Week 1: Understanding chronic pain

Week 4: Healthy thinking, healthy self

Week 5: Balancing your activity patterns

Week 6: Maintaining your gains and staying well

Understanding chronic pain and getting to know your symptoms

Getting to know your pain

Before you can create an effective treatment plan for your chronic pain, it is important to know what triggers your pain and keeps it going. This could include things like activities or thoughts that work against you. When you are aware of the factors that influence your pain, you can take action to change them. For treatment to be effective, it must be matched specifically to your needs. As such, you need to get to know your chronic pain, which requires personal insight and observation. 

Before trying to make changes in your life, it can be helpful to simply monitor your pain. By observing your pain, you can start to identify patterns in how it shows up. Perhaps it is best in the morning, worsens throughout the day, and is most unbearable in the evenings. Or, maybe it follows the opposite pattern. Observation also allows you to find out what exacerbates or makes your symptoms worse. For example, you may notice that certain activities are aggravating or that certain emotions are linked to an increase in pain. 

Getting to know your symptoms also involves understanding how you respond to them. In other words, you need to gain insight into what you do to cope. Some people avoid situations and withdraw completely in an attempt to minimise their pain, whereas others will try to ignore their pain and push on until they can barely move. Some coping strategies are more helpful than others, and strategies that help one person may make things worse for another. As such, you need to observe your own experience to find what works and doesn’t work for you. 

Once you know your symptoms, you can identify areas for improvement. These areas will form the basis of your treatment plan and should guide your next steps. For example, once Rachel identified that her pain was consistently worse in the afternoon, she learned to schedule important tasks in the morning and leave her afternoons for rest. To understand your pain better, you can do what is called ‘self-monitoring’. Self-monitoring involves observing and recording your pain and the events surrounding it on a daily basis. 

A pain diary is a common tool for self-monitoring and can be a helpful part of pain management. A pain diary is used to help you record important information related to your pain. This may include things like:

  • Time of day 
  • Recent pain experiences (where, how long and how bad)
  • Your activity levels or other possible triggers (e.g., movement, temperature changes)
  • The impact of any pain relief strategies used (e.g., cold/hot packs, medications)
  • The emotional or psychological effects of pain 
  • Other important information (e.g., injury, illness, medication changes etc.)  

The pain diary is meant to be a summary, not a moment by moment account, of your pain. A moment by moment account would likely be counterproductive, as the increased focus on pain might worsen its intensity.  As such, it is suggested that you make an entry in the diary at set periods throughout the day (e.g., morning, midday, afternoon). This will give you a regular record of how your pain changes over time. It will also prevent an excessive focus on your pain at other times during the day.  

Once you have recorded information over a couple of weeks, you can begin to analyse your findings and draw conclusions. The benefits of having the information from your pain diary can help you to establish patterns and find out what is effective in giving you pain relief. It can also be a useful tool to discuss with your doctor, as it helps to give them in depth information that can guide their treatment recommendations. The pain diary creates a detailed picture that forms your baseline, or starting point, for recovery. 

As you progress through this course, and perhaps explore other treatment options, you can compare your pain over time to assess your progress. People are often not great at accurately remembering what their pain was like in the past. Therefore, having a record can help you avoid bias and give you the motivation you need to keep going. 

Describing your pain

Part of getting to know your pain involves being able to accurately describe your pain. It is also extremely important to be able to describe your pain when communicating with health professionals. When filling in your pain diary, you will need to be consistent and specific about the type and intensity of pain you are experiencing. This will allow you to track changes in your pain over time. 

When describing your pain, it is important to consider things like its:

  • Location (e.g., right shoulder)
  • Sensation (e.g., sharp, dull ache, throbbing, burning, shooting etc.)
  • Intensity (e.g., on a scale from 0 to 10)
  • Duration and frequency (e.g., persistent, intermittent) 

It is common to use a pain scale to describe the intensity of pain. As shown in the image below, this is a numbered scale, ranging from 0 (no pain) to 10 (worst pain possible). The pain scale provides a simple and easy way to describe and compare pain at different time points. Several ratings on the pain scale can be averaged to give an overall rating for a particular day or week.