The first article in this series explored the nature of chronic pain, the added misery recent over-reliance on opioid prescribing has wrought, and the mounting evidence that is moving pain management in a variety of new directions. This follow-up article discusses some ideas about the role a Wellness Recovery Action Plan (WRAP) can play in helping chart a new course. This requires a few foundational assumptions:
People with chronic pain are often frustrated when they talk with medical providers. Those without the necessary expertise usually default to focusing on the pain by asking the same old question: “On a scale of 1 to 10, what is your pain (10 being the worst pain you’ve ever experienced)?”
What a Number Can’t Convey
One problem with this approach is that it’s more appropriate for acute pain. As my friend who is a pediatric emergency nurse explained to me, “I ask this before I give the child a medication that should offer some relief, and then give it time to work before asking again. If the number doesn’t come down, I might have to admit the child.” Sounds reasonable in the context she described, but not so much for someone who’s in pain all the time. Another problem is that the nature of a person’s pain history realigns the scale. A 10 for someone whose worst pain was a broken arm years ago is completely different than a 10 for someone with four relatively recent back surgeries. I don’t think you can assign a number to what makes life feel like it’s worth living for someone dealing with chronic pain. However, the first section of a WRAP for chronic pain can be used to describe a baseline for negotiating the activities and functions that are important to maintaining your quality of life.
Section 1: Daily Maintenance Plan
This section usually begins with a profile of what it’s like when things are going well. For chronic pain, I use this to paint a picture of what it’s like when I am not losing important ground. Care must be taken not to describe what life was like before pain became an issue. I don’t talk about the six-mile trial runs in the Great North Woods, the bike tours across the farmlands of the Midwest, or the hours spent in an ecstatic endorphin haze at the gym, not that I don’t miss it all or that I wouldn’t reclaim it if I could. But I can still live well without those things. On a practical level, not being able to drive because I can’t move my neck enough to check my blind spot when changing lanes on the highway—well, that really gets me. Postponing work I need to complete because I dread my body’s response to getting back into my office chair is no way to complete the great American novel. On the other hand, asking for help instead of hauling in heavy grocery bags and paying the price later—that I can live with. Each person creates this baseline for themselves in light of their own circumstances, values, and priorities.
The next element is a simple list of the minimum daily actions needed to sustain an acceptable level of functioning and mobility and to maintain a positive outlook. A primary item on my list: do not overdo it when I feel good or underdo it when I feel bad. Feeling pretty darn good for a few days doesn’t mean it’s time to enter a breakdancing competition. Likewise, I have to resist the temptation to lie in bed, immobile, on days when I wake up in pain. Personally, I find that I can easily ignore messages my body sends about things like thirst, hunger, and the need for sleep when I am immersed in my work. Finding ways to take care of myself such as allowing my eyes to rest, getting up from the computer and stretching, or taking a nap to catch up on sleep are no longer optional. Like many people with chronic pain, I’ve experienced a great deal of medical trauma. I am super avoidant when it comes to health maintenance and would rather stay home and shoot off my toes than go to the doctor. But it pays to take care of certain things before they start to unnecessarily contribute to my discomfort.
Higher Ground: What I Am Not Willing to Lose
The final component of my Daily Maintenance Plan is a more extensive list of strategies I can turn to for relief. These are strategies that offer physical, emotional, and psychological relief. They include ones I use regularly, some I employ only on occasion, and options I have considered if they become necessary. Naturally, this list changes with time, and I find myself adding things I’ve tried that were much more helpful than anticipated.
Section 2: Triggers
The first component of Section 2 is a list of what contributes to making chronic pain intolerable or debilitating. I can’t overemphasize the importance of recognizing triggers that reinforce feelings of hopelessness or helplessness and prompt negative projections about the future. These are at least as important as the physical pain triggers. The second part is a list of action steps I can take to minimize the impact of these triggers. There are both pre-emptive measures and actions to take in response to these situations. This is a helpful tool to have on hand when pain takes center stage and impacts my perspective and problem-solving abilities.
Section 3: Early Warning Signs
The first part of this section is informed by the baseline description from the beginning of the Daily Maintenance Plan. It’s important to think about frequency, intensity, and duration when listing things that signal it may be time take action. Not being able to drive on one or two occasions is different from it happening regularly over a period of several months. If that kind of situation continued, I would need to take action. This section not only flags the indicators I want to keep on top of, it also includes steps I can take to address them. These steps may be aimed at preserving or at reclaiming what I’m determined not to lose. Sometimes the action required is consultation with my doctor or a pain management specialist. Other times, I might look for ways to interrupt or minimize the discomfort associated with an activity, or I may find ways to ration the activity.
These ideas about applying WRAP to living with chronic pain are both informed and limited by my personal experience. The advantage of creating a WRAP through a facilitated group process is that it transcends the limitations we are subject to when we take on something alone. It would be wonderful to hear from you before the final installment of this series. Please share your ideas and experience regarding WRAP and living with chronic pain on our Facebook page.