Module 1: Identifying Your Values & Goals for Managing Your Pain

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Darcy Williamson
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Module 1: Identifying Your Values & Goals for Managing Your Pain The sensation of pain can grow if you focus your thoughts on the pain; however, it can decrease if you focus on and approach your

You can learn how to better manage your chronic pain by focusing on your goals and values, rather than avoiding movements or situations that cause pain Think back over the past week and try to recall

1 Module 1: Identifying Your Values & Goals for Managing Your Pain The sensation of pain can grow if you focus your thoughts on the pain; however, it can decrease if you focus on and approach your value driven goals. You can learn how to better manage your chronic pain by focusing on your goals and values, rather than avoiding movements or situations that cause pain Think back over the past week and try to recall a situation, such as an attending an appointment, going to work or participating in a social gathering, where you were able to effectively achieve your objective or enjoyed your time with friends or family members. If you can t recall a situation in the past seven days, think back another week or more until you can recall a situation where you were successful at achieving your objective. Do you have the situation in your mind? Now, think about what was important about the situation or objective. If you attended an appointment, what thoughts or feelings helped you to complete the appointment? If you went to work, despite feeling pain, what kept you moving? If you were friends or family members, what positive feelings seemed to help you participate in the activity or gave you the strength to attend the social gathering? Now, write down some of the thoughts or feelings that help you to achieve your objectives or help you to move even when you are feeling pain. Also, make a note of the little things that seem to help, such as going with a friend, receiving support from family members, or the time of the day (e.g., you may feel less pain in the morning or afternoon). The following modules are designed to help you increase the thoughts, feelings, and resources that seem to get you moving with or without pain. You are likely to have most of the mental and physical skills needed to manage your pain, but you may not be aware of all your skills or how to use them when you are feeling pain, depressed, frustrated, anxious, or angry. The following modules will help you increase your skills as well as learn how to use them when you are feeling anxious, hopeless, or frustrated. The first step is to identify your goals and values so you can learn how your pain is disrupting you from reaching your destination. Your values are the principles by which you live and how you want others to view you. You may value being smart, physically active, a great parent to you children, a supportive friend, a dependable employee, a creative thinker or trustworthy. Your goals often support your values, such as 1 updated on December 2, 2013

2 acquiring a job to take care of your family, losing some weight to have more energy for sports, or taking college classes to increase your knowledge. Take a few minutes to read the following paragraph, known as the miracle question it s used to highlight your goals and values. Miracle question: Imagine that when you go sleep tonight, a miracle occurs. You don t know what happens, but when you wake up, your life has changed and you no longer have the problems you had when you went to bed. You no longer feel the pain, anxiety, frustration or other emotions that you felt when you went to bed. You wake up and feel very different from the way you have felt in the past mornings. How will you know that a miracle has happened; what will be different in your thoughts, feelings and physical sensations? What will you do when you get up and get out of bed? What will your day look like at work, with your family, or with your social activities? What will you do in the evening or on the weekend? Take out a note pad and write down all your thoughts, behaviors and feelings that you will experience after the miracle occurs. These thoughts, actions and feelings will be your destination; i.e., the road map for your journey through the following modules. Avoiding situations or behaviors that can cause pain is natural; however, if you have chronic pain, avoiding situations that are important to you can lead to increased feelings of hopelessness, frustration, and anxiety as well as decreased tolerance for pain. In other words, avoiding your valued-driven goals due to pain, can actually lead to an increase in the sensation of pain. The good news is that you can learn how to increase your tolerance or endurance for pain as you move closer to your goals and values. So, do you want to know how you can use your values to manage chronic pain? If yes, keep reading An easy first step for you is to write down all the important things in your life that you just imagined when reading the miracle question. You will use this list as your road map that will lead you to your destination get you closer to your goals and values. We have a form that you can use to design your road map; it s called My life areas, values and activities. You can start by picking a life area that you would like to use as your destination. You can use one, two or all of the life areas as your guide. Any life area will work as long as you care about that aspect of your life. You can list your values under each life area. Again, only select the values that you strive for; the ones that would get you going each day and help you approach situations even when experiencing pain. Under each value are activities that keep you close to your values. An activity is a goal that you can pursue each day. The list can include activities that you: are now avoiding because of pain (or the fear of increasing your pain), stress or other feelings, would like to increase, such as getting back to work or would like to try, such as a new activity that you have been interested in trying 2 updated on December 2, 2013

Mapping Out Your Destination Visualize being in the old west where you travel by stagecoach. You are sitting on top of the stagecoach, driving your team of horses.

You have a team of wild horses pulling your stagecoach. Each horse represents a challenge in your life that can cause you to feel pain, stress or frustration.

3 Mapping Out Your Destination Visualize being in the old west where you travel by stagecoach. You are sitting on top of the stagecoach, driving your team of horses. All elements of your life are in the stagecoach, including your family, friends, work, home, your healthcare and all other aspects of your life that you are responsible for or care about. You have a team of wild horses pulling your stagecoach. Each horse represents a challenge in your life that can cause you to feel pain, stress or frustration. These horses are strong, impulsive, and have a tendency to go off in different directions, which can increase your sensitivity to pain, stress or undermine your goal of reaching your destination. However, you can use the horses to reach your destination remember that they are strong and can be organized into a powerful force to pull your stagecoach if you can keep them all on the same path. That path is your values and goals. The key to your success is developing a road map that clearly reflects your goals and values. The more detail that you add to your map, the more likely you are to keep your horses on the path. Here are some guidelines for developing your road map. Guideline 1: Repeat strategies that helped you approach and manage situations in the past while still feeling pain or other difficult feelings (remember that you are likely to have the skills needed) Write down all the techniques that have worked for you in the past when you need to accomplish a task while feeling pain Guideline 2: Avoid or minimize using strategies that numb or distract your mind while feeling pain, such as alcohol, marijuana, pain killers, or food Distracting or numbing your mind can actually increase your sensitivity to pain, stress, and other emotions; in other words, using alcohol, food or marijuana to manage your pain can lower your tolerance for pain and other feelings over time Guideline 3: Take baby steps toward your goals and avoid making big leaps Increasing your tolerance or endurance for pain, stress or anxiety is similar to increasing your endurance for jogging start by walking a few times a week and gradually build up lung strength to start running 3 updated on December 2, 2013

Watching Out for Bandits in Your Mind Your thoughts about your past or worries about the future may attempt to rob your stagecoach as you travel toward your destination keep any eye out for these

manage pain have another problem while driving your stagecoach; i.e., your past! Your past is stored in your brain in the form of mental rules that you have used to solve problems in the past.

4 Watching Out for Bandits in Your Mind Your thoughts about your past or worries about the future may attempt to rob your stagecoach as you travel toward your destination keep any eye out for these bandits in your mind and stay focused in the present to keep them away from your stagecoach You already have the skills to keep your horses on the path, but you and everyone else who struggles to manage pain have another problem while driving your stagecoach; i.e., your past! Your past is stored in your brain in the form of mental rules that you have used to solve problems in the past. Your mental rules evolved over time through experiences and learning. You can view your mental rules as bandits hiding in the shadows and behind rocks along your path. Each bandit was created out of your past trips when you were exposed to painful situations, difficult experiences, made mistakes or were unable to reach your destination. These bandits know you and your goals and values; so they will know where you want to go and will attempt to rob your stagecoach as you move forward. In other words, your mental rules from your past can undermine your confidence that you need to reach your goals. The problem with many of these mental rules is that they are based on the past, rather than on present information. Consider these thoughts, which you can view as bandits using information from your past: I will likely feel more pain if I go to the picnic today, I can t believe I m feeling pain this morning when I have so much that needs to get done, I should not have to feel pain, Pain is bad, and I can t function with pain, or The best way to reduce my pain is to withdraw from activities How do you feel after reading these statements? You may have similar thoughts, which tend to increase feelings of stress or worry about the future (e.g., I will feel more pain), frustration, self-pity, fear, and isolation. As you can see, your thoughts can create powerful emotions and withdrawal patterns that come from the thought. Through each module, you will learn how to develop effective steps toward your goals while managing pain and other feelings. Part of your learning will include spotting the bandits in your mind who will want to stop your stagecoach from moving forward. 4 updated on December 2, 2013

5 In each module, you will learn how to identify and manage mental rules that are based in the past. You don t need to get rid of these bandits or try to avoid them; instead, you can learn how to update your mental rules; i.e., retrain your bandits, by using information that is based on present facts. Like the wild horses, your bandits will always be around in your mind, but you can manage them by focusing on present information and your values. As an example, here are updated rules to the thoughts noted above: I have felt pain in the past when I go to family picnics, but the pain rarely bothers me when I m having a good time and I tend to feel better when I get moving I have pain every day when I wake up and I have planned for the pain; today, I will pace myself and I will add in some stretching before I get started I tend to feel better when I get something done rather than sitting around and getting nothing done The majority of people feel chronic pain, so I am like everyone else, but I will feel worse if I focus on my pain and not on what I want out of life I am able to do many things when I feel pain, but I have to pace myself with pacing, I can all the things I want, but at a slower pace The best way to reduce my sensation of pain is to get out and do the things that are important to me Now, how do you feel after reading these statements? You may notice that you felt slightly better after reading these statements. If so, you now can see how easy it is to change your emotions as well as your energy level, by updating your mental rules. Assignments: For this week, begin to complete the form My life areas, values and activities. You can identify one or more areas to address that seem the most important to you. In particular, make a note of all the meaningful aspects of your life that you are avoiding because of your concerns about feeling pain. You and your wellness coach can begin to help you move back to your valued activities. Also, write down all the strategies that you have used to move closer to your goals while you felt pain. You and your mobile wellness coach can talk about how to use these strategies when you meet on the phone or at the clinic. If you have time, you can also list all the mental rules; i.e., the bandits that have undermined your goals in the past. These bandits will come back, so you can begin to develop a plan for updating your outdated mental rules. 5 updated on December 2, 2013

Neurotransmitter Questionnaire:

Neurotransmitter Questionnaire: The goal of this quiz is to see if your body is struggling produce one or more of the major neurotransmitters involved in healthy brain function. We have broken this into