When pain returns

“Relapse” means a long setback

Unfortunately, chronic pain that lasts for at least 3 to 6 months is hard to cure. While pain can lessen with time there can continue to be good and bad days, improvements and setbacks. A setback, like a period of increased pain, may lead to unhealthy changes in behavior, such as:

 

  • Decreased activity
  • Increased worries about pain
  • Overreliance on medication
  • Increased social isolation
  • Depression

While it is hard to predict if or when this might happen, it is important once progress has been made, to be prepared to deal with the setbacks that can occur, in order to have them end as quickly as possible. This can prevent a relapse.

Paul’s story

Paul is a good example of someone with a setback that got out of control. He slipped and fell on his back while coming down some stairs. He had almost forgotten his previous back pain and surgery. Now his old pain was back and worse than ever. His doctor said there was no additional damage to his back. He was given pain medication and told to rest for a short time, then resume normal activity and return in one month. Paul decided to limit his activity and to stop exercising.

Over the next two weeks Paul had more stiffness and noticed that his back and leg muscles were weaker. This made him think that further damage had taken place, so he relied more on his pain medication. He took a leave of absence from work and stayed inside reclining most of the day.

After 3 weeks, Paul was even more discouraged that there was no improvement, and requested more pain medication. He remembered when his back pain was very bad and he worried that this time things were not going to improve. He went right back to where he was before – in severe pain, not sleeping, relying on medication, feeling weak and socially isolated, and being depressed.

How to prevent a relapse

There is a difference between a lapse, which is a short setback, and a relapse, which can leave you completely deconditioned, disabled and depressed. Everyone has lapses. What you want to avoid is turning your lapse into a relapse. Here are some ways:

  • Look for gradual progress. Gradual progress is better than trying to change things instantly. It is easy to get impatient, but slow change with gradual progress and the chance to maintain the gains is best.

  • Develop a written plan. Have specific goals with timelines. List realistic things you can accomplish, both short-term and long-term. Show your plan to someone who knows you well to get realistic feedback about your goals and timelines.

  • Keep records. Monitor your condition. Daily records that include your pain, mood, activity level, sleep, medication use, and recurrent worried thoughts will help you to see patterns and help to identify early signs of relapse.

  • Maintain an activity program, no matter how brief. Engage in some activity every day: range of motion exercises, stretching, or mild aerobics such as walking. Gradually getting back to a regular activity program will set you on the road to improvement.

  • Watch for body cues. Bodily signals of the onset of a setback are increased pain and fatigue. Be aware of excessive muscle tension and things that cause YOU stress. Pace yourself and avoid stress as much as possible.

  • Practice relaxation exercises. Diaphragmatic breathing, tensing and relaxing muscle groups, repeating phrases to yourself and guided imagery, can all combat stress and excessive muscle tightness. Listen to relaxation CDs or calming music every day.

  • Avoid negative habits. Replace bad habits, like smoking, staying inside, and eating “junk food” with positive habits that improve your health and help you feel better about yourself.

  • Provide time for something fun. Schedule activities that you enjoy. Say ‘no’ to things that cause further stress and don’t try to get back to all your previous activities too quickly. Try to find humor, laughter and good company.

  • Seek professional help. Healthcare professionals can help you identify ways to get better control over your situation. Find someone who can listen to you and offer concrete feedback. Counselors using cognitive-behavioral therapy are most useful. Support groups focused on building positive skills can be particularly valuable.

What happened to Paul?

Paul decided to make some changes. He reminded himself that he had made progress in the past and should avoid the negative thinking that made him feel sad and frustrated.

He set goals to increase his activity gradually. Despite some initial discomfort, he showed improvements in his endurance and strength. He kept his mind occupied and began listening to a 30-minute relaxation CD twice a day. He started walking slowly each evening. With time, he saw that he could go further than the day before. He used his medication as prescribed. His sleep improved and others remarked that he seemed less irritable and more prone to laugh. Even though he continued to have pain, his lifestyle had improved. Overall, he felt that he had recovered from his setback and avoided a relapse.

References

Caudill M.A. (2002). Managing Pain Before It Manages You, Revised Version. New York: The Gilford Press.

Otis, J.D. (2007). Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach. New York: Oxford University Press.

Thorn B.E. (2004). Cognitive Therapy for Chronic Pain: A Step-By-Step Guide. New York: The Gilford Press.