Living a Healthy Life with Chronic Pain (5 page)

Like solving problems, making decisions is an important tool in your self-management toolbox. The steps for making decisions resemble the steps for problem solving. They are as follows:

1. Identify your options.
   Sometimes your options can be a simple choice between changing a behavior or not changing at all. For example, you may have to make a decision about getting help with housework or continuing to do it all yourself.
   
2. Identify what you want.
   It may be important for you to continue your life as normally as possible or to have more time with your family. Perhaps you no longer want to be responsible for certain chores, such as shoveling the walkways or mowing the lawn. Sometimes identifying your core values (such as spending time with family and friends) will help you set your priorities. Identifying your values and what you want can even increase your motivation to change.
   
3. Write down pros and cons for each of your options.
   List as many items as you can for each side.
   
4. Rate each pro and con on your list.
   Rate each pro or con on a scale from 0 to 5, with 0 indicating “not at all important” and 5 indicating “extremely important.”
   
5. Add up your ratings for each column and compare them.
   The option in the column with the highest total should be the option you choose. If the totals are close or you are still not sure, skip to the next step.
   

Figure 2.1
Decision-Making Example

6.   
Apply the “gut test.”
For example, does going back to work part-time feel “right” to you? If so, you have probably reached a decision. If not, the way you feel should probably win out over the math.

You can see a decision-making example and a blank decision-making chart in
Figure 2.1
and
2.2
.

In the example shown in
Figure 2.1
, the clear decision is to get help because the pro score (11) is significantly higher than the con score (7). If a decision made in this way feels right in your gut, you have the answer.

Now it’s your turn! Try making a decision using the chart in
Figure 2.2
. It’s okay to write in your book.

Figure 2.2
Decision to be made:

We have just discussed how to identify problems and make difficult decisions. These are important first steps but often knowing what to do is not enough. Now, it is time to do something, to take action. We suggest you start by doing one thing at a time. In the material that follows we outline the steps to taking action. First, set a goal and evaluate your options for achieving that goal, then begin by making a short-term action plan.

Before you can take action, you first must know what you want to do. Be realistic and specific when stating your goal. One self-manager wanted to climb 20 steps to her daughter’s home so she could join her family for a holiday meal. Another wanted to overcome his fatigue and attend an evening class once a week. Still another wanted to continue to ride his motorcycle regularly even though he could no longer handle his 1,000-pound bike like he used to.

Take a few minutes and write your goals in the chart in
Figure 2.3
. Feel free to add more lines if necessary.

Figure 2.3
Goals

Put a star (
) next to the goal you would like to work on first.

There are many ways to reach any specific goal. For example, our self-manager who wanted to climb 20 steps could climb a few steps each day at first, begin a slow walking program, or look into holding the family gathering at a different place. The man who wanted to attend evening classes could plan rest periods throughout the day, go on very short outings, ask a friend to go along for assistance, or talk to the health care team about his fatigue concerns. Our motorcycle rider could buy a lighter motorcycle or a three-wheeled model, use a sidecar, or put “training wheels” on his bike.

As you can see, there are many options for reaching each goal. Your job is to list the options and then choose one or two to try out.

Sometimes it is hard to think of all the options yourself. If that’s true for you, share your goal with family, friends, and health professionals. You can call community and national organizations such as the American Chronic Pain Association or the Canadian Pain Coalition for advice. Or you can research potential options on the Internet. Don’t, however, ask others what you
should
do; rather, ask for
suggestions
about what to do. It is a subtle but important distinction. It is always good to have a full list of options, but in the end
you
must prioritize them and pursue the ones that you feel are the most promising.

A note of caution: you may not seriously consider some options because you assume they are unworkable. Never make this assumption until you have thoroughly investigated the option. One woman we know had lived in the
same town all her life and felt that she knew all about the community resources. When she was having problems with her health insurance, a friend from another city suggested contacting an insurance counselor. The woman dismissed this suggestion because she was certain this service did not exist in her town. It was only when the friend came to visit and called the Area Agency on Aging (which exists in most counties in the United States) that the woman learned there were three insurance counseling services nearby. Then there’s our motorcycle rider who thought that training wheels on a Harley was a crazy idea, but he overcame his skepticism and investigated the possibility. He added 15 years to his riding life using training wheels. In short, never assume anything. Assumptions are major self-management enemies.

Write a list of options for your main goal in
Figure 2.4
. Place a star (
) next to the two or three options you would most like to pursue.

Figure 2.4
Options

One last note about goals: not all goals are achievable. Chronic pain may mean having to give up some options. If this is true for you, don’t dwell on what you can’t do. Rather, start working on another goal you would like to accomplish. One self-manager we know who uses a wheelchair talks about the 90 percent of things he
can
do—not the 10 percent he has had to quit doing. He devotes his life to developing this 90 percent to the fullest.

Once you’ve identified a goal and narrowed down your list of options, you should have a pretty good idea of where you are going. However, the path ahead may be overwhelming.
How will I ever move? How will I ever be able to garden again? How will I ever ___________________?
(You fill in the blank.) One of the problems with goals is that they often seem like dreams. They are so far off, big, or difficult that we are overwhelmed, so we don’t even try to accomplish them.

The secret is to not try to do everything at once. Instead, look at what you can realistically expect to accomplish within the next week. We call this an action plan. An action plan is short-term, is doable, and sets you on the road toward your goal.

Action plans are probably your most important self-management tool. They help you do the things you know you should do in order to achieve your ultimate goals. For example, most people with chronic pain can walk. Some can make it just across the room, others can walk for half a block. Many can walk several blocks, and some can walk a mile or more. However, few people have a systematic exercise program to improve their ability to walk even with chronic pain. In the material that follows, we discuss the steps for making a realistic action plan.

First, decide what you will do this week. For the person who wants to climb 20 steps, the goal for the first week might be climbing just three steps on each of four consecutive days. The man who wants to continue riding his motorcycle might
spend half an hour on two days researching lighter motorcycles and motorcycle training wheels.

Make very sure your plan is action-specific. For example, instead of just planning to “lose weight” (which is not an action but the result of an action), plan to “drink tea instead of soda with meals.”

You can get specific about your plan by answering the following questions:

• Exactly WHAT are you going to do?
  If you want to lose weight, are you going to walk? Eat less? Practice distraction techniques? Again, be specific. “Losing a pound this week” is not an action plan because it does not involve a specific action; “not eating after dinner for four days this week,” by contrast, is a fine action plan.
  

• HOW MUCH will you do?
  Answers to this question often involve time, distance, repetitions, or quantities. Will you practice relaxation exercises for 15 minutes? Will you walk one block, or make two trips up the stairs each afternoon? Will you eat half portions at lunch and dinner?
  

• WHEN will you do it?
  Again, this must be specific: before lunch, in the shower, upon coming home from work. Connecting an action plan with an old habit is a good way to trigger the new behavior and make sure it gets done. For example, make brushing your teeth your reminder to take your new medication. Make a plan to do your new activity before an old favorite activity such as reading the paper or watching a favorite TV program.
  

• HOW OFTEN will you do it?
  This is a bit tricky. We would all like to do things every day, but that is not always possible. We recommend initially aiming for three or four times a week. If you do more, so much the better. However, if you are like most people, you will feel less pressure if you can do your activity a few times a week and still feel successful. (Note that taking medications is an exception. This must be done exactly as directed by your health care provider.)
  

There are some other general guidelines for developing your action plan that may help. First, the action plan should be about something
you
want to do or accomplish. Do not make action plans to please your friends, family, or doctor.

Second, “start where you are,” or start slowly. If you can walk for only one minute, start your walking program by walking one minute once every hour or two, not by trying to walk a block. If you have never done any exercise, start with a few minutes of light stretching. If your goal is to lose weight, base your plan on your existing eating behaviors, such as having half portions of some of your usual foods.

Third, give yourself some time off. All people have days when they don’t feel like accomplishing much. That is a good reason for planning to do something three times a week instead of every day.

Fourth, once you’ve made your action plan, ask yourself the following question: “On a scale of 0 to 10, with 0 being totally unsure and 10 being totally certain, how sure am I that I can complete this entire plan?”

If your answer is 7 or above, you probably have a realistic action plan. If your answer is below 7, look at your plan again. Ask yourself why you are unsure. What problems do you foresee? Then see if you can either solve the
problems or change your plan to make yourself more confident of success.
Table 2.2
summarizes the features of a successful action plan.

Table 2.2
Basics of a Successful Action Plan

Once you have come up with a plan you are happy with, write it down and post it where you will see it every day. Thinking through an action plan is one thing. Writing it down makes it more likely you will take action. Keep track of how you are doing and the problems you encounter. (A blank action plan form is provided at the end of this chapter. You can find more at the end of the book.)

If your action plan is well written and realistically achievable, completing it is generally pretty straightforward. Ask family or friends to check to see how you are doing. Having to report your progress is good motivation.