestyles, or extreme sportssupplements/ medication Chemical/ medication use stay clean of chemicals tobacco, medication overuse/ conflict, stimulant, illicit drugs

E Joy Anger Being creative, imaginative (cooking, gardening, art, music) Repetitive boring daily routine. Same spot every dayEmotion Confidence Anxiety Finding joy in the little things in life Ignoring how your body expresses emotion. Feelings Calm Nervousness Practice relaxation and breathing to calm emotions Avoiding conflict. Not Dealing with itAffect Happiness Sadness Practice positive psychology daily: appreciate blessings Lack of appreciation

Contentment Depression Identify, discover, express your emotions Ignore feelings and emotionsS helping others self-centered Review handout: positive relationships self-centered, withhold/ignore social supportSociety harmony and peace conflict/ abuse Help others daily isolated, avoid othersPeople receive social support lack of support,lonely, isolated Be routinely courteous and respectful Disrepact to othersRelationships Positve relationships Secondary gain Provide social support to friends and family Disability and litigation

Tolerant/ Forgiving Intolerant/ Unforgiving Create win-win in resolving conflicts getting revenge with violence and cruelty

S Self-compassion Stress and Burnout Practice meditation and gain insight, solutions Not dealing with stress and burnoutSpirit Self esteem Hate and low self esteem Practice prayer and ask for help Living with hate and anguishPurpose Clear purpose and direction Lost/ Meaningless Set goals and defining life purpose and direction Living a life with no meaning and purposeBeliefs Defined belief and faith Disbelief/ Cynicism/ Doubt Follow dreams, hopes, and aspirations living with no hope or aspirations

Hope/ Optimism Hopelessness / Pessimism Bring passion to life Lack of passion, excitement, and enthusiasm, even if quiet M Understand whole problem Ignorance of whole problem Learn about condition and it's risks and protective factors Ignore, deny, or avoid being honest and telling the truthMind Resilience/ rebound Low resilience Resilient (humor, balance, flexibility, toughness, centered) Catastrophizing, thin the worst will happenCognition Self-efficacy/ control Low self-efficacy/ control Self-motivated, growth, responsible Deny responsibilityThoughts Accept responsibility Deny responsibility Optimism and positive affirmations Wallowing in negative/ pessimistic/ self-degrading thoughts

Daily compliance Poor compliance Practice new healthy habits/ behaviors daily, use reminders hurried disorganized mind with poor complianceRealistic expectations Unrealistic expectations Define small steps and realistic goals/ expectations Maintain unrealistic expectations and goalsActive coping Passive coping Learning active coping and adapting skills Over react to or avoid changes in your life

E Clean Infective, filthy clean and organize the home clutter, unprotected sharps, guns, dangerous furnitureEnvironment Organized Chaotic reduce home air pollution Living in home air pollution (smoke, dust, chemicals)Nature Safe surroundings dangerous surroundings follow food safety Poor cleaning or storing foodSurroundings protective accident prone Safe home and work environment, protect the head cluttered, disorganize, careless home

cautious/ careful Negligent Follow good safety practices at work and home avoid risky environments, settings