Pain is something we all experience at various points in life, and it is an important protective mechanism that actually keeps us safe from harm. Some people have pain that lasts a long time, and it can make life harder. About 30-50% of people have this kind of pain, and it can be tough to figure out what’s causing it or how to make it better. Pain can make it hard to go out, do your regular activities, or even just get through the day. Some people feel stuck in a "pain cycle," where the pain keeps affecting them.

But research shows that the more you understand pain and feel in control of it, the better you can handle it and feel better in the long run.

pain cycle.png

 

Types of Pain

There are two types of long-lasting pain:

  • Primary pain: This kind of pain doesn’t always have an obvious cause. It’s often because the body’s nervous system (the system that controls your body’s reactions) gets too sensitive or overprotective.
  • Secondary pain: This kind of pain comes from something that can be easily seen, like an injury or sickness.

Things like sleep, eating, exercise, and mental health can affect how much pain a person feels.

 

Understanding Pain and Your Nervous System

Pain is real, even if doctors can’t find a clear cause for it. Pain happens because of your nervous system, which includes:

  1. Your brain: It’s like a computer that makes decisions for your body, both big and small.
  2. Your spinal cord: A bundle of nerves that goes from your brain down your back.
  3. Your nerves: These are like cables that carry information from your body to your brain and back.

When you hurt yourself, your body sends a message to your brain to warn you. If the brain thinks something is dangerous, it will make you feel pain to stop you from making it worse.

For example, if you touch something hot:

  1. Your nerves feel the heat.
  2. The message goes to your brain.
  3. Your brain decides it’s dangerous.
  4. You feel pain and pull your hand away to stop getting burned.

Sometimes, pain can happen even if there isn’t damage. This happens because the body’s pain system can get too sensitive, like a loud alarm going off even when nothing’s wrong.

 

How Pain Can Be Tricky

Pain doesn’t always match up with what’s really happening in the body. Sometimes, pain can happen without an obvious cause, or it can feel different depending on things like the weather or where you are. People with long-lasting pain might have a nervous system that’s stuck in an “overprotective” mode, making everything feel like a danger.

 

How to Handle Pain

Understanding how your body works can help you handle pain better. There are things like sleep, exercise, eating well, and taking care of your mental health that can help reduce pain and improve your life.

 

Summary

Long-lasting pain is complicated and can affect many parts of life. Things like your body, your thoughts, and the world around you can all affect how much pain you feel. But by learning how to take care of yourself, you can manage the pain and still live a happy life.

 

Further Reading and Resources:

Living with chronic pain or tiredness can make normal activities, like going to work, taking care of others, shopping, and even hobbies, really tough. Some people also feel mentally or emotionally tired when trying to concentrate on tasks.

What is Pacing?

Pacing means managing how much you do to avoid making your pain or tiredness worse. It helps you take breaks or slow down to feel better.  It includes not just physical rest but mental / emotional rest as well.

 

Boom and Bust Cycle

Sometimes when people push themselves too hard on a busy day, they end up feeling extra tired and in more pain afterward. This can make it harder to sleep, and then they might need to rest for several days. It’s easy to get stuck in a pattern of doing too much one day and then doing too little the next, which can make things worse over time.

 

Pacing an Activity

When you have chronic pain, doing something for too long can make your pain worse. It’s helpful to take breaks before the pain gets too bad. For example, instead of doing an activity for an hour, you could do it for 20 minutes, take a break, and then do a little more. This can help you feel better in the long run.

 

How Much to Do?

It’s hard to know how much to do. A good rule is to start small, like doing something for 10 minutes, then stop, even if you feel okay. If you feel fine after, you can try doing a little more the next time. If it makes your pain worse, try doing half of what you did before and slowly build back up.

 

The Phone Battery

Think of your energy like a phone battery. Some activities drain your energy fast, while others can recharge it. Activities that use lots of energy need planning to avoid completely draining your battery.  It's important to make time for things that help you feel better as well.

 

Consider what activities or situations charge or drain your energy levels 

Things that CHARGE my battery  

 

 

 

Things that DRAIN my battery 

 

Tools to Help You

There are tools, like special chairs or walking aids, that can make activities easier. These can help reduce strain on your body, and you can talk to a health professional to see what might work for you.

 

Spoon Theory

 

The Spoon Theory is a way to think about your energy. Imagine you have a certain number of spoons each day. Every activity uses up some of your spoons. If you have a busy day, you might run out of spoons, so it’s important to plan ahead and make sure you don’t do too much. Watch the video below to learn more about this.

https://www.youtube.com/watch?v=jn5IBsm49Rk

 

Barriers to Pacing

It’s hard to pace yourself sometimes because of family or work responsibilities, or because you feel frustrated or guilty. But it’s important to know that it’s okay to take breaks and not do everything all at once. Talking to others, like family or a therapist, can help.

 

Planning and Prioritizing

Planning ahead can help a lot. For example, if you know you have a busy day, leave extra time to take breaks. You can also prioritize tasks to do the most important things first and save others for another day.

 

Tracking Your Activity

 

Keeping track of what you’re doing and how much can help you see where you need to slow down or take breaks. You can use an activity diary to keep track.

An activity diary helps you keep track of what you do each day and how your body feels. It’s like a journal that shows how you spend your energy throughout the day. This helps you learn how to balance your activities, so you don't do too much or too little.

 

How to Complete an Activity Diary

 

You will find an activity diary template at the bottom of the page. You can use this or make your own. Follow the steps below to complete the diary

1. ·  Date At the top of the page, write the date. This helps you remember what happened on each day.

 2. · Time of Day Split your day into morning, afternoon and evening or record hourly like on our example.

 3.  What Did You Do? Write down the type of activity you did during each part of the day, for example, getting dressed, going to work, attending a meeting , meeting a friend. Remember activity can be physical, mental or emotional or social. Watching TV would be an example of rest.

 4. How Did You Feel?  You can categorise these activities as high, medium and low intensity depending on how much energy you need to spend. You can colour code them as given in the example. You can even write a word or draw a smiley face to remember how you felt about that activity. It can help to record your pain level at the end of each day.

 

Below is an example of a blank activity diary to complete or you can make your own.

 

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Below is an example of a completed activity diary:

 

diary 2.png

Try completing an activity diary like the one above for yourself for 2-3 weeks. Do you notice any patterns or anything you could change?

 

What did you learn?

 

At the end of the day, it can be helpful to write a note in your diary of one thing you learned e.g.   I felt better when I took breaks, or I was sore after working too long. 

It is important to notice early signs of pain or tiredness so you can take a break. Here are some signs to look out for: - Muscle tightness, slower movements, needing to rest more often, feeling more tired than usual.

Take a look at your completed activity diary and try answering the questions below.

  • Are there any surprises?
  • Are there any patterns or themes?
  • Is there a balance between rest and activity?
  • Do you spend most of your time on one particular type of activity?
  • Which activity do you find most tiring?
  • Is your day spent mostly resting? / Is there any rest during the day?
  • How do you rest?
  • Are your current activity levels working for you?
  • If not, what might be more workable, what changes could you make?

 

Top Tips

 

  1. Celebrate small wins, like finishing one task or taking a break.
  2. Do harder tasks when you have the most energy.
  3. Write down what you do and how much to help you plan better.

 

Useful Links

 

You can find more tips and help on websites like:

Exercise and rest are both really important when you live with pain. They can help you feel better and make managing pain easier.

Exercise and Your Experience

If you’ve been active before, it can be hard to adjust your expectations when you have pain. You might try to do too much, and that can make your pain worse, which can be frustrating.

Sometimes, people like physiotherapists or personal trainers might not understand how hard certain activities are for you. When you can’t keep up with what others expect, it might make you feel bad about yourself or like you’re not doing enough. This can even make you want to skip the next appointment or exercise session.

There’s also a hidden effort involved in exercise. For example, swimming might seem like an easy exercise, but there’s a lot more to it than just going into the pool. You have to get to the pool, change, shower, dry off, and get home. For some people, swimming is a great exercise, but it might not be right for everyone.

When you have pain, exercise might stop being something fun and turn into something you do because you have to. But exercise can still be enjoyable if you find the right balance. If you finish exercising without making your pain worse, and you feel proud of yourself, that’s a big win!

You can learn more about exercising with pain in these two articles: Exercising When It Hurts Moving More Guide Digital

Click the drop down headings below for more information on exercise.

 

What is Exercise?

 

Exercise means doing physical activities with a purpose. Physiotherapists think about three kinds of exercise:

  1. Strengthening exercises: These help make muscles stronger.
  2. Cardio exercises: These make your heart beat faster and your lungs work harder.
  3. Flexibility exercises: These help you move your body more easily.

Most exercises mix all of these types together!

 

Why Exercise?

 

 

Exercise has many benefits, even if you’re not able to do the recommended amount each week. Doing a little bit of exercise is still better than doing none. Exercise helps calm down your nervous system and can make pain more manageable. Your body has a “comfort zone” for how much activity you’re used to. If you try an activity that’s too far outside your comfort zone, it might make your pain flare up. For example, gardening or painting might hurt because you don’t do them regularly enough.

 

Please find below more information on the benefits of exercise for general health which you can read about here:

https://www.nhs.uk/live-well/exercise/exercise-health-benefits/.

Or you can watch this video:

https://youtu.be/3F5Sly9JQao

 

How to Exercise

 

Drop down 3 text: It’s really important to find exercises you enjoy and ways to stay motivated. If you’re not sure where to start, you can talk to someone who specializes in exercise for people with pain, like a Rehabilitation and Exercise Practitioner (REP). Your physiotherapist can advise on this.

Thriving Nottingham can also help you get more active. They might help pay for gym or swimming sessions, connect you with local exercise groups, and give you one-to-one advice to keep you motivated. You can learn more and sign up by clicking here. Thriving Nottingham | Helping you to live well and feel great .

Any activity which gets you moving such as gardening or dancing can help – exercise is not just about the gym or sport. Social Prescribers can link you up with community groups that match your interests. You can ask your GP practice for more information on this.

Here are some exercise options to check out: · Versus Arthritis – Exercising with Arthritis · Stronger My Way · Dance 4 Fibromyalgia · Hydrotherapy Pool · Derby Back Care

 

Rest

 

Getting good rest is just as important as exercise for your physical and mental health. Rest helps your body in many ways, like:

  • Lowering your heart rate and blood pressure
  • Reducing muscle tension
  • Helping your digestive system work better
  • Making you feel better emotionally and mentally

Resting doesn’t just mean sleeping. It can be physical, mental, and emotional rest. Sometimes, things like being on your phone, watching stressful TV shows, or doing other things that make you think a lot don’t actually count as rest. People find different things restful, like spending time outside, taking a warm bath, or listening to calming music.

 

Mindfulness

 

Mindfulness, which is being aware of how you feel in the moment, can help you rest better. You can try these mindfulness exercises:

You can also use an app like SoundCloud for free mindfulness exercises.

You can learn more about other people’s experiences of exercising with chronic pain here: Paul and Anne discuss the benefits of Tai Chi with osteoarthritis

 

Activities

 

Try to do one of the mindfulness activities above every day this week.
You can try different ones to see which one you like best.

Think about what kind of movement or exercise you enjoy. How can you fit it into your week?
You can try one of the ideas above or choose something else that feels right for you.

Pain can affect how we feel and think, and it can make us feel more tired too. Sometimes, pain can make us sad, frustrated, or anxious, and those feelings can make the pain worse.

Here’s how pain affects us in different ways:

  1. Thoughts and Feelings: Pain can make us feel upset or worried. These feelings can lead us to do things that make the pain worse. For example, we might push ourselves too hard when we feel frustrated, which can make the pain flare up. 
  2. Identity: Pain can change how we see ourselves. It might make us feel like we can’t do things we used to do, like work, spending time with friends, or doing hobbies we enjoy. But it’s important to remember the things that are still important to us, like our values, and try to do things that make us happy even if we can’t do everything we used to.  See this video for further explanation:  https://www.youtube.com/watch?v=ZUXPqphwp2U
  3. Mental Health Conditions: Living with pain can make us more likely to feel depressed or anxious, and those feelings can make it harder to feel better.

 

What You Can Do to Help Your Mental Health:

 

This is hard for people, and how we think can really affect this. Watching the “Passengers on the bus” video can be a useful way to understand this. You can watch it here: https://youtu.be/yLroVwoPFW8

 

Another useful strategy to follow is CLANGERS:

C: Connect - with people, nature, community, or yourself.  Social Prescribing is a service that can help with this.  Social prescribers can help you find activities and groups that can improve your well-being. Your GP can refer to a social prescriber.

L: Learning new things – e.g. watching documentaries, doing puzzles / crosswords, reading, cooking new recipes, learn an instrument.

A: Active – regular movement within your limitations.

N: Notice - who and what is around you, be in the moment without focusing on the past or worrying about the future.  This is commonly referred to as mindfulness.  You can try a few mindfulness exercises like breathing or body scans to feel better. Here are some videos to try:

G: Give back – we can give our time, buy a small gift for a friend / family member, show gratitude, smile at a stranger, volunteer your time to help your community.

E: Eat well – consider what healthy swaps you could make.  See the following link for tips:

https://www.nhs.uk/healthier-families/food-facts/healthier-food-swaps/

R: Rest – you can’t pour from an empty cup, so take time to refill the cup.  This could be reading, listening to music, watching tv, sitting in the garden, playing a game, doing mindfulness.

S: Sleep – work on different strategies to maximise your sleep quality – see sleep section later in the programme.  Also, think S for Self-compassion: be kind to yourselves.

Here is a video on other tips to help you feel good:  BBC - The Social - Learn how to hack your happy hormones

 

Talking therapy

 

You can refer yourself for talking therapy on the link below if you are struggling with your mental health. https://notts-talk.co.uk/

They may suggest low intensity therapy with a Psychological Wellbeing Practitioner, or you may be triaged to higher intensity therapy such as CBT. This is a type of therapy that helps you change unhelpful thoughts. It can help you feel better and can be useful if you want to work on specific goals.

ACT (Acceptance & Commitment Therapy): This therapy helps you accept difficult feelings and still move forward. You can learn more about it by watching some videos by a doctor named Russ Harris. Here’s a video that talks about happiness myths: The 3 Happiness Myths

 

Further Support :

 

If you ever feel like you’re struggling, here are some places you can reach out to:

  • GP or health professional
  • Text Notts: A free text support service (Text 85258)
  • Samaritans: Call 116 123 for free support
  • Turning Point Nottingham: Call 0808 196 3779 for emotional support

Remember, it's okay to ask for help when you're feeling down or struggling with pain. There are people who care about you and want to help you feel better!

 

In an Emergency

If you ever feel like you want to hurt yourself, it's very important to get help right away. Talk to your GP, the Crisis Team 0808 196 3779 or services like the Samaritans (see above).  If you are in immediate danger of harm, call emergency numbers like 111 or 999.

 

Activity

Look back at the CLANGERS above. Give one or two of them a try this week.

Sleep and pain are closely connected. Sometimes

  • Not sleeping well can make your pain worse.
  • Having pain can make it hard to sleep.

We know that persistent pain is difficult to treat with medications and so improving sleep is one of the things we can work on to improve pain and quality of life.  

Changing your sleep habits can take time, for example a year of steady effort. Many people try something to help their sleep but stop when it doesn’t work right away.

Our plan is to help you understand what might be causing your sleep problems and slowly make changes. These small changes can add up to big improvements.

 

Why You Might Have Trouble Sleeping

Most sleep problems come from three things:

  1. Homeostatic Disruption: Things like drinking caffeine or taking naps can confuse your body about when it’s time to sleep.
  2. Hyperarousal (stress and anxiety): If you’re too worried or thinking too much, your mind stays awake and it’s hard for your body to fall asleep.
  3. Circadian Disruption (sleep/wake cycle): This happens when your body isn’t used to a regular sleep schedule, for instance falling asleep or waking up at different times every day.

 

Tips to Help You Sleep Better:

 

  • Don’t force it: If you can’t fall asleep after approximately 20 minutes, get out of bed and do something relaxing for 10 minutes, then try again. It’s important to think of your bed as a place to sleep.
  • Avoid blue light: Phones and TVs have blue light that can make your body think it’s still daytime, which keeps you awake. Try to avoid them before bed or put devices onto ‘night mode.’
  • Get comfy: Make your bed as comfortable as possible e.g. pillows, blankets, the right temperature (not too hot).
  • Write things down: If you can’t stop thinking, try writing your thoughts down before bed, or try mindfulness meditation to calm your mind.
  • Take your medicine at the right time: Some medicines, like vitamin D or amitriptyline, should be taken at certain times (generally - take vitamin D in the morning, amitriptyline at night.)
  • Get sunlight: Try to get outside in the morning for sunlight, and make sure your curtains block light at night.

 

Other Helpful Tips

 

  • Everyone is different: Some people are night owls, and some are early birds. Try to find a sleep schedule that works best for you.
  • Food and drinks: Caffeine can keep you awake, so don’t drink it after 3 pm. Alcohol might help you fall asleep, but it stops you from sleeping deeply.
  • Try new things: You could try listening to calming stories, reading, or using smells like lavender to help you sleep.

Remember: Improving your sleep can take time, but small changes can add up to big improvements!

 

Further resources

 

Here are some helpful links for more sleep tips:

 

Activity

 

 

To help you understand more about your sleep, you can fill out the sleep questionnaire below:

Sleep Questions

Homeostatic Disruption (Things that affect how well you sleep)

  1. Do you take naps during the day?
  2. Do you sit or lie down most of the day without moving around much?
  3. Do you drink things like coffee, tea, soda, or other drinks that have caffeine, or use things like cigarettes or alcohol?
  4. Do you spend a lot of time in bed when you're not actually sleeping?

Your Body’s Clock (How your body knows when to sleep and wake up)

  1. Do you wake up at different times each day, even by an hour or more?
  2. Are you someone who likes staying up late and having trouble waking up early, or the other way around?

Worrying While Sleeping

  1. Do you spend a lot of time thinking or worrying when you’re trying to sleep?
  2. Are you worried about your sleep?
  3. Do you feel like you have to do certain things or follow routines to fall asleep or stay asleep?
  4. Do you feel stressed, upset, or frustrated when trying to sleep?
  5. Are you stressed because of school, home, or other things happening in your life?

 

Do your answers suggest there are any changes you could make in order to improve your sleep? Try these out over the next week but remember, changing your sleep takes time. Don't give up if you don’t notice changes straight away.