After months of living with painful, often excruciating, symptoms and working with your medical care team to find the cause and treat it, you’re told that there is no cure. Your pain is no longer acute, it’s chronic, and you need to learn to practice self-management. If you’re like most people who were raised in the western medical care system, you might be thinking, ‘Self-management? What is that? Isn’t it your job as my doctor to fix me?’

Over 50 million American adults live with chronic pain. For many of these patients, treatment goals will shift from resolving the pain to reducing and managing it. This will often involve the use of self-management techniques.

According to Gwenn Herman, LCSW, DCSW, Clinical Director of Pain Connection, a program of the U.S. Pain Foundation, “Self-management is when you take responsibility for your treatment plan. It’s using any kind of tool outside of the medical setting that helps you lower your pain level and lower depression and anxiety. It includes things like pacing, breathing, guided imagery, reiki, acupressure, meditation, art therapy, music therapy, and writing groups.”

Oftentimes, people that are newer to living with chronic pain are more hesitant to try any self-management techniques. Herman notes: “Some people are resistant because they still have the mindset that the pain will go away by medication or a procedure. But that is not typically the case.” 

“Self-management is the number one, most important part of the multidisciplinary model because medications may help some, but not completely, and we’re living day to day with pain that goes up and down,” Herman says. “We need to figure out different types of skills that can get us through.”

Techniques that everyone can try

Herman considers pacing to be one of the most helpful self-management tools: “Most everybody realizes that if you do too much, you’re going to have a flare-up or relapse.” 

The U.S. Pain Foundation conducted a nationwide survey earlier this year. 2,275 individuals living with chronic pain responded. Interestingly, when asked, “What techniques, skills, or knowledge do you find most helpful when it comes to self-management?”, 73% of respondents with chronic pain found activity restriction to be the most helpful self-management technique.

According to the National Library of Medicine, “Pacing is considered to be a multifaceted coping strategy, including broad themes of not only adjusting activities, but also planning activities, having consistent activity levels, acceptance of current abilities and gradually increasing activities, and one that includes goal setting as a key facet. The aims of activity pacing include to reduce overactivity-underactivity cycling (fluctuating between high and low levels of activity) in order to improve overall function and reduce the likelihood of exacerbating symptoms.”

Another self-management technique that Herman identifies effective for chronic pain is breathing, as she finds it’s an easy technique to learn. The London Pain Clinic explains, “Diaphragmatic breathing has an extremely therapeutic effect on chronic pain. It has a major influence on relaxing the muscles which tense up as a result of pain and in turn further aggravate the pain itself.” 

Guided imagery is also an important self-management technique that Herman teaches.

“A lot of men, some women, but mostly men, have a hard time doing guided imagery,” she shares. “What I do is just ask them to think of something that they love and that they’re passionate about. This one guy loved fishing, so I told him to picture being in the store, buying bait, going to the boat, putting the bait on the line, and casting into the water. I guided him through the whole process. At the end, when he opened his eyes, I said, “How was it?” He said it was good, and I told him he just did guided imagery.”

She adds, “A lot of people get nervous or anxious that they aren’t going to do it right or that it’s not going to work. So it’s really about trying to work with somebody to see what they will accept and then developing the skill to fit them.”

Building a multifaceted plan that works for you

People living with chronic pain are like zebras—just as each individual’s stripes are different, each person with pain is entirely unique. This means that the most effective strategy for managing chronic pain is a multimodal approach, incorporating self-management in addition to other treatment modalities, and will most likely involve a lot of trial-and-error. What works for one may not work for another. That’s why the U.S. Pain Foundation offers so many free resources, such as:

• Support group meetings provide compassionate support and evidence-based education to help people with pain reclaim their quality of life. Learn about the wide variety of support groups available by visiting Pain Connection, a program of U.S. Pain. 
• “Building Your Toolbox” is a videoconference series to teach people pain management techniques that they can do on their own and that don’t involve insurance or spending extra money. 
• MyPainPlan is an interactive site for individuals to learn about all of the options for pain relief and identify a personalized list of treatments to try or to discuss with one’s health care provider.
• Check out “Mindful Mondays with Gwenn Herman” to learn new self-management strategies every Monday between 8-8:30 pm ET on U.S. Pain Foundation’s Facebook page each Monday from 8-8:30 p.m. ET. 

“In conjunction with traditional pain management, there are a number of self-management strategies that can help reduce pain levels and improve your quality of life,” Herman says. “Don’t underestimate your ability to have an impact on your health and pain levels!”