Over the past few months, I’ve been writing a bit about supported self-management. In part, this topic has become a hot topic, given that medication and exercise can only slightly reduce pain and disability, and that people have other lives besides swallowing pills and doing 3×10 reps. It’s also because there are. And partly because that’s what we end up doing. That’s the majority of what people living with pain use to get by.
Self-management refers to a wide range of strategies that people with pain use in their daily lives to help them live a better life. We are aware that there are multiple definitions of self-management, and they are not very consistent. And of course, throughout my discussion, I always think of self-management as: supported. It is supported by relationships with medical professionals, friends, family, and within the health care system. Or maybe the latter isn’t so much the case.
To quote Nicholas and Bryce’s 2016 commentary (because it’s so good), the key elements of self-management are:
- Actively participate in daily activities to manage the effects of pain
- Learn about pain and options for managing it
- Monitor and respond to signs and symptoms
- Work with medical professionals and others to develop ways to avoid pain
From my perspective, here are the things that seem important in self-management:
- Know how to set limits on demands and obligations from others. This is important. Because whether you like it or not, Pain limits what we can do. I don’t know if this is always considered, but it is, especially when I hear that people in pain are being asked to do more than what is expected of me. It is natural for people in pain to say no. Saying no shouldn’t come with a variety of negative consequences, such as being disobedient, not trying hard enough, or using our pain as an excuse to quit. of things. Unfortunately, for those facing personal injury claims, the consequences of saying no can be quite harsh.
- Know how to adapt, adjust, adjust and change what is suggested. This includes things like mindfulness, exercise, medication, pacing, etc…and this is crazy. [insert strategy here] It’s a method.IIf there is an agreement, everyone will get a better outcome, right?We don’t and we see so many different ways [insert strategy here] I think I can say with a lot of confidence that no method is the only way. Consideration needs to be given depending on the situation. What this means is that you can adapt, adjust, tweak, or change things to suit your purpose or situation. “How does it work in this context?‘ is probably more important “What will happen from a medical perspective?”
- Being able to feel the effects. Find out what it feels like and use it to guide your actions. No, I don’t just mean short-term effects (resting feels so good sometimes), but long-term ones. Question: Do you have this? [insert strategy here] Will it give you more options, allow you to move toward what’s important, and allow you to adapt and adjust over time? Allowing someone to feel what it feels like and use that “body knowledge” in any situation probably means less conversation from the therapist, leading them to be aware and reflect. To do. This is a set of skills that many therapists, especially exercise therapists, have never been taught before.
I have previously written about how the ‘social’ is often ignored in ‘biopsychosocial’ approaches to pain. The factors that cause us to fall into social factors are precisely the factors that cause us to live with chronic pain. largely It has to be dealt with. how well we listen to medical professionals and others, whether we can say no without harsh consequences, and how we do things (including what clinicians suggest). ) social influences, such as the extent to which it is okay to adapt, adjust, tweak, or change the How much attention we pay to our bodies (because we’re often talked about and distracted from what we’re actually experiencing) and even whether we get a decent night’s sleep ( I’m that person) who takes a break from social events and lounges in bed at 9:30pm!).
Social factors also spread what is on offer, how much it costs, who can provide it, and whether it fits our lifestyles. Our gender, age, ethnicity, cultural background, religion, socio-economic status, education, and type of work are all social. And they make a huge difference in how we manage ourselves. A study by Webster et al., (2022) investigated how people with chronic pain engage in medical activities while struggling to make ends meet. They discover that efforts exist to manage chronic pain alongside poverty and survival, and they seek to legitimize their efforts. It understands the needs (and itself), tries to conform to the biomedical model (even when it is clear that social background factors contribute significantly), and navigates multiple diagnoses. The author calls this “chronic struggle.” This term resonates with my experience as a clinician listening to people with chronic pain. The experiences they speak of are ‘social’ and, clinicians, we need to listen.
If you work at a supermarket, you can’t just stop the line of people at the checkout line to stretch or pace yourself. The skills needed to make that happen lie in his three self-management skills: being able to safely say no, being able to adapt (and so on), and using your emotions to guide your actions. The social aspects of self-management require grit, confidence, good communication skills, and considerable personal strength. And for many people with chronic pain, assertiveness and controlling expectations come with high risks.
Social is participationwhen using ICF (WHO – ICF). Participation is all about being able to do things. In the words of ICF: “…Involvement in life situations…Participation limitations are problems that individuals may experience when engaging in life situations.” and then go on to say “…because the current environment embeds a social context, the performance recorded by this preliminaries can also be seen as “involvement in life situations” or “lived experience” in the real context in which people live. I understand. ”
Since self-management concerns everyday life, it necessarily involves participation in life situations. To see if what is being suggested as “self-management” can actually be done, learn about the person’s actual daily life situations and make sure that people with pain at least use these three skills that I have suggested. It is up to medical professionals to help them develop. . And we all need to resist attempts to limit our ability to do them without kickbacks.
Nicholas, M. K., and Bryce, F. M. (2016). Are self-management strategies effective in treating chronic pain? Pain Management, 6(1), 75-75–88. https://doi.org/https://doi.org/10.2217/pmt.15.57
Webster, F., Connoy, L., Sud, A., Rice, K., Katz, J., Pinto, A. D., Upshur, R., and Dale, C. (2022). Chronic struggles: An institutional ethnography of chronic pain and alienation. J pain. https://doi.org/10.1016/j.jpain.2022.10.004