Coping with pain

What is pain?

Pain is the nasty feeling we have when our body becomes or could be damaged. The amount of pain we feel for different things will be different for each person. Pain is a physical feeling in part of the body, but is also an emotional feeling too.

Chronic pain is when pain carries on for 3 months or more past what it should take to heal, and doesn’t go away with normal treatment for pain. Chronic pain can be constant or come in waves.

How does pain work?

When something hurts our body, our pain nerves (called nociceptor neurons) join up with nerves in our spinal cord and give a signal to our spinal cord and up to our brain. These ‘joins’ are called synapses.

Our spinal cord can help us react quickly to the thing that is hurting us by making our body move away from the painful thing or curl up to protect ourselves. This all happens very quickly and before we feel the pain.

Our brain tells us that we are in pain and where the pain is. It is our brain that feels the pain so without a brain we wouldn’t feel anything. This does not mean that you are imagining, exaggerating or making your pain up. It is your brain that is telling you how much pain you have.

Sometimes pain can start with some sort of injury or problem but it can carry on even when this has healed. This often happens with chronic pain because our brain can get stuck in a habit of feeling pain even when it has gone away. As we only feel pain in our brain, this pain is the same kind of pain as when the injury was there. Sometimes people don’t understand this and may say that people are ‘making their pain up’, but this is because they cannot find the thing that is causing it.

Pain gates

The joins (synapses) between our pain nerves and the nerves in our spinal cord can be thought of as ‘gates’ that allow the pain signal through. These gates also let other signals through like touch and vibration signals. Different things can make these gates open or close to let through different pain signals.

Below is a list of things that open and close people’s pain gates.

Things that open the gates

These can cause us to feel more pain:

• Stress
• Worrying (particularly about the pain)
• Arguments with family and friends
• Poor sleep
• Feeling upset, angry, frustrated, frightened, or wanting to ‘give up’
• Changes in activity levels by either doing too much or not doing enough
• Focusing on the pain
• Medical ‘flare-ups’
• Thinking bad thoughts

Things that close the gates

These can cause us to feel less pain:

• Distraction
• Having fun and doing things you enjoy
• Not focussing on the pain
• Thinking positively
• Relaxing
• Having help and support from family and friends
• Medication
• Managing activities so not doing too much or too little

Because so many things can affect pain, this means just one thing on its own may not be enough to get rid of the pain. For example, this is why some days you can take painkillers for a headache and the pain goes away but this may not work every time.

Getting stuck in the pain cycle

People can get stuck in with pain that can help problems getting out of control:

• constant pain
• doing too much or too little
• feeling tired and lacking energy
• muscles get weaker and are less fit
• leads to stress, worry and tension
• leads to anger, fear and frustration
• low mood and thinking negatively
• time off school and worrying about education

And the cycle continues.

Here are some ideas about things that you can do to help you cope with your pain. Different things will work in different amounts on different days. Just because something doesn’t work one day, doesn’t mean it won’t work the next day. It may take a lot of patience and practice before you get good at using these.

Learning to manage with your pain

Medication

Most people use medications to help with their pain. All medications have side effects, and people have different side effects to different medications. This is why your doctor may still be trying to find the best ones for you. You and your doctor will need to find a balance between the pain taken away with the side effects you are happy with. Make sure you talk to your doctor if you are not happy with your medication for any reason.

It is important to take your medication as your doctor has told you. Stopping the medication when you feel well may not be the best thing since you may feel more pain again. Some medication takes time to ‘build up’ so if you stop too soon you may not feel better. If you are not happy with how the medicine makes you feel, talk to your doctor.

Pacing activities

When dealing with pain on a bad day, when you are in lots of pain, you likely rest and recover, not doing anything in case of making your pain worse. Then, on a good day, when you don’t feel in as much pain, you tend to want to do everything you weren’t able to do when you had a bad day. But you could do too much, which could cause a bad day.

This is known as a ‘boom and bust cycle’ (the ‘boom’ is when you do everything and the ‘bust’ is when you can’t do anything). For some people their boom and bust cycles can be weeks long, and for other people they can be hours long.

Doing daily activities at a even pace such as walking, doing schoolwork, and playing with friends is important for dealing with your pain.

By not pushing yourself on ‘good days’ but also doing something on ‘bad days’, over time you should feel able to do more. This is about being kind to yourself and not trying to do things that you won’t be able to do. You should take regular breaks at times before you need them.

You should also break tasks down into small steps and doing them one step at a time.

Sleep

Sleep is hard when you are in pain. At night there is less to distract you from noticing your pain, and your mind is not as good when tired.

Keeping a good sleep pattern (also called ‘sleep hygiene’) is essential. This means going to bed at the same time and getting up around the same time. Your body clock works in a routine and is easily ruined by changing when you sleep. If you rest and sleep lots in the day, you are not likely to feel tired at night. To help manage your pain, it is better you are awake in the day and not at night when there is less distraction. It can help to:

• Set an alarm for getting up at a good time. If you like to press ‘snooze’ then factor this into the time you plan to get up
• Keeping to a bedtime.
• Train your brain to think ‘sleep’ when you go to your bedroom. By doing lots of things in your room other than sleeping, your brain can stay busy when being in your room. It can help to only use your room for relaxing and sleeping, and do active and busy things like school work, games consoles, and TV in a different room.
• If you don’t sleep at night, don’t try to catch up in the day. Try to get back in the normal sleep pattern so that you sleep better the next night.

Looking after yourself

Looking after your whole body is very important.

Try your best to:

• Eat a balanced diet as this can help your mood by keeping your body fit and healthy. A balanced diet doesn’t mean eating perfectly, but it does mean not always eating rubbish.
• Have good hygiene with washing and grooming your body daily.
• Regular exercise or stretching to help keep you busy and your muscles stretchy and flexible. When you don’t move your body, it can tighten and this can lead to you feeling more pain.

You might have been given exercises to do by your physiotherapist. Physiotherapists understand how much exercise you can do. It can be difficult at times to feel like doing these stretches and exercises, and you might feel worse at first due to tiredness or soreness but this will pass with time.

If you haven’t got a physiotherapist, it is important to make sure you stretch and move around regularly. Don’t sit in the same position for longer than an hour.

Dealing with worries

Our worries often start with small things, but in thinking about them over and over, they tend to get out of control. Worrying means you are focusing on your pain and so you could feel it more.

It is important to try not to get carried away with our worries, and take a step back to make sense of them. This can be done by:

• talking about your worries with friends, family, doctors and nurses in the hospital
• thinking about having proof as to whether you are right to worry as much as you do by listing why it is right or wrong to worry
• thinking about what you would tell your friend if they were worried about this and needed to cope with it

If you think that things are going to go wrong, you will worry more. Positive self-talk involves saying things over in your mind to help yourself feel better. The more you do this, the more likely you are to do well and to feel less pain. You can say things like:

• “I can cope with it”
• “It won’t be as bad as I think”
• “It might be difficult but I can do this”
• “I won’t let it beat me”

These things can be hard to do at first, but the more you practice this, the better you will get at it. You will also find this easier to do on some days than on others.

Distraction and doing things you enjoy

It is hard to distract yourself from your pain because pain grabs your attention. When you have pain, it doesn’t help to focus on the pain all the time.

Doing things to distract yourself from your pain is important. Things that are more likely to distract you from your pain are things you enjoy doing, and things that involve being with other people.

Relaxation

Learning to relax is one of the most useful things you can do to help with your pain. It works by dealing with tense muscles and slowing your thoughts down.

We all spend time ‘chilling out’ when we listen to music, watch our favourite programmes on TV, or play our favourite games. This is important stuff that helps to make us feel less stressed and worried.

Relaxing is different to ‘chilling out’. Relaxing is when we concentrate on slowing our bodies and minds down. Learning to relax can be hard at first but with practice, you will get better at it. Below is a quick and simple way of trying to relax:

5 deep breaths

• Sit or lie comfortably with your legs uncrossed
• Close your eyes
• Take a deep breath in
• Breathe it out slowly for about 5 seconds
• When you breathe out, let your body go floppy
• Think of a picture in your head of somewhere that makes you feel calm, safe, happy and relaxed, whether it be a real place or made up
  • What can you see?
  • What can you smell?
  • What can you feel?
  • What can you hear?
  • Repeat this for 5 breaths
  • Sit quietly for as long as you want after you’ve finished

It is good to practice relaxation when you are not in too much pain or too worried, as this will mean you will be better at using it when you are feeling this way.

Building a support team

Learning to manage your pain can take time, and you will need help from people around you. It can sometimes be difficult to know how to ask for help. You may also have lots of people all trying to give you help and this may feel too much for you.

It is important to work with the people around you to help you manage your pain. This may include family, friends, doctors and other people from the hospital. Find out how people might help you, and make sure you speak to them about the things that you feel they can do to help.

Setting action plans

It is important you agree on what steps you are going to take and when you are going to do things since setting a goal means you are more likely to do it. Keep things simple and small to start with, but keep setting something every day.

You are likely to have ‘bad days’ too so be prepared for this and make a different plan. Think about how you will cope if you can’t do the things you want to do.

Set-backs can actually be very helpful too. If you make a note of what might have triggered the set-back, then you can try to avoid it next time. You will also learn how to cope when things don’t go to plan.