This is just a quick ponder on the words we use in pain management.  Quite often we talk about ‘goals’ and ‘prioritising’ and ‘planning’ and ‘skills’ – as if it’s an event that will come to an end.

‘Oh I’ve done my planning, and achieved my goals’.

The team I work with has started to consider whether an overarching theme in our programme should be around the process of changing – a process that never stops.  In the programme maybe there will be three elements throughout the three weeks – one that focuses on skills for managing pain; another that helps develop skills for managing change; and still another that provides opportunity to consider change itself.

One of my long-term concerns about pain management programmes, and in fact any intensive programme of change, is that it’s all fine and dandy while the programme is running.  Lots of skills, lots of new things that generate energy, and lots of new plans to put in place.

But after six months, what will have actually changed?  What will remain of those skills, that energy and those plans?

When I asked people who had ‘graduated’ from a three week pain management programme what was different about their lives since they completed the programme, it was sad to hear that so little had changed.  Yes, attitudes towards pain had changed, and most talked about ‘pacing’, ‘exercise’, ‘relaxation’ – but their day to day lives didn’t look at lot different.  Their outlook and ideas for the future hadn’t changed much.

They gave lots of reasons for not implementing their skills.  Things like ‘you can’t do pacing at work’, ‘you can’t go away and do a relaxation at work’, ‘my case manager wanted me to do something else’, ‘I look stupid doing exercises’, ‘I don’t have any time to do my relaxation/exercises/social stuff/look for work’… And these comments were from people who were motivated to see me about returning to work!

Something wasn’t gelling – it’s almost like ‘lead a horse to water and watch them walk away’… Or is it?

At the time I was naive to the Prochaska and DiClemente model of stages of change – perhaps some of these people were simply not yet ready to integrate their pain management into a ‘new life’.  And some had very complex psychosocial situations with mental health problems, family problems, as well as (often) medical influences.

But as I reflect today, I wonder whether we talked about specifically planning, over time, to implement each piece of the pain management puzzle until it formed a ‘new’ life.  And I know we didn’t talk about the process of acceptance…

So, here are 10 thoughts to help people weave new habits into their lives…

1. Begin by making small changes.  Pick one or two skills to begin with each fortnight.  Get used to these before adding in some more.

2. Mentally link changes to daily routines you already do. This can make changes like taking on a new habit happen much more smoothly. For example, if you want to begin using relaxation at home, try adding it in to your bedtime routine.

3. When a change feels most stressful, it’s probably about something really important. Achieve in this area, and others will feel much easier.

4. A timetable or checklist to record progress helps maintain your motivation.  And you can show it to others to keep yourself honest!

5. Remember that all change involves a degree of learning. You don’t expect to be skillful until after you’ve practiced.

6. Remember that upheaval and confusion are often natural parts of change. Both you and other people may find it difficult to feel comfortable with new ways of doing things.  It won’t always feel great.  It will probably be ‘odd’ until you no longer have to think about it to do it.

7. Don’t feel like you have to cope with changing circumstances or the stress of making a change on your own. Talk about what’s going on for you with a friend or write about it in a journal. Sharing your feelings can give you a sense of relief while helping you find the strength to carry on.

8. No matter how large or difficult a change is, you will eventually adapt to these new circumstances. Remember that regardless of how great the change, all the new that it brings will eventually settle into the right places in your life.

9. When you feel ambivalent about ‘doing it’ pick something, anything, to do and do it right away! Don’t stop to think about it! Completing something provides impetus to keep doing.

10. If you’re trying to change a pattern of behavior or navigate your way through a life change, don’t assume that it has to be easy. Wanting to cry or being moody during a period of change is natural. Then again, don’t assume that making a change needs to be hard. Sometimes, changes are meant to be that easy.

 It takes about six to eight weeks for a new behaviour to start to feel automatic.  Some things help make it easier, I’ll be posting about these shortly!


  1. Thanks for the great suggestions… I’ll be linking to them when I post about other resources in a series I’m currently doing. The series is about helping yourself to use pain management skills regularly – making that change!

    Btw, there’s also a contest starting today about habit-change, with a great book about pain as the prize. I hope you’ll check it out.

  2. Hi and thanks for visiting! I’m heading on over to your blog today, looking forward to joining in the contest (oh no, no more putting off that resolution)

  3. Hope you don’t mind my adding my two cents worth here. When I was teaching I found that change didn’t happen unless a cue was in place, a reminder. Take for example a cue to bring to students attention that an unacceptable noise level was reached, all pause and change behaviour. What I’m getting at here is something that causes you to pause and reflect and then puts you in a frame of mind to choose “change or no change’. Personally I’ve also found I am most likely to be compliant when I have a very clear understanding of what exactly is required. An example of this is visits to a physio who says do this exercise and that stretch and swim etc in vague terms. I am most likely to do the therapy if it’s prescriptive eg when given a set of exercises with a number giude and time guide and a written instruction with a “do six of these’ written next to a picture.

    I”ve attended a pain clinic where we were given handouts and learnt about mechanisms of pain, awareness, alternative treatments etc. As you’ve indicated over the long term people went along much as they had before. The program was great, most wanted to do it annually “to be refreshed and kept on tract” but in actual fact, not much changed. Most felt follow up group therapy would have been useful. I personally think having the tools at hand to help ourselves would be great. A self paced program which is begun in a clinic so that it is well understood and practised could then be continued at home. It would need to be simple (people in pain have poor concentration), do-able (easily understood and followed), and in achievable componants which would have the reward of accomplishment.


  4. Hi jeisea
    I agree that a cue can be helpful – one thing I heard of was to go home and move something from its ‘normal’ place so that each time you see it you are reminded that you’ve decided to make a change.
    As for ‘prescriptions’ – sometimes this is great, especially if you’re a person who likes to plan, and if you’re ready to ‘do it’. It falls down when you are someone who prefers to do things more fluidly, you are not yet ‘ready’, or where you’re not keen on other people ‘telling’ you and prefer to work collaboratively.

    Self-paced learning works well if, and only if, you have the necessary motivation and resources to do it independently. If life gets tough, or you’re low in motivation, or don’t have resources it can be a very lonely and difficult road.

    So in the end, there needs to be a range of ‘ways’ of learning and adopting new coping strategies – and your job as someone who wants to learn is to work with the therapist to get what you want!

    Thanks for visiting!

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