By Martha Butler, OT

What is self-management?
You may feel like chronic pain is controlling your life. Self-management puts you in control. Medical science does not have all the answers. Otherwise,you would not experience chronic pain. As long as you are waiting to be cured, your life is put on hold. Self-management strategies empower you to prevent increases in pain. They help you to modify your pain. This can help to improve your functioning.

Self-management means using strategies to cope with and reduce chronic pain. It can help you to take control and have a good quality of life despite your pain. Self-management means taking an active role in managing your chronic pain rather than simply relying on health care providers to treat it.

Self-management involves accepting that chronic pain is a part of your life, and learning to live with it. This means recognizing the biological, social, and psychological impacts of pain on your life, and knowing that you can do something about them.

There are various strategies or tools of self-management. You can benefit from using different tools at different times. Some tools, such as regular stretching and relaxation, may be used help prevent excessive pain. Others, such as changing self-talk and assertive communication, may help you to deal with flare-ups of your pain. The goal of self-management of chronic pain is for you to use the tools that work for you when you need them. They can help to reduce pain and allow you to participate in activities that are important to you. There are many tips for self-management in the Patient Resource Centre.

When you learn how to self-manage your chronic pain, you can change your focus to what you can do, instead of focusing on the pain and what you can’t do.

Why is learning to accept your chronic pain important?
Research over the past 10 years has shown that acceptance of a chronic pain condition is associated with lower pain levels, less disability due to pain, and less emotional distress about the pain.

Acceptance is an ongoing daily process which involves:

  • realizing the need for help
  • receiving a diagnosis
  • realizing there is no cure
  • realizing it could be worse
  • redefining normal

Dr Diane LaChapelle and her colleagues studied 45 women (ages 23 years to 75 years) with arthritis or fibromyalgia. They wanted to understand the process of how these women accepted their chronic pain conditions. The women did not like the word “acceptance” because to them it meant giving up or giving into the pain. Instead, the women chose words and phrases like “embracing,” “dealing with,” and “coming to terms”. The participants described acceptance to include taking part in life activities despite the pain, taking control of their lives despite the pain, and hoping for the pain to get better, but also realizing that the pain was chronic.

What is acceptance commitment therapy?
Acceptance Commitment Therapy (ACT) helps people living with chronic pain to learn how to accept their condition and make the most of their lives. There are two parts to this therapy.

First, acceptance is the willingness to experience pain or other upsetting events without trying to control or avoid these experiences. Frequently if you have pain, you may try to control or avoid the pain by avoiding activities or seeking surgery. You need to be willing to accept your experience rather than working so hard to change it. This means accepting that you will have pain, or that you may miss activities because of the pain.

Second, values-based action means that you will partake in actions that fit with your values and are meaningful for you. If you have chronic pain, your actions may be directed at getting rid of the pain. And, as a result, you might give up valued activities while trying to avoid the pain. A return to valued activities, despite the pain, is needed. Values-based actions can happen in all areas of life. These include family relationships, citizenship, leisure, personal growth, and spirituality.

In addition to acceptance and values-based action, other tools in ACT include:

  • mindfulness: focusing on the present moment
  • cognitive defusion: getting some distance from your thoughts
  • committed action: making a choice to do something and then committing to doing it

ACT references
Living Beyond Your Pain: Using Acceptance & Commitment Therapy to Ease Chronic Pain (2006) by Joanne Dahl and Tobias Lundgren. New Harbinger Publications.

Acceptance and values-based action in chronic pain:
A study of treatment effectivness and process by Kevn Vowles and Lance M