WRAP for Chronic Pain: Rethinking, Reclaiming and Replacing

Niki A. Miller, MS, CPS, Senior Program Manager, Advocates for Human Potential, Inc.

Niki A. Miller, MS, CPS, Senior Research Associate,
Advocates for Human Potential, Inc.

In part 1 and part 2 of this four-part series, I offered examples of how a Wellness Recovery Action Plan (WRAP) can lay a foundation for meeting the challenges of living with chronic pain. This is part 3.

It’s been said that the definition of a miracle is a change in perception. Like many people who have overcome addiction or are recovering from serious mental illness, I have learned how important it is to live in the solution. Chronic pain requires this sort of miracle of resilience—one that allows us to keep our eye on the donut and not on the hole. But, when you’re in pain the proverbial hole seems cavernous. And the donut? Just a wad of gluten marinated in trans-fat that probably contributes to inflammation. WRAP can help!

Section 4 – When Things are Breaking Down

This component of my WRAP functions like a canary in a mind shaft. If I’m heading down a dark pathway, it warns me to turn around when the air gets too thin and the oxygen supply is low. “Yellow flags” can be related to discomfort or physical limitations. I may be spending more time in bed, utterly exhausted, but unable to sleep. Perhaps none of my remedies offer relief. Working can become difficult or impossible. However, the red flags are invariably psychological. It’s not my pain that is paralyzing; it’s my thinking. And it goes like this: I can’t go on, can’t get up, can’t take it another day, can’t live like this and so on.

Re-thinking

That paralyzing thinking requires action to wage a fight to keep my independence and win back whatever may have temporarily slipped through my arthritic fingers. As a committed pacifist, I’m not one to indulge in a lot of pugilistic metaphors, but the battle lines are drawn when things are breaking down. I must lay out my weapons of choice long before my functioning becomes affected by chronic pain. So, I create this menu of actions when I feel strong and disinclined to take it lying down—literally or figuratively. I keep a running list of practitioners that have helped people I know (acupuncture, physical therapy, pain management, etc.). There are also non-opioid medications that have helped in the past, including some that are also prescribed for depression. An advertisement for one says, “Depression hurts.” I think it should say, “It’s depressing to hurt.”

There are other actions worth considering, like escaping the ominous beauty of the long New England winters before the trees outside my window are bare. Oh, and now they have cars with technology that allows you to see what’s behind you on a screen, without having to turn your head. If mobility makes driving difficult on a regular basis, I have options. Sometimes it’s uplifting just to remember that I have them.

Section 5 – Crisis Plan or Advance Directive

A crisis plan for chronic pain may be activated like any other health care advance directive—implementation can be formalized through mechanisms that give it legal standing. Or not. Whatever route you decide to go, I can tell you from experience, the price for being completely unprepared to lose the physical capacity to exercise any degree of choice can be very high. I was young when I experienced this, and it was unexpected. Now, I am older, not so wiser, but certainly a lot achier. So, I begin with that portrait of quality of life from Section 1 of my WRAP and think about what I can retain, replace, or reclaim an acceptable level of functioning and autonomy.

For me, the most important preparation is the people. It is important to talk with providers, family members, partners, friends, and adult children about issues that may arise and to designate people who can speak for me when I am unable to speak for myself. Defining the conditions that might activate aspects of your crisis plan is also a matter of personal preference. I want a support person who will advocate on my behalf if I am near a hospital, even for an outpatient procedure, and possibly at doctors’ appointments—if I am in the care of a stranger. Many mistakes happen in hospital settings and especially in emergency departments. Risk of developing a hospital-based infection is also high. A recent study by researchers at Johns Hopkins University ranked medical mistakes as the third leading cause of death in the U.S.[1]. So my first rule of engagement is never go it alone. Trust no one. The truth is out there. My crisis plan keeps me from “going it alone” no matter what happens with my pain.

In the fourth and final installment of this series, I’ll discuss my post-crisis plan for dealing with chronic pain. Until then, please share how you address chronic pain in sections 4 and 5 of your WRAP. Visit our Facebook page and leave a comment with your tips and strategies.

Miss an earlier article? Here they are!

[1] Institute of Medicine (US) Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System.Kohn LT, Corrigan JM, Donaldson MS, editors. Source: Washington (DC): National Academies Press (US); 2000.; Makary Martin A, Daniel Michael. Medical error—the third leading cause of death in the US BMJ 2016; 353: i2139. Available online at: http://www.bmj.com/content/353/bmj.i213

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