Changing Your Pain Pathways: Ways to Cope with Pain in Daily Life

By Bonnie Cai-Duarte, Cara Kircher, Bronwen Moore and Sarah Sheffe

Changing Your Pain Pathways offers simple yet compelling strategies that you can use to live an active and rewarding life with pain. Filled with practical advice, this workbook breaks down pain science, clinical best practice and research to help guide you along the path of change with kindness and compassion. Explore the possibilities for a richer quality of life through straightforward worksheets, examples and accessible resource ideas. You will get a deeper understanding about how pain works and how to foster pain self-management techniques that will work as part of your daily life.

Use these techniques to:
- Discover how pain works in the mind and body
- Clarify what matters most to you and how to live a more satisfying life
- Change how you deal with stress, sleep struggles, difficult thoughts and emotions
- Explore ways to move gently and safely
- Enjoy stronger relationships through assertive communication
- Feel more in control of pain

"Changing Your Pain Pathways succeeds in bringing the theory and practice of pain management together with the difficult task of making the information easily understood, relevant and practical. It is a user-friendly guide to a difficult topic. Key topics are well researched and the use of clinical examples personalizes the information making it more relevant to the reader. The authors have done a remarkable job and should be commended for it. I highly recommend it."
- A. Snaiderman, M.D.,F.R.C.P (C)
Director, Neuropsychiatry Clinic, Brain and Spinal Cord Program, Toronto Rehab - University Health Network
Assistant Professor, Departments of Psychiatry and Medicine, University of Toronto

The authors, Bonnie Cai-Duarte (B.Sc.P.T., M.Sc.), Cara Kircher (B.Sc.O.T.), Bronwen Moore (B.Sc.O.T., M.A) and Sarah Sheffe (B.A., M.Sc.O.T.), created this book as part of their ground-breaking work with the Toronto Rehab Brain and Spinal Cord LEAP Service at the University Health Network. This team of occupational and physiotherapists has 55 years of combined experience in working with clients with neurological conditions and pain. Cara Kircher, Bronwen Moore and Sarah Sheffe hold lecturer status appointments with the University of Toronto Department of Occupational Science and Occupational Therapy. Bonnie Cai-Duarte holds a lecturer status appointment with the University of Toronto Department of Physical Therapy.

• Language: English
• Publisher: Tellwell Talent
• Release date: Jul 23, 2018
• ISBN: 9781773707044

Book preview

Copyright © 2018, 2023 Toronto Rehab Brain and Spinal Cord LEAP Service,

University Health Network

UHN - Toronto Rehab Rumsey Centre

Toronto Rehab Brain and Spinal Cord LEAP Service

345 Rumsey Road

Toronto, ON M4G 1R7

Purchasers of this book have permission to copy worksheets for personal use or use with individual clients. No other part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the authors. For permission requests, write to the authors at the above address or at [e-mail].

ISBN

978-1-77370-703-7 (Paperback)

978-1-77370-704-4 (eBook)

This book was published with the generous support of the Toronto Rehab Foundation as an educational resource and fundraising tool for persistent pain. Proceeds from the sale of this book go to pain treatment, education and research.

Acknowledgements

This book would not have been possible without the vision and skilled leadership of Allison Freeman, former manager of the Toronto Rehab Brain and Spinal Cord LEAP Service. Her optimism, patience and practical good sense were instrumental in getting this project launched. When duty called Allison away at a pivotal moment, Tess Devji took over as the LEAP Service manager. Tess hit the ground running and carried the project over many hurdles, and we are forever grateful for her determination and faith in the team.

We are deeply appreciative for the support and encouragement of Joanne Zee, Senior Clinical Director of the Brain and Spinal Cord Rehab Program and Business Development, and Dr. Mark Bayley, Medical Director of the Brain and Spinal Cord Program. We are honoured by the trust they placed in our team to develop a new service dedicated to managing pain for people with neurological conditions, and their willingness to support our work as it continues to evolve.

We acknowledge, with great gratitude, the Toronto Rehab Foundation for making the publication of this work possible, and for opening so many doors through their generous support for research, education and patient care.

Heartfelt appreciation goes to the clients of the LEAP Service who have taught us so much over the years. We thank them for the opportunity to be part of their journeys and to learn from their wisdom. Particular thanks go to those clients who generously contributed their feedback, insight and editing skills to developing and refining this book.

Thanks go out to our community of colleagues at Toronto Rehab Rumsey Centre for their kindness and encouragement.

Finally, we are forever grateful to our families for their loving support.

Praise for Changing Your Pain Pathways

"Changing Your Pain Pathways succeeds in bringing the theory and practice of pain management together with the difficult task of making the information easily understood, relevant and practical. It is a user-friendly guide to a difficult topic. Key topics are well researched and the use of clinical examples personalizes the information making it more relevant to the reader. The authors have done a remarkable job and should be commended for it. I highly recommend it."

A. Snaiderman, M.D.,F.R.C.P (C)

Director, Neuropsychiatry Clinic

Brain and Spinal Cord Program, Toronto Rehab - University Health Network

Assistant Professor, Departments of Psychiatry and Medicine, University of Toronto

"The book Changing Your Pain Pathways helped me break through a plateau in my ongoing recovery for chronic headaches and migraines. This book was easy to read, and distilled complex topics down to bite-sized pieces of information. By applying the practical pain management strategies outlined in this book I was able to reduce pain levels, increase physical activity, establish a personalized sleep routine, acknowledge difficult emotions and communicate them more effectively with others. I would recommend this book to patients suffering from chronic pain, as well as the medical personnel and family members who support them."

Samantha H.

"Changing Your Pain Pathways: Ways to Cope with Pain in Daily Life will be an extremely helpful and user-friendly resource for those who suffer from chronic pain and for their clinicians. It provides the reader with a biopsychosocial approach to the management of pain reviewing the impact of modifiable factors (such as our thoughts, emotions, behaviours, sleep, physical activity, communication styles) on the pain experience. It urges the reader to take control of their pain and provides a multitude of practical exercises thus serving as an ideal self-management tool."

Lesley A. Ruttan, Ph.D., C.Psych.

Clinical Neuropsychologist & Clinical Psychologist and Practice Leader, Toronto Rehab - University Health Network

Adjunct Lecturer, Graduate Department of Psychological Clinical Science, University of Toronto Scarborough

This thoughtfully written workbook is bursting with evidence-based techniques for managing pain. The science of pain and stress is brought to life through descriptive writing and relatable examples. Each section is a little treasure box of practical strategies, providing hope and encouragement that there are things you can do to change the experience of pain. This is a bountiful resource for anyone who works with people experiencing pain.

Erin Cunningham OT Reg. (Ont.), M.Sc. (OT)

Occupational Therapist

Brain and Spinal Cord Program, Toronto Rehab - University Health Network

I found this book very helpful during my injury. It touched on a lot of questions I had and even things I didn’t realize could affect pain were broken down and explained simply in this book. The activities help to get you thinking and applying methods to your life. I found after every chapter I was constantly referencing the book and noticing where to apply the points made. This book is also helpful for those who support those going through pain. Pain has the ability to bring out our worst selves unintentionally. Those who provide support to those in pain may find reading this book helpful, as it gives background, reasons and triggers of pain. Having someone who understands what you’re going through is a great support. Reading this book for those you support with pain, and reading this if you are the one going through pain—is comforting and guides you to apply methods and techniques in order to continue living the best you can under the circumstances. I highly recommend this book.

Sandra A.

Brain Injury Survivor

Thank you for the great resource. This book is very organized. It explains exactly what I want to tell my patients. The understanding of pain chapter is concise and to the point. The chapter on doing what matters" helps to re-shift the focus of pain. Each chapter of this book covers an important concept of pain management. Thank you so much for creating Changing Your Pain Pathways! This is excellent!!!"

Alice Kam, M.D., A.B.P.M.R, F.R.C.P (C)

Physical Medicine and Rehabilitation, Toronto Rehab - University Health Network

Table of Contents

Acknowledgements

Introduction

How to Read This Book

Meet the Clients

Setting a Personal Goal

References

1: Understanding Pain

What Is Pain?

Understanding Pain: What’s in It for Me?

What Is the Purpose of Pain?

How Does Pain Work?

What Happens When You Feel Pain?

How Do You Feel Pain?

Neuroplasticity and Persistent Pain

Surprising Facts About Pain

What Can I Do About My Pain?

Move Towards the Things That Matter

Ways to Manage Pain

Want to Know More?

Common Pain Terms

Websites

Books

Key Messages

Test Your Knowledge

References

2: Doing What Matters

What Is Doing What Matters?

Doing What Matters: What’s in It for Me?

Values: Knowing What Matters So You Can Live a Fuller Life

Fear and Avoidance of Activities

How Can I Do What Matters to Me?

How to Pace Yourself

Adapting Activities

Change How You Measure Success

The Pareto Principle

Finding Shortcuts

Want to Know More?

Websites

Books

Key Messages

Test Your Knowledge

References

3: Stress Management and Relaxation

What Is Stress?

Fight, Flight or Freeze

Stress Management: What’s in It for Me?

Why Talk About Stress When You Have Pain?

Why Talk About Stress When You Have a Disability?

How Does Stress Work?

Signs of Stress

How Much Stress Is Healthy?

What Can I Do About My Stress?

Know Your Stress Patterns

Relaxation

Breathing

Top Healthy Stress Coping Strategies

Want to Know More?

Websites and Books About Relaxation

Apps

Key Messages

Test Your Knowledge

References

4: Movement and Physical Activity

What Is Physical Activity?

Physical Activity: What’s in It for Me?

Why Is Movement Important?

Physical Activity and Pain

The Therapeutic Window

How Much Physical Activity Should I Do?

Recommendations for Physical Activity

Types of Physical Activity

How Can I Make Physical Activity Work for Me?

Find Your Level

Set a Goal

Track Your Progress

Start Low and Build Up Slowly

Adjust the Activity

Talk Back to Difficult Thoughts and Emotions

If Your Pain Flares Up, Stay Calm

Visualize the Movement

Want to Know More?

Safety Considerations and Reasons to Stop an Activity

Websites

Key Messages

Test Your Knowledge

References

5: All About Sleep

What Is Sleep?

Understanding Sleep: What’s in It for Me?

Benefits of Sleep

Persistent Pain and Sleep

Sleep Can Be a Step Towards Your Values

How Does Sleep Work?

Sleep Stages

How Does the Body Know When to Sleep?

How Much Sleep Do You Need?

Sleep Disorders

Behaviours That Interfere with Sleep

Conditioned Arousal

What Can I Do About Sleep Problems?

Track Your Sleep

Sleep Strategies

Want to Know More?

Websites and Books

Key Messages

Test Your Knowledge

References

6: Thoughts and Pain

What Are Thoughts?

Dealing with Difficult Thoughts: What’s in It for Me?

Thoughts and Pain

Thoughts and Values

How Do Thoughts Work?

Taking a Broader View of Thoughts

Experience Influences Thinking

Thoughts, Emotions and Behaviours

Thought Patterns To Watch For

What Can I Do About Thoughts?

Grounding

Unhooking

Challenge Your Thinking Patterns

Practice Coping Thoughts Every Day

Patience

Want to Know More?

Websites and Books

Key Messages

Test Your Knowledge

References

7: Managing Emotions

What Are Emotions?

Examples of Emotions

Examples of Body Sensations

Managing Emotions: What’s in It for Me?

How You Cope with Emotions Makes a Difference

How Do Emotions Work?

How Pain Can Bring About Difficult Emotions

When Do Emotions Cause Problems?

Sadness

Anger

Anxiety

What Can I Do About Difficult Emotions?

Cultivate Self-Care

Cultivate Calmness

Cultivate Gratitude

Cultivate Acceptance

Want to Know More?

Books

Movies

Key Messages

Test Your Knowledge

References

8: Assertive Communication

What Is Assertive Communication?

Assertive Communication: What’s in It for Me?

How Do People Communicate?

Passive Communication Style

Aggressive Communication Style

Passive-Aggressive Communication Style

Assertive Communication Style

Assertiveness Tips

Start Easy

What Can I Do to Communicate More Assertively?

The 3 F Script

I Statements

How Does a 3 F Script Look?

Pick a Good Time

Pick a Good Place

Setting a Consequence

Assertive Script Critique

Problem-Solving Communication

Pick Your Battles

Reward Yourself

Want to Know More?

Websites and Books

Key Messages

Test Your Knowledge

References

9: Planning for Pain Flare-Ups

What Are Pain Flare-Ups?

Planning for Pain Flare-Ups: What’s in It for Me?

How Do Pain Flare-Ups Work?

What Can I Do About Pain Flare-Ups?

Want to Know More?

Websites and Books

Key Messages

Test Your Knowledge

References

Conclusion

Overview of the Workbook

Chapter 1: Understanding Pain

Chapter 2: Doing What Matters

Chapter 3: Stress Management and Relaxation

Chapter 4: Movement and Physical Activity

Chapter 5: All About Sleep

Chapter 6: Thoughts and Pain

Chapter 7: Managing Emotions

Chapter 8: Assertive Communication

Chapter 9: Planning for Pain Flare-Ups

Final Thoughts

Appendices

Appendix A: Test Your Knowledge Quiz Answer Key

Appendix B: YouTube Channel Directions for the LEAP Service

About the Authors

Introduction

How to Read This Book

This book is designed to help you understand your pain and find practical ways to manage it in your daily life. Each chapter covers a topic relevant to persistent pain and includes an explanation, coping strategies and related worksheets for self-management. The worksheets are optional, and are simply designed to help you choose and practice the strategies to find out what works best for you. You don’t need to read the book from cover to cover, however, we recommend you start with Chapter 1 as it covers the foundation for understanding why the strategies work well for pain management. Following this, feel free to flip to the chapter that interests you most.

Meet the Clients

As you move through the book, you will hear about the stories of three people living with pain, and how they relate to the topic of the chapter. These stories may help to show how the content can relate to daily life. These fictional characters and events are based loosely on ideas drawn from the many clients who participated in the LEAP Service (Living Engaged and Actively with Pain), which is part of the Brain and Spinal Cord Program at Toronto Rehab, University Health Network in Toronto, Canada. However, any resemblance these fictional characters have to real people is purely a coincidence.

A short introduction to each client follows on the next couple of pages; you will learn more about them as you move through the book.

Elisa

Hi, I’m Elisa. I’m 22 and I’ve been working odd jobs since I finished high school. I have been trying to save up for a big trip, but, after paying my rent and bills, I haven’t gotten very far. Last year, I broke my neck when I slipped on ice and fell down a flight of stairs. I spent a lot of time in rehabilitation recovering, hoping that one day I might be able to walk again, but that isn’t going to happen. My hands are still weak and I drop things all the time. Now I use a manual wheelchair to get around, and, if I’m doing a lot of wheeling, I start to get shoulder pain.

Ever since my injury, my life has been thrown off course. I had to move in with a friend because I couldn’t pay my rent after I lost my old waitressing job. My friend is great, but I know I can’t stay there forever. I get regular social assistance cheques, but the money doesn’t go far. I can’t do a lot of the things I loved, like playing guitar, or playing sports. None of my friends really understand what happened to me and what it’s like, and my girlfriend broke up with me after the injury because she couldn’t deal with it, so I am quite lonely. I don’t really have any support from family, so I’ve become used to doing things for myself, and it’s hard to have to ask for help now.

Worst of all, I’m in pain every minute. If it isn’t the shoulder acting up, then I get burning pain around my chest, like a belt wrapped around me. I had so many plans to travel and figure out what to do with my life, but now I’m stuck. I’m worried I’ll never be able to do anything I want to do because of this pain. I’m so angry this happened to me!

Ahmed

Hello, I’m Ahmed. I’m a real estate agent. Six months ago, I was walking along a sidewalk to put up Open House signs for a client when I was struck by a pickup truck. I hit my head on the concrete—which gave me a brain injury—and I broke my ribs and collarbone. I still haven’t gone back to work. I’m only 40, and I don’t want this to be the end of my career.

Even though I went through rehab to help my left side work better, my left arm and leg are weak and I often lose my balance when I walk. I have also noticed some thinking difficulties with my memory, attention and making decisions. My driver’s license was suspended for medical reasons. Hopefully I will be able to get it back someday, since I need it to work.

I have a lot to deal with now: all the lawyers, doctors and insurance workers that are in my life. I don’t like to talk about it, but I still have flashbacks