Tuesday, 3 January 2017

Meet on the Same Stage (Stages of Change and Pain Management)

change and chronic pain
Imagine you are acting in a play. Your goal is to follow instructions from the director, in order to tell a story. The problem is that the director is in a different room, and can’t see the stage you’re acting on. The director calls out instructions, but they don’t seem to fit with the set or the props that you’re working with. You know the director is experienced, and has spent a lot of time studying this play, but his cues just don’t make any sense. He seems to become increasingly frustrated with you, as the play is not progressing in the way he intended. You are equally frustrated with him, because it feels like he does not understand your situation or respect the effort you are making. You are both trying to achieve the same goal, but it seems like you’re on two completely different pages. 

Now imagine that instead of being an actor, you are a person in pain. The “director” is someone trying to help you. It could be a health care provider, family member, or simply an acquaintance who read something on the internet. Whoever it is, they are well-meaning and have something they want to share with you. No matter how much they know about pain, you are the one who is living with it every day. Unless they understand your unique set of circumstances, their suggestions may not work for you. They may seem frustrated with you, because their attempts to be helpful are not resulting in an improvement of your situation. At the same time, you may feel frustrated with them because it seems like they simply do not understand.  

Now let’s look at the word “stage” a little differently. Instead of thinking of a stage as a platform for acting out a play, let’s think of the other kind of “stage,” a point in a process. Just like it is essential for a director to understand the set and available props, anyone who intends to help someone in pain needs to understand where the person is, and what their strengths and challenges are.

When it comes to managing chronic pain, self-management is often an essential component. But simply giving people a one-size-fits-all list of steps to take may not be effective.  This type of approach will likely result in a similar scenario to the one described above with the actor and the director. The clinician and person in pain will become increasingly frustrated with each other, and the intended goals will not be achieved. Clinicians can sometimes assume people will follow every single recommendation and it can be a source of tension for both parties. There can be a multitude of reasons for this disconnect, such as the information clients have previously been given about their pain, their stress level, their responsibilities (looking after children, keeping a job, etc), and their beliefs and values.

The clinician needs to start by understanding where the client is. One model that can be useful is the stages of change. Today we’ll make some suggestions about how we believe the stages of change apply to lifestyle changes that people want to make, such as pain self-management strategies. Please note, there is no right or wrong stage to be in. Telling someone they are in the wrong stage of change would be like telling someone they’re in the wrong stage of grief after a loss. Everyone deals with challenges in their own individual way, and it may change over time.

stages of change and chronic pain

Precontemplation: “I don’t have any control over this.”
In terms of coping with chronic pain, a person in this stage is looking for someone or something outside of themselves (a medication, a new doctor, a new treatment, etc.) to make their pain go away. This might mean they feel completely helpless and that their pain is out of their control. 
  • If you are in this stage
    • If you are reading this blog, you are probably not in this stage. Unless someone suggested you read the blog, in which case, thanks for checking it out.
  • If you want to help someone in this stage
    • Support them as they look for answers.
    • Express that you believe them and how pain is affecting their life.
    • Let them know you’ll be there for them along their journey.
    • Note: If you give a lot of suggestions about self-management to a person in this stage, it may not go over well. This is like the actor and director we described above. You may end up feeling frustrated that they are not taking your suggestions, and they may end up feeling like you don’t understand their situation. If you do give them suggestions, it may work best to frame it as something to keep in the back of their mind.
Contemplation: "Maybe I can have some control over this.”
In the world of pain, a person in this stage may be dissatisfied with the symptom relief they experience from their current treatment, and they may be looking for more options. They may begin to feel that there could be something they can do about their pain, but they are not yet confident that change will make a difference.
  • If you are in this stage
    • Look to reliable sources of information and support. This may include your health care providers, support groups, books, and other sources. (We like to think of ourselves as one of these reliable sources!)
    • It may be helpful to make notes or jot down ideas that seem interesting to you
    • Try not to get overwhelmed by all the different perspectives out there
  • If you want to help someone in this stage
    • Recognize that their interest in change may rise or fall, and that’s okay
    • Try not to overwhelm them with too many different suggestions
    • Try to encourage them without pushing
    • Remember that this is their journey.
Preparation: “This is how I’m going to try and take control.”
A person in this stage is formulating a specific plan.
  • If you are in this stage
    • Decide on one small, sustainable change that you want to start with
    • When deciding what change to make, consider what changes might take the least effort and/or have the most reward
    • Eliminate barriers that would stand in the way of achieving your goal
  • If you want to help someone in this stage
    • Identify the positive results that this change would bring about
    • Express that you believe in them, and their ability to carry out the change
Action: “I am taking control now.”
A person in this stage is carrying out their plan.
  • If you are in this stage
    • Don’t be afraid to start very small. Walking for two minutes more than you have been is a huge step in itself.
    • Don’t be too hard on yourself if it doesn’t work some days
  • If you want to help someone in this stage
    • Encourage them on rough days
    • Make the change along with them, if you’re a family member or friend
    • Help them celebrate their accomplishments - both the small successes and the big ones
Maintenance: “I have tools and resources that I can use to help manage my pain”
  • If you are in this stage
    • Recognize that there will be ups and downs
    • Keep learning and trying new strategies to add to your “tool belt”
    • Celebrate how far you’ve come

We purposely put these steps in a circle because although they are a logical progression, they are not necessarily linear. People may move backwards, forwards, or sideways depending on what’s going on in their lives. What may feel like a set-back may just be part of the journey. Remember that just like the actor and the director at the beginning of this post, the person in pain and someone who wants to help them will both find the experience more rewarding if they are on the same stage.


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