• Reversing pain sensitisation
• A Self-Management Program
• The Key to finding a Path out of Pain
• Listening to your pain
• Why relax?
• Mindfulness in your day
• Rest, Recreation and Relaxation
• Why Exercise?
• Find a balance between rest and activity
• Working with your Body
• Components Of Your Daily Routine
• Being honest with yourself
• Not Getting the Results you want
• Creating an Environment for Healing

Reversing Pain Sensitisation

If the heart of fibromyalgia (and chronic pain) is pain amplification or pain sensitisation then reversal of this state is the path to healing. Pain sensitisation is a lowering of the pain threshold: recovery involves raising the pain threshold back to a normal level. Normal activity and pressure to the body will no longer cause pain and tenderness.

Unfortunately, though, many people with fibromyalgia/chronic pain end up in a trap. As the pain sensitisation develops they start to protect themselves. It is almost as though they wrap themselves in cotton wool shutting themselves off from the world in an attempt to avoid the pain. Their activity is reduced, as well as their contact with people. They tend to withdraw physically and emotionally. Sadly this pattern of withdrawal from life does little to solve the problem. Frustration, despair, and helplessness become regular visitors feeding the pain amplification state. This is a very normal reaction for people who are accustomed to doing a lot in life and expecting a great deal of themselves. To lose their independence and to be restricted in their activities causes a great deal of anguish. Unfortunately, fighting these limitations only leads to further pain and anguish. However, it is possible to reach a level of acceptance of the situation but at the same time know that it is not permanent. Accepting how it is now can be the start of the healing process. People are often surprised at how quickly things start to change when they do start to "accept how it is now". The pain bothers them less, they find activities they can enjoy, and find unexpected solutions to what seemed like insoluble problems.

The focus of this self-management program is reversal of the pain sensitisation syndrome. Everything in the program directly or indirectly assists this process and the bottom line is feeling good. Many people believe that the only way that they can feel good, is to be as they were before injury or before the pain began. Being willing to change, is perhaps the most important step you can take. The program can involve substantial changes in your lifestyle including learning to relax, exercising regularly, eating well and learning to be positive and accepting. The key to success is commitment. Those who persevere and learn to be patient, get results. It would be easy to reverse the pain sensitisation state if you adopted these changes immediately, but most people take time to integrate them into their lives. Sometimes the path out of pain involves looking at yourself and your lifestyle closely. This can be quite confronting and many people feel reluctant to do this at first. However, this is all just part of a process and if you are prepared to take the first step, you can be rewarded for your courage and insights. The pain sensitisation state is reversible. Top of Page

A Self-Management Program

In this age of increasing reliance on sophisticated technology it can be easy to forget that people have a remarkable capacity to heal themselves. The key to self-healing is creating an environment to facilitate healing and reawaken this healing potential in the person experiencing pain. This program is designed to help you reawaken your healing potential. Health Care Practitioners can support this process as they treat you, asking questions and inviting you to take responsibility. In this way you can benefit from their particular skills and be supported in developing your self-management program. The diagram below represents the components of this self-management program.

In the centre of the diagram are the core components: relaxation/meditation and exercise/movement. Some people in pain recover once they have learnt these skills and keep using them in their daily life. Other people need to explore more deeply, asking themselves questions like "Why this?" and "Why now?" More profound healing comes when people explore questions like "Who am I?" and "Why am I here?" that address purpose and meaning in life. However, everyone in chronic pain will need to explore their attitudes to the pain, the self-management program, and their life generally.

Many people believe that they are doing all that they can because they have been to yoga, done a course in meditation, had some Feldenkrais lessons or been given exercises by the physiotherapist. However, it is only when you put it all together in a daily program, that you can be effective in reversing a chronic pain syndrome. This self-management program provides an integrated approach, addressing mind, body, emotions and spirit. It is a 6-day program because it takes at least 6 days to learn the skills. However, the course is only the beginning, and many people need to have individual sessions, after the course, to address their personal concerns about their situation and the program. Self-Management takes a great deal of skill and the more skilful you become the greater the chance you have of recovering. You can read more about what is involved by looking at A Prescription for Self-Management. Obstacles to Self-Management describes some of the obstacles to getting your program up and running. I have included a few more comments, below, about each aspect of the program and about the reasons for seeking psychotherapy or counselling.

Relaxation and Meditation
There are many different ways to practice relaxation and meditation. It is important to find a method which suits you and your lifestyle. I have found that mindfulness meditation is most helpful for people with chronic pain syndromes because of the focus on the present, and increasing awareness of thoughts, feelings and behaviour. Awareness is a powerful tool in life, and for healing. It is often best to start with muscle relaxation techniques and later move on to breathing techniques. Some people find visualization useful and others find that visualization doesn't come naturally. Try some different approaches and then use your chosen approach regularly because it is the regular practice which will give you results. Tapes can be helpful, particularly at the start, but you will need to learn how to relax without a tape.

Learning to relax is essential to recovery but it is probably the most difficult skill, for people in pain, to learn. When tension and activity have become habitual it can be challenging to stop and relax. Here are some of the reasons why people are reluctant to practice relaxation.

• Some people are scared of what will happen if they stop;
• Some say it hurts more when they sit still;
• Some fear the loss of control when they start to let go;
• Some feel bored by doing nothing;
• Some become anxious when they try to relax;
• Some people feel guilty when they relax;
• Some people feel that they are wasting time or,
• Some feel that there is not enough time to practice relaxation.

Working with your obstacles to practising relaxation, will help you find your path out of pain.

Exercise and Movement
Similarly there are obstacles to doing an exercise/movement program. The most common one is that it hurts to move or the pain gets worse after exercise and activity. This can become a trap because you need to move to find a path out of chronic pain. It is how you move, and which exercises and movements you do, which will determine how successful you are with this aspect of the program. You can read more about the components of a daily exercise program in Components of your Daily Routine.

Attitude
When I say attitude I include, attitudes to the pain, to the self-management program, and to your life generally. You can read more about developing helpful attitudes to pain in Turning Reactions into Responses and in Posters. If you can learn to recognize your reactions and change them into responses, you have a very powerful tool to help you on your journey out of pain. Beliefs can Hinder or Heal explains the impact of your thoughts.

Occupation
It is difficult to recover from illness or chronic pain when you have no reason to get up in the morning. But, when you feel useful and you enjoy your work, healing is more likely to happen. Unfortunately, chronic pain can present all sorts of challenges to finding such work as you may have constraints on what you can do. Sometimes people have to retrain or do alternative duties for a while. However, research has shown that people who return to work soon after their injury, do better than those who have extended periods away from work. It is best to seek assistance from rehabilitation consultants who can design a graduated return to work plan and ensure that you have the right furniture and equipment for your job.

Psychology/Psychotherapy/Counselling For some people chronic pain is just a nuisance lurking in the background of their lives and for others it is devastating; affecting their quality of life, their relationships, and their capacity to work. It is useful for anyone with chronic pain, to explore questions like "Why this?" and "Why now?" to help discover personality characteristics (see Pain and Personality) and lifestyle patterns that could be behind the chronic pain. Skilled therapists can help you explore these questions and make the necessary changes to your lifestyle. Therapists or

People with chronic pain can experience anxiety, depression, grief, relationship difficulties, conflict, anger, and fear. Psychologists and counsellors are trained to assist you with these problems. It is best to seek assistance early as these problems will amplify your pain and make your recovery much more difficult. If you are not getting the results you want, you may need to do longer term work in therapy, exploring core beliefs or schemas that may be standing in the way of your healing.

The key to finding a Path out of Pain

Finding a path out of pain means being willing to identify, face, and work with the obstacles to self-management. Each person with chronic pain has their own set of obstacles and they can find their own solutions. In other words there is no one path out of pain. People who pass through the Door of Willingness move beyond attitudes of avoidance, resistance, helplessness and hopelessness to acceptance, curiosity, courage and patience. They have let go their resistance to change and developed curiosity about what lies beyond the door of willingness. Beyond the "Door of Willingness" the pain is transformed from something representing danger and a catastrophe, to opportunity.

Turning Risks and Obstacles into Opportunities

What seemed like a catastrophe can become an opportunity when the apparent obstacles to self-management are faced. Obstacles can become challenges if you are prepared to go through the door of willingness. You can learn many useful life skills and find greater health and happiness through doing this program.

Top of Page

Listening To Your Pain

Two common reactions to pain are:

1. To stop when it hurts;
2. To ignore it and keep going.

Neither one is a good strategy as they represent 2 ends of a continuum of responses. Your response to pain needs to be much more finely tuned. Sometimes people begin with the second strategy and then turn to the first because they can't keep it up. They have to leave work and/or stop most activities around the house. It is an all or none response and many people live their lives reacting in this way forgetting that there is a whole range of responses in between. They see the world as black or white without shades of grey.

Turning a Reaction Into A Response
A reaction is something you do automatically whereas a response is something you consciously choose to do. To learn to respond rather than react you first need to recognise your reactions. The poster Attitudes to Pain illustrates many reactions people have to chronic pain. As you get to know your reactions better you can then make choices about how you would like to respond. You may need to try out different approaches and determine what works best for you. Working with Your Body and Finding a Balance between Rest and Activity, later in this section, gives you many strategies you can try.

Dancing Or Being In Step With Your Pain
A fixed reaction is very limited. To be able to move in step with your pain gives you flexibility. You will need to stay aware to be able to make these adjustments. You may need to:

All through the day you can monitor yourself. This means being mindful (see Mindfulness in Your Day later in this section). Ask yourself how are you moving, breathing, feeling, sitting, and relating. You can make the appropriate responses as soon as you notice any increase in tension or speed.

Let It Be
You can even learn to just let it be; neither reacting nor responding in the sense of doing anything. To simply allow your experience to be as it is, can be very powerful. It is our reaction to pain which makes it so painful. As you learn to stop reacting you will find the pain less bothersome and eventually it will diminish or even disappear.
Top of Page

Why Relax?

1. To reduce pain
   • by reducing muscle tension
   • by focussing on something else
   • by changing its character (size, shape, colour, etc.)
   • by opening to the pain
2. To let your body heal itself
3. To reverse the stress response (i.e. decrease blood pressure, breathing rate, muscle tension, heart rate, etc.)
4. To reduce your anger, anxiety and frustration
5. To learn mind control
   • stop thoughts
   • let go of thoughts
   • change thoughts
6. To increase your energy
7. To increase your tolerance and acceptance
8. To increase your awareness
   • of muscle tension
   • negative thoughts and feelings

Learning to relax takes:

• Time
• Perseverance
• Commitment
• Patience

Top of page

Mindfulness In Your Day

Mindfulness is to be fully present in each moment, to be aware of whatever it is you are doing or not doing. Most people live their lives on automatic pilot just repeating the same old habits and patterns without noticing what they are doing. As they drive their car, eat their meal or talk to someone their mind might be anywhere except focussed on the driving, eating or talking. To be mindful in your day is to bring a meditative attitude to everything you do. Everyone wins. You can feel calmer and are more efficient and effective; others will feel heard when you are talking with them. It is a simple concept but it takes a lot of practice to make it happen in your life. The partner of mindfulness is forgetfulness. It can be easy to slip into forgetfulness.

Ways To Stay Mindful During The Day
Stop and ask yourself:

Remembering Mindfulness
There are some things you do everyday and these could be your triggers to remember mindfulness. Map out a mindful routine. Some examples are given below.

1. Morning quiet time. Be with your self for 5 minutes or more. Even one minute would help. Be still and do nothing or watch your breath. A few stretches first would be a good start to the day.
2. Breakfast. Eat something mindfully. Read the newspaper some other time.
3. Traffic lights. Check your breathing and muscle tension.
4. Morning break. Take a calm break for some of the time. Be with yourself. Ask yourself some of the questions above.
5. Writing. Ask yourself the questions above.
6. Phone call. After a phone call, check in with yourself.
7. Standing up after sitting for a while. How am I walking?
8. Sitting at your desk. Stop every hour and tune into yourself. Make sure you do some stretches several times during your day.
9. Talking to a colleague. How am I relating?
10. Returning home. Pause before you return to the family. Stop the car in a quiet street. Top of page

Rest, Recreation and Relaxation

When I ask people how they relax, they usually tell me about how they rest or what they do for recreation. I believe that there is a difference between rest, recreation and relaxation. All of them are important for finding pain relief but learning to relax is essential for those who have not done this before or find it difficult to relax.

Rest
Rest is about taking it easy. Deep rest comes when we are free of demands, pressures, and conflicts. We stop planning and doing, and just drop our bundle. It takes organisation and planning to find the time and place to do this but rest enables us to restore ourselves and become aware of the pressures and demands which we accept as normal. Getting away from home makes it a great deal easier and you might be surprised at just how deep your sleep can become when you free yourself in this way. I am often told that it takes at least a week to unwind before the rest begins. Many of us live at an extraordinary pace today. Try taking some time away on your own; it is a very powerful way to restore your self.

Many people experience guilt about resting. They feel they must finish everything before they can rest and, of course, that time never comes.

• Challenge your conditioning about the need to be busy all the time.
• Give yourself permission to rest.
• Plan regular rest breaks by marking them in your diary.
• Explore new and beautiful places; nature restores and heals.
• Take some time this week even if it is only half a day or even an hour.

Recreation
Recreation enables us to switch off from work, or our regular duties, by doing something enjoyable and different. Reading, gardening, dining out, playing sport, going to films, bushwalking, and handicrafts are common ways of seeking recreation. Have you forgotten about recreation? People in pain often forget the importance of recreation or believe that the pain prevents them from having any recreation. Here are some suggestions:

• Take up an old hobby or interest.
• Try some new hobbies or interests.
• Be adventurous and creative in finding new things to do.

Relaxation
Relaxation is different to rest because it is an active process requiring concentration. Falling asleep with a relaxation tape does not teach you how to relax. You may fall asleep in the early stages of learning to relax because you are so tired and need the rest. It is a good idea to practise your relaxation early in the day before you get sleepy. There are many ways to relax and these can be explored on the "Path out of Pain" course. Relaxation is a prelude to meditation and allows the meditation to be deeper and more peaceful. Relaxing the body and quietening the mind makes it possible to sit and just 'be'. Top of page

Why Exercise?

• To restore functioning
• To facilitate healing
• It feels good
• It can reduce depression, release anger, and make you feel alive.
• To increase your mobility
• To increase your strength
• To increase your fitness
• To prevent further injury
• To restore confidence in your body
• To improve sleep
• To create health

Remember

• If you are not exercising you are not taking responsibility for your healing.
• Start with a little and keep increasing it.
• Pain may increase at first because you haven't been moving much.
• Exercise leads to pain relief in the long-term.
• If you don't use it, you lose it.

Barriers to Overcome

• Fear that you have damaged yourself when the pain increases.
• Belief that rest cures chronic pain. Top of page

Finding a Balance between Rest and Activity

It can be difficult to find a balance between rest and activity when you have chronic pain. It is common for people to do too much or too little. These two patterns are described below.

1. The Over-doers
   Some people say to themselves "I am not going to let this thing beat me", or "I am going to do this anyway in spite of the pain; there is no-one else to do it". They tend to over-do activity and often end up aggravating their condition. Their frustration from being restricted by the pain drives them to test themselves out and do more, not less. Most people feel frustrated at some time and do burn up their frustration by bursts of activity. Small bursts of activity are OK, even when rest is required afterwards. It is important to do some things we enjoy even if they do cause a little pain. The secret is to know when to stop and this requires listening very carefully to what your body is telling you. Don't throw away your determined attitude; it is the determination which will eventually get you better. But, at the same time, keep it under control. What we are looking for is the right balance between rest and activity. Only you can find this balance and you will need to be finely tuned into your body to adjust your level of activity each day. Keep pushing your limits a little further each week, but do it gradually. Don't act out of frustration; act out of a good knowledge of your capabilities.
   
   Overdoers do too much; they need to slow down and learn to ask for help.
   
   
2. The Under-doers
   " Over-use" Syndrome can become "Under-use" Syndrome. This second group of people tend to react to pain by ceasing activity. They may say to themselves "I must not do this because it makes the pain worse" and they even anticipate an increase in pain before they actually start doing something. They remember what it was like at work, or just after they stopped work, and they measure their capabilities against this period of time. One year, or even two years after the injury, they are terrified of doing something which will cause a recurrence of the original injury. But, their problem is no longer one of 'overuse' but 'under-use'. They experience pain because their body is not used to activity - the muscles are weak and the joints are stiff. Perhaps even more important, is the fear they experience. Fear intensifies pain. In addition, the expectation that activity will cause pain usually results in pain when that activity is undertaken. The main problem, then, for under-doers, is to overcome their fear, and expectation that activity will cause pain. They may even have to increase their tolerance to pain and not be afraid of causing some pain. While they react to the pain, saying "I knew that would cause pain, it will take me days to get over it, I shouldn't have done it", their pain will continue.

A more helpful attitude would be to say "I can handle the pain", and "I may have done too much, but I am just learning to get the right balance". Over-reacting to the pain ends up in the person doing less and less. Remember the sayings:

• "You lose what you don't use".
• "You get what you expect".

Some people swing from being an over-doer to being an under-doer. When they overdo things, they become frightened by the pain and stop almost all activity and, later, they repeat the same cycle. They need to find the balance point in the middle instead of moving from one extreme to the other.

Under-doers do too little; they need to get going and become more independent.
Top of page

Working with your Body

How do you relate to your body when you are doing daily chores and exercises? Even the word chore is often viewed as a negative. Chores have to be done and generate no pleasure. Do you get frustrated and disappointed with your body when it refuses to perform as it used to prior to the injury or onset of pain? Perhaps you resent the limitations and the pain you experience when you do your daily chores and exercises. Perhaps you avoid both for some or all of these reasons, or do you carry on regardless pushing yourself to get it all done? I wonder how your body feels when it receives these messages from you. How different it could be if you found a way to encourage, coax, and even love your body as you discovered new ways to move and do things. How would your body respond to loving messages? I guess a good analogy would be teaching a child how to play tennis, ride a bicycle or read. If you constantly expressed your frustration and disappointment with their attempts to learn these skills they would be unlikely to do well or enjoy themselves. A good coach (teacher or parent) knows when to be firm and when to be gentle. Sometimes more discipline and practice are required but even this message can be given in a loving way. There are other times when a break is required or the routine needs to be eased up for a while.

An Experiment
Next time you notice yourself becoming frustrated, disappointed or resentful when you start doing an exercise or daily activity, stop and pause. Notice what you have been saying to yourself. For example:

• It shouldn't hurt.
• It shouldn't be like this.
• It is taking too long.
• I will never get finished.
• I wish I could do it the way I used to do it.
• I must stop because I am damaging myself.
• I am going to do it anyway.
• I am scared that I will aggravate the problem.
• I had pain for days last time I did this.
• I can't handle the pain.

Frustration and disappointment are natural reactions to these limitations particularly if you are a person with high expectations of yourself. In fact it is the expectations that generate the problem. The desire to be the same as before and maintain the same frenetic pace causes the frustration and disappointment. Accepting the change is part of the healing process; whilst grief persists it is not possible to move on to a new life. Accepting the situation doesn't mean accepting that it will always be like this, it simply means this is how it is now. Paradoxically this allows progress to occur. Struggling to make it different to how it is only leads to more frustration and disappointment.

When you have noticed your reaction (thoughts and feelings) you can choose to ACT rather than REACT. There are many ways you can acknowledge the situation and change your attitude.

1. How do you view the activity?
   • Is it a chore? or
   • Is it something which will assist with your healing?
   • Is it something to be got out of the way? or
   • Is it something to learn from?
   • What can you discover from doing this activity?
2. What can you say to yourself?
   • This is how it is.
   • I have all the time I need.
   • I am learning from everything I do.
   • It becomes easier as I slow down.
   • Accepting this allows me to progress.
   • What's the hurry?
   • Slow down.
   • Go gently.
   • Let go.
   • Be patient.
3. How could it be more pleasurable?
   • Be fully present.
   • Be curious.
   • Be playful.
   • Take your time.
   • Notice the comfort.
   • Create a welcoming environment (colours, textures, sounds).
   • Let go of your demands.
   • Notice things you haven't noticed before.
4. How could you take the pressure off yourself?
   • Lower you expectations.
   • Take one step at a time.
   • Expect the unexpected.
   • Appreciate what you can do.
5. What qualities could you invite in?
   • Patience
   • Love
   • Gentleness
   • Firmness
   • Acceptance
   • Tolerance
6. How could you reward yourself?
   • Notice the small gains.
   • Buy yourself a present when you have reached a goal.
   • Take a bath or spa.
   • Buy some flowers.
   • Pamper yourself .
   • Praise yourself.

Finally, notice the difference when you change your attitude. Perhaps there is less pain, or is the activity easier than you expected? Changing your attitude will change the outcome. You could be surprised and delighted by how simple it is to let go the frustration and disappointment when you consciously change you attitude.

Summary

• Stop and pause when you notice frustration and disappointment in doing something. Acknowledge your thoughts and feelings.
• Choose to act not react by changing your attitude. You can change your perception and your self-talk. It can become pleasurable as you take the pressure off yourself and invite in qualities such as patience, acceptance and love. Remember to reward yourself.
• Notice the difference.

Do You Believe?

• Life should be pain free.
• Life should not change.
• Pain is to be avoided.

You may notice a big difference if you start to believe the following:

• Being in a body means that we will experience pain (physical and emotional).
• Life changes constantly.
• What we resist, persists. Avoiding pain is a recipe for maintaining pain. Top of page

Components Of Your Daily Routine

These are the components of the program that I teach. A similar approach could be used with exercises that you have been given.

Rhythmic Movement
Before stretching loosen up with gentle rhythmic movements such as knee drops, knee circles, neck side bends, lift and lower (for the shoulder). Use gentle rhythmic movement to ease any tension that develops during the day.

Stretching, Strengthening, Stabilising (SSS)
Stretching
Select your releasing movements to meet your needs, but sometimes do a full routine of releasing movements and stretches for the whole body. You might be surprised at how good you feel afterwards. ÔNeck and Shoulder Release and Relief' can be done at the office or whenever you have to sit for long periods. You could start your day with some standing stretches and release tension at the end of the day with releasing movements on the floor.

Strengthening
As you learn the exercises and movement sequences in this program you can identify your weak muscles. To strengthen them you need to hold a position for longer or increase the number of repetitions of the movement, or do both, depending on the muscle you are strengthening. You may need individual assistance to identify your weak muscles.

Stabilising
The stabilising muscles need to be activated and strengthened. During the day activate the stabilisers (of the shoulder girdle and/or lumbar spine) as many times as you can. Remember to stabilise before you stand up, lift, and turn.

Relief Positions (for opening and releasing)
Use one of these for 10-15 minutes every day. You could combine this with one or more of your relaxation techniques. You could also a rolled up towel to facilitate the opening and release (see ÔNeck and Shoulder / Low Back Release and Relief').

Attitudes

• Treat yourself with Respect, Care and Love
• Make every movement loving and healing.
• Move with awareness. Top of page

Being Honest With Yourself

It can be confronting to be honest with yourself but this is the only way that you can overcome your obstacles to self-management. Do you recognize any of the following as reasons you give for not doing your program?

• No time,
• Too many demands, or
• Unexpected demands or interruptions.

These are excuses: they let you off the hook.

Could it be?

Be honest with yourself because, then, you can work directly with the obstacle and find a way to keep your program going. Try to be:

• Specific and Realistic;
• Committed and Compassionate;
• Disciplined and Organised.

Above all be honest with yourself Top of page

Not Getting Results?

1. You may need to set aside more time for your program.
   90 mins relaxation and exercise daily (or 6 days a week) may be necessary over many months to get the result you want. You may need to do more than this!
   
2. You may need to do more self-exploration.
   • Are you really doing the program?
   • Be honest with yourself.
   • What are the obstacles?
   • What lifestyle changes do you need to make?
   • Have you made them?
   • How are you resisting the changes?

   Remember: The results of a lifetime of poor self-care can't be reversed overnight.

3. Do you have ownership of your problem?
   or
   • Are you still blaming someone or something else?
   • Until you own your problem nothing will change.
     
4. What are you measuring?
   Pain, function, happiness, calmness, fitness, energy......

Pain is difficult to measure because it is subjective. It is also difficult to measure the change in pain intensity over time because it is subjective and the change may be slow. It is difficult to remember how it was a few weeks ago. It may take a flare-up for us to realise how much progress we have made. Perhaps you will notice that you need fewer pain killers and then realise your pain must have decreased.

Remember:

1. If you are doing more and the pain doesn't seem to have changed, in real terms, it has changed. You are doing more and your pain hasn't increased.
   
2. If you are happier and calmer your pain will bother you less and slowly decrease.

Notice the small changes. Top of page

Creating an Environment for Healing

• Believe you can heal yourself.
• Put your health and healing as top priority.
• Live.
• Relax your body and mind.
• Exercise your body and mind.
• Focus on the positive
  • think helpful thoughts
  • adopt helpful attitudes
• Take Charge of Your Life.
• Cease Reacting to the Pain.

Remember:

• It is what you do that counts most.
• Relaxation and rest are different.
• Hurt is not harm.
• Chronic pain is not a warning signal.
• Pain does not prevent activity; your beliefs about pain prevent activity.

These qualities will help you on your path out of pain:

• Patience
• Perseverance
• Purpose
• Courage
• Conviction
• Hope

Recovery from chronic pain can be a full-time job.