How to set realistic goals when you have chronic pain

Written by: Joanne ZeisReviewed by: Kevin L. Zacharoff, MD, June 2014

Learning Goals

➢You have been living with pain for a while, and you’re probably wondering if your life will ever get better. Will you be able to do any of the activities that you used to enjoy?

In this lesson, you will:

1. Understand the trade-offs between getting good pain relief, and being able to reach your activity goals

2. Learn the value of having a "pain action plan"

3. Learn how to set up your own action plan

4. Learn how to track your action plan

Balancing pain and activity levels

➢Once you identify your goals, you’ll most likely need to find a good balance between managing pain, and improving function to achieve them.

Managing pain means using a variety of ways to lower your pain. Some ways are:

❖Medications prescribed by your health care provider❖ Injection therapy, such as cortisone shots to joints, or to sensitive “trigger” points on the body❖ Pain-coping techniques, such as deep breathing, or imagining a trip to a relaxing place❖ Lowering the stress levels in your life❖ Changing your lifestyle -- for example, by dieting and losing weight

Improving functioning means finding ways to handle day-to-day tasks and being active, in spite of your pain. Examples of improving functioning are:

❖Working❖ Preparing meals❖Doing more of the fun activities that you used to do❖Walking farther than you do now❖ Socializing with friends more often

The pain action plan

➢An action plan lists the steps that you can take to reach your goals. Your health care provider will help you learn how to:❖Set real goals that you can, and should, be able to reach

❖Put your plan into action

❖Work with other members of your medical team to reach your goals

❖Keep an eye on your progress

Action plan goals

➢Your action plan needs to have goals that are good for you – not necessarily goals that your spouse or family members think would be good to reach.

➢Good goals are: ❖Reasonable: Running five miles a day is not a reasonable goal for many people. However,

working up to walking a mile is sensible.❖Sustainable: Everyone can start a diet as a New Year’s resolution, but very few people can

keep that diet going over time. Make sure that your goals are ones you can do for the long haul.

❖Specific and positively stated: A specific and positive goal could be, “I will plant one row of flowers in my garden.”

❖Measureable: Make sure that your goals can be measured. For example, “I will work for 15 minutes before resting, unless my pain level is at 6 out of 10 or more.”

➢An action plan includes: ❖Starting with goals you can meet, so your success will keep you going❖An ending goal, like “picking up my grandchild” ❖Breaking long-term goals into smaller, easier to achieve goals

Action plan help – working with your provider➢Your health care provider wants to work with you, so that you’re able to reach

the goals in your action plan.

➢Talk with your care provider to make your goals as realistic as possible. For example:

❖If your goal is “to work in the garden,” but you haven’t been outside of your house in six months…

❖your care provider may suggest that you switch your first goal to “reaching the front porch” instead.

➢Your care provider may suggest other sources of support for you, such as new medical or exercise equipment, or a therapist to work with you.

➢Be open to learning to do things in a new or different way. For example, you may have to find a way to raise a section of your garden to a higher level, so that you can have less pain by sitting down instead of kneeling.

Track your progress

➢It’s important to track how much you’re able to do over time. Keeping a chart of your progress, or writing it all down in an activity diary, can do wonders for your self-esteem as you watch yourself getting stronger.❖Put your progress chart in a place where you’ll see it, and fill it in, every day❖Don’t be discouraged if there are some days when you’re not doing as well as

other times. Your chart will track how you’re doing over the long term. Short-term setbacks are just that – short-term!

❖Bring your progress chart to any appointments with your health care provider. They will look at the chart and help you to decide whether your action plan needs to be adjusted

❖Celebrate whenever you reach any of the goals on your action plan. Reaching a small goal is just as important as getting to a larger one

Putting your plan into action

➢Your life may have been difficult up to this point. Be proud of yourself for moving forward! The small steps that you take may not seem like much at first, but each step will get you closer to your goal.❖Start with small steps❖Each successful step forward should encourage you to take another one❖Like a cat lying in the warm sun, you should bask in your achievements❖By moving forward, you’re already accomplishing more than you have in a long time!❖Once you’ve reached your goal, remind yourself of how long and hard you’ve worked

to get to this stage. Congratulate yourself, and be proud. You, more than your family or friends, know just how difficult this has been

➢Start now! You know that you can do it. There are always reasons to delay, but there’s no time like the present to start reaching for your goals.

Self Check

➢If you want to start a physical activity that’s harder than usual, and you think that it might increase your pain, which option is best: ❖Take more pain medication before you start.

❖Get extra sleep the night before.

❖Ask your health care provider for his or her approval before you start. You may need to increase your activity level slowly, even if it takes a long time to reach your goal. You might have to deal with more pain.

❖Push yourself as hard as you can, and then give up if you can’t do it.

Answer:

➢Ask your health care provider for his or her approval before you start. You may need to increase your activity level slowly, even if it takes a long time to reach your goal. You might have to deal with more pain. You should set realistic activity goals with the okay of your health care provider. You might have to increase your activity slowly, though, and deal with some extra pain.

Self Check

➢When you set goals in a pain action plan, which of these options is not important?❖Action plan goals should be specific and framed in a positive way

❖Action plan goals should be measurable

❖Action plan goals should be reasonable

❖Action plan goals must be hard to reach so that they’re worth it, no pain no gain

Answer

➢Action plan goals must be hard to reach so that they’re worth it, no pain no gain. An action plan goal should not be too difficult. You might do more harm than good if you do too much in a short period of time.

Additional Resources:

➢American Pain Foundation. Treatment options: a guide for people living with pain. (search on “publications”), http://www.painfoundation.org

➢Bruce, B. & Hooten, W. (2008). Mayo Clinic Guide to Pain Relief. Rochester, MN: Mayo Clinic Health Solutions.

➢Caudill, M.A. (2002). Managing pain before it manages you (Revised Version). New York: The Gilford Press.

➢Turk, D.C. & Frits, W. (2005). The Pain Survival Guide: How to Reclaim Your Life. Washington, D.C.: American Psychological Association.