“None of these techniques work when my pain is really bad” is a common statement made about self-care techniques when pain persists. When pain intensity increases, as is common with chronic pain conditions, previously effective techniques might not be effective enough. Their physiological changes might not be sufficient to counteract the higher pain level and the associated chemical changes and ramped-up protective mechanisms of the body and mind. Flare-ups can drain energy reserves impacting an individual’s ability to effectively perform self-care techniques.
When people in pain are challenging their limitations and abilities, there are occasions when working a deeper edge will lead to an intense, even though temporary pain increases. A logical response to these realities is to create at least two different pain care plans – one for ‘the usual’ days, and another for when the pain and/or ease of movement are worse. We might also consider whether both plans rely on self-care, or maybe include external support.
Some nuances to consider here:
Is this person expressing that the experience of not being able to control the pain is scaring them or draining their energy?
Is the person expressing that they want you to show them a plan that works when pain worsens?
Is there a loss of hope that there is any way to influence the pain when it intensifies (and fear of what that means for the future)?
Is this individual losing faith in the practitioner, wondering if they have the competence required for this pain and this problem?
Let’s assume that on reflection, the message is that there is a loss of hope, and there is also frustration and fear that there isn’t some technique, pill, or injection that works better when the pain intensifies.
So how do we proceed?
Consider first asking the person to show you how they are performing their self-care techniques. It is possible that modifications might help, or that you didn’t provide instructions that the individual fully understood.
Then see what happens when you add two of the pain self-care techniques together. Maybe these two have an additive effect. When doing this, it can help to discuss the idea that we have a medicine cabinet inside us, and that different techniques release different chemicals ‘from the cabinet’. This can be surprising to those who have not studied pain science, or even those who have been through years of treatment for pain.
We often search for THE answer, not knowing that there are multiple mechanisms through which pain can be changed. With most individuals, there’s no need to get into the complexities of this. However, it can help to provide examples of this that other people in pain have told you. For example, a person who can calm the pain and their mind usually with simple breath awareness, but when the pain worsens needs to work twice as long and combine breath awareness, aromatherapy, a heat pad, and body tension releasing to find the same relief. If this is the answer you are looking for, it is going to take some testing with the individual to find that just-right combination.
We have more options. Rather than focusing on self-care, you may know how much better this person feels when they are in with members of their community. We know that social engagement can have a profoundly positive effect of our nervous systems, so maybe part of the solution is practising self-care with others rather than on their own. Or this individual may have told you how much relief they get from the hands-on treatment of practitioners. Therapeutic interventions that include touch and that allow one individual to take time caring for another can also be added to a flare-up plan when it is accessible.
Based on our understanding of bioplasticity, hope is realistic that we can find a pain care plan that will provide some relief when pain flares or is intense. Everyone has different physiology and different capacities. When you hear an individual struggling to find some control and relief when pain intensifies, remember to check on the related thoughts and emotions, and to check how well the individual understood your previous guidance for pain care techniques. Remember the medicine cabinet and multiple mechanisms of pain relief, while you add techniques together. And most of all, remember that social engagement and expert hands-on support might be what is needed in addition to self-care when the pain “is really bad”.