Click on the blue text and the images shown to open the associated website/video. You can then click "back" in your web browser to return to this page to review more materials.
As opposed to "passive" treatments like taking pills, reading the content and viewing the videos provided will help you engage in "active" treatment, also known as "active self-management". This is the key to long-term improvements in your chronic pain condition. Doctor prescribe you pills to take, but prescribing exercise and mindfulness meditation/psychology is just as important for your care. Consider this a type of prescription. And remember, you get out of it what you put into it.
Some videos will make more sense for your pain condition, but I encourage you to review all of the content provided here. This will take time, so let's get started!
** Don't forget to turn on your speakers. Many of the websites/links have videos that require that you turn on your computer's speakers.**
There are many great videos, for example the ones by Lorimer Moseley and Neil Pearson that I've provided links to on this website. These two have other very useful videos on Youtube, and I encourage you to search for them and see them too.
Note that some videos have an ad at the beginning, or even within the video. I am not recommending any specific products - and in fact you can ignore that information. I am just trying to show you the information discussed by the presenters in the videos and have picked out ones that I think have content that will help you.
Keep in mind that trauma (psychological trauma such as having been abused as a child or as an adult, or being in a life-threatening situation such as a motor vehicle collision) is a common reason why some patients pain does not go away. In most patients with fibromyalgia, my experience is that there is something they experienced in their life that was terrible, and that changes how their brain and spinal cord process pain (this is called central sensitization, you can learn more about this and about trauma and post traumatic stress disorder on Youtube as well, just make sure you are viewing something that is from a professional such as a psychiatrist or psychologist, or you may be seeing incorrect information). If you think you have been a victim of trauma, it may be difficult to improve your pain and depression/anxiety/sleep problems without the help of an experienced professional such as a psychologist or psychiatrist or a really good counselor - you should talk to your family doctor about what you are experiencing and ask them for a referral to a professional who can help. The following are some local resources for people who have post traumatic stress or who have been a victim of abuse, and if you aren't comfortable talking to your family doctor about this, you should contact the Canadian Mental Health Association (24 hour a day phone number: 1-866-933-2023, website: cmhamiddlesex.ca/programs/where-to-begin )
Even if you haven’t experienced trauma, and even if you don't have fibromyalgia, you will still benefit from working with the professionals and programs listed above (and with a physiotherapist/personal trainer and learning the skills described on this pain website), and it is important to use all of these resources if in spite of medications and injections or other treatments for pain you still have a lot of pain and find yourself unable to exercise or enjoy your life as you did before you had chronic pain.
It is important to get moving, but when you do you need to start slowly and pace yourself so that you are improving your function/walking/sleep/mood etc without worsening your pain by doing too much. This link shows some good basic advice on pacing for chronic pain: http://media.psychology.tools/worksheets/english_us/pacing_for_pain_and_fatigue_en-us.pdf
If you are having trouble getting started on an exercise program, you may need the help of a physiotherapist. Physiotherapists are experts in getting people moving, in an appropriate way for your abilities and pain problem. If you have private insurance, you can get started at any physiotherapy clinic.
One good one where you can work with physiotherapists in a very warm saltwater pool is the aqua fit Physiotherapy Clinic [(519) 474-0240, http://www.aquafit.on.ca/].
The City of London has swimming pools (look for the warmer ones, ask when you call or look on their website to see which are the warmest pools, these are the best for exercise usually), and you can join one of the aqua fit classes or exercise on your own [ phone number:(519) 661-4455, website: https://www.london.ca/residents/Recreation/Aquatics/Pages/Aquafit.aspx ].
Article: I helped my fibromyalgia with aqua fitness classes
The Arthritis Society [ phone number: (519) 433-2191, website: https://arthritis.ca/ ] also has classes to help get you moving, you can contact them about this. Another option to get you moving in a personal trainer, who are available at gyms, including the YMCA. If you don't have private insurance that covers a gym or the YMCA, you can probably get a very reduced rate (if your income is very low, they sometimes reduce this rate to about $40 a year, or even zero).
The Boys and Girls Club [ phone number: (519) 434-9114, website: http://www.bgclondon.ca/ ] has a very warm pool that you can do aqua fit or swimming in. Aqua fit can be done in deep or shallow water. If you haven't done it before, ask for aqua fit in a shallow pool or the shallow end - even people who can't swim well can do this if the pool has a lifeguard (ask, they usually do). If you don't have private insurance, ask your family doctor to refer you to an OHIP-insured physiotherapy clinic (this will be free). If you still have trouble accessing a gym or a warm pool to exercise in, ask your ODSP or OW worker (if you are on disability you will probably have one of these contacts) or a social worker for help.
www.painbc.ca/sites/default/files/ThePainToolboxFINALJan132012.pdf download this pdf file and start reviewing the resources it points you to:
thepain.ca - there are a lot of resources of this website, about getting active in spite of pain and why that it important to learn to do, and about managing negative emotions and why that is important for controlling chronic pain - please review the entire website to learn about these different issues.
American Pain Foundation
Canadian Pain Society
Help for Headache
Dr. Andrew Gross, UCSF (University of California San Fransicsco) Rheumatology Clinic Director at the UCSF Osher Mini Medical School for the Public
Dr. Andrew Gross: Fibromyalgia: It's Real It's Manageable What You Can Do
McKenzie exercises (do this only if advised to use this technique by your pain physician, this technique may helpful for certain types of low back pain. You can also ask your physiotherapist about exercises that may help your pain)
www.lifeisnow.ca - This is Neil Pearson's website. He has a lot of good resources, and in addition to reviewing his website I encourage you to view all of his youtube videos
American Academy of Orthopedic Surgeons
American Academy of Orthopedic Surgeons
PRINT THIS CHRONIC PAIN SPIRAL DIAGRAM AND PUT IT ON YOUR FRIDGE - READ IT EVERY DAY TO REMIND YOURSELF THAT IF YOU THINK YOU CAN'T GET CONTROL OF YOUR PAIN, THERE ARE ACTIONS YOU CAN TAKE TO IMPROVE THE SITUATION. YOU CAN ASK DR. PETERSON TO HELP YOU UNDERSTAND THE DIAGRAM IF ANYTHING IS UNCLEAR, BUT IT SHOULD BE SELF-EXPLANATORY IF YOU READ IT CAREFULLY.
Want more information about dealing with back pain? See this website from the Institute for Work and Health in Ontario
Other Excellent Websites
Iceburg Analogy for Chronic Pain
Developed by Dr. Mike Peterson MD MSc CCFP
This is one of many different low-impact techniques to increase mobility and decrease disability and pain in people with chronic pain (including severe pain, and in all ages) - your pain will get worse and your ability to walk and do things will also get work if you don't keep active. Yoga and aquafit are other excellent options. Start slowly for a few minutes, and increase slowly when you're ready. Even people with severe pain and disability (especially these individuals) should aim for 60 minutes of exercise per day. Most people will benefit from breaking up activity into small periods of 10-30 minutes at a time. If you have trouble starting an exercise program, ask for a wellness/program orientation at the YMCA or Boys and Girls Club or a gym. Or ask a physiotherapist for help finding what type of activity is most appropriate for you.
Up to Date
If you have severe pain that isn't improving, especially if it's accompanied by depression, anxiety, lack of social interactions or other activity, or any other comorbidities, you would likely benefit from developing individualized techniques to manage these symptoms and reduce tension in your muscles and the feeling of being overwhelmed by chronic pain and stress by working with a pain psychologist. Here is how to get one (you can also look up Psychologists in the phone book):
londonmindfulness.ca - This is a tremendous local resource - Dr. Kate Partridge, Psychologist, is the local expert in mindfulness meditation for chronic pain. She is also an expert in managing and diagnosing anxiety problems, which are a common problem in chronic pain that must be identified and controlled for pain control to be optimal. She has free and paid sessions that can help different patients, depending on their coverage. I encourage everyone with chronic pain to attend her free sessions (see her website) to get a taste of what mindfulness can do for helping to control chronic pain. Patients who seek out resources like this will learn about "locus of control". That means whether you feel that you are able to control your life, or whether you are just a passenger in life and let the world around you dictate how you feel. People who learn about this, and take control back rather than letting others get them depressed or anxious, will have better control of these emotions, and their chronic pain (and life!)
Go to neuronovacentre.com and review all parts of the website - you'll find great books, audio discs for mindfulness meditation for chronic pain, and you can even find out about more intensive sessions that you can register for with an expert in mindfulness (psychology) for chronic pain, Dr. Jackie Gardner-Nix.
Dr. Mike Evans
The American Chronic Pain Associationhas a number of introductory videos on pain at this website: theacpa.org/videos
CCAC (Community Care Access Centre)
Click on the link above to go the CCAC's programs page. There are many helpful programs, but the key one is "Living a Healthy Life With Chronic Pain". All patients with chronic pain should complete this excellent free workshop. There are other programs that may be of benefit such as ones they offer on how to get the most out of your healthcare appointments.
Smoking tobacco dries out the discs in your spine and proliferates/causes more trigger points in your muscles. Therefore if you smoke, you will have more pain, and you will become more disabled if you continue to smoke. Smoking also increases fatigue, worsens anxiety, and worsens sleep. Here are some tools to help you quit. Most importantly, talk to your family doctor and pharmacist!
The best pain clinics in the world have implemented the use of psychology for chronic pain, because it works. Here's what St. Joseph's Hospital's Pain Clinic says on their website about the role of psychology for chronic pain (a similar approach is taken at all of the best pain clinics in the world, like Stanford's and the Mayo Clinic's):
Benefits of Psychotherapy for Chronic Pain
Psychological services are a standard and helpful component of a patient's overall treatment program. This is due to the fact that pain creates a tremendous amount of stress in an individual's life. Pain sensations are often experienced as stressful, frustrating, and anxiety-provoking. Pain can also lead to a wide range of changes, complications, and losses in many areas of life. For example, our patients commonly report that their pain interferes with leisure and hobbies, with family and marital relationship, and with work and finances. There are few areas of life that are not affected by chronic pain!
Stress exacerbates pain conditions
Over time, however, high levels of chronic stress can worsen pain and other symptoms that patients experience, such as poor sleep or difficulties with memory and concentration. Stress exacerbates pain conditions just as it exacerbates heart disease and other medical conditions. At the same time, stress depletes an individual's inner resources (their energy, motivation, hope) for managing their condition effectively.
Develop behavioural strategies
To break this vicious circle, a psychologist works with patients to help them develop behavioural strategies to keep their levels of pain and stress as low and steady as possible. In a sense, individuals are taught to function as their own psychologists day to day. Strategies that help our patients minimize their levels of pain and stress include relaxation training, mindfulness meditation, cognitive therapy, pacing, physical exercise, assertiveness, and others. Over the past several years, scientific research has shown that psychological treatments can help improve the quality of life among individuals with persisting pain conditions.
Realize that any medication started is always a "trial". This means that if a medication is not helping you I may need to stop it, especially in the case of opiates (narcotics) because they have many risks including constipation, drowsiness, itchy skin, motor vehicle collisions or other types of accidents, respiratory problems, lack of sexual interest or performance, addiction, and death to name a few. You should not drive or operate machinery while your dose of ANY medication is being increased, to ensure that you are fully alert when doing important tasks. If you are having ANY side effects, or feel that you need to stop or decrease the amount of any prescribed medication, speak with me, don't just stop the medication and not tell me. When you start a medication, it's important that we start slowly. This will minimize side effects so that you can get to a dose level that helps your pain and function. Please be patient during this process. Never take more than prescribed, and always be aware of the obligations of your opiate treatment agreement (ensure you have read it in full and ask me any questions you have right away).
Understand that some treatments such as nerve blocks have risks such as temporary weakness that can cause falls and injuries, especially within the first 30 minutes after the injection. Be very careful getting off the table, and don't drive if you feel weak, come back and talk to me about it before leaving. Ensure that you have read the information about the risks of nerve blocks and other pain-relieving procedures I do, and understand and accept these risks before trying any procedures. I will explain the risks to you but if you feel this has not been done enough to answer all of your questions, please ask me before we proceed so that you fully understand the risks. You do not have to do any procedure you do not want to do.
Updated July, 2013 by St. Joseph's Hospital
Websites and Videos Dr. Peterson Recommends to Help with your Chronic Pain
Learn more about the pain problem the doctor has diagnosed you with. Check a reliable website written by doctors for patients, such as the following (please click on text to be directed to corresponding website). Even if a pain problem like fibromyalgia or low back pain isn't your problem, there are learning points within the associated articles, websites, and videos so I encourage you to review all of the materials that follow.
If you learn to control your body's response to stress you will have less anxiety, depression, fatigue, and pain. Some of theses CD's and books I mention on my pain website may be available at the public library to borrow for free. There are many others and the public library as well.
Audio Books by Matthew McKay:
Body Awareness and Imagination
Applied Relaxation Training
Meditation and Autogenics
Go to www.painmed.org/pain-awareness and watch all of the videos there
CEP provides some good resources for dealing with Chronic Pain:
Dr. Peterson recommends to help with chronic pain:
Living Beyond Your Pain: Using Acceptance and Commitment Therapy to Ease Chronic Pain by Joanne Dahl and Tobias Lundgren
A Consultation With the Back Doctor by Hamilton Hall
The Brain that Changes Itself by Norman Doidge
The Back Book by Royal College of General Practitioners
So Your Back Hurts
Coping with Stress
Books by Robin McKenzie:
Treat Your Own Back
Treat Your Own Neck
7 Steps to a Pain-Free Life: How to Rapidly Relieve Back, Neck, and Shoulder Pain
Only you can learn self-management techniques that work for your own pain – No one can do this for you, but there are some resources and supports to help you get started. Begin by carefully reading the following diagrams (ICEBURG ANALOGY FOR CHRONIC PAIN, CHRONIC PAIN SPIRAL, and YELLOW FLAGS for chronic pain. Then continue reading on and viewing all of the videos and websites and other resources on the rest of my pain website below.
You can learn more about the chronic pain spiral and other aspects of controlling pain by searching Youtube for
"Dr. Grinsted". You'll know you have the right videos if it says Dr. Steven Grinsted, and he's talking about managing chronic pain. Watch all of his videos as a starting point, they will help you start to put things into perspective and learn what is necessary to control your pain (it's not taking more pills!)
** McMaster Pain Clinic removed the household chores handout but there are many useful tools on their pain clinic patient resources website which is linked above instead and Dr. Peterson recommends reviewing and using all of these tools. Expand the section called "Living Well With Chronic Pain" to review helpful sections within it.
Professor Lorimer Moseley
CHECK YOURSELF FOR "YELLOW FLAGS" - IF YOU HAVE ANY OF THESE, THEY MAY BE STOPPING YOU FROM TAKING IMPORTANT SELF-MANAGEMENT APPROACHES THAT WILL HELP YOUR PAIN.
Other excellent smoking cessation websites/workshops:
CAMH (Centre for Addiction and Mental Health)
London-Middlesex Health Unit (They often hold workshops and offer free nicotine replacement (worth $$$) and often list their workshops on their website, if not you can call the health unit. If you smoke, you should use this excellent local resource to finally quit).
Canadian Institute for the Relief of Pain and Disability
Add this app to your phone: Stop, Breathe and Think
The correct one will look like the photos shown at the left.
The publisher is Tools for Peace.
Use it every night before sleep.
Use it during the daytime to help control when your mind gets racing or overwhelmed, or to help control your pain when it starts to flare. Most people would benefit from using it three times every day.
There are paid parts you can download to add on, but you don't need to do that, the basic meditations are probably all you need.
Another great app is Headspace - you can get a lot of the basic content for mindfulness meditation for free
Other Pain BC Videos
This website is a PRESCRIPTION to help you treat your Chronic Pain.
It is as important and effective as a prescription for a pill (and a lot safer and fewer side effects!)
This prescription to read the articles on this site and to view the videos and links is probably going to be more effective in the long run for your pain than any prescription for a pill or patch, and more important than pain injections as well. Most patients who continue to struggle with pain have not exhausted non-drug treatments for their pain such as reviewing and applying the following resources (daily, as though it were your job), or when this is not enough worked with their family doctor (or psychiatrist or psychologist) on intensive pain psychotherapy or managment of depression, anxiety, or post-traumatic stress that often remain untreated in severe chronic pain patients. Treating mental health symptoms such as anxiety, insomnia, depression, or post-traumatic stress is beyond the scope of what your pain doctor can do for you, but if you have these problems you can and should seek help or referral from your family doctor. Improvement won't happen overnight. You need to seek out ways to learn techniques to manage your pain and emotional symptoms such as depression, anxiety, insomnia etc (if present), and then apply them on a daily basis (the application of them is the key part). You need to be committed to treating your pain and emotional symptoms and applying these techniques on a daily basis, because no one can do active self-management except for you, and you are the one it benefits (so you have a vested interest in putting in the effort).
Think about how active you are in managing your own pain symptoms right now... How many minutes per day do you spend doing mindfulness meditation, myofascial pain self-release techniques, sleep hygeine meditations, writing down 3 positive things about your day, or setting a goal to achieve within the next month like walking around the block or joining an arthritis aquafit class? Try to gradually increase the proportion of your time you spend on these positive actions to help yourself, and spend less time doing things that are making your pain and quality of life worse, like smoking, sitting at watching TV, dwelling on what you can't do, etc. Track your progress on a calendar or in a diary, and you will start to see that things begin to go your way more often. This will reinforce you continuing to do the same positive and active actions to improve your pain, disability, and emotional symptoms such as any depression or anxiety that frequently accompany chronic pain.
General Orientation to Chronic Pain Management: Treatment Goals
In chronic pain it usually difficult or impossible to completely eliminate pain. Expecting to have your pain "go away" often leads to frustration and often worsens your perception of pain, depression, anxiety, and worsens your ability to function in life (see Yellow Flags below). A more achievable goal for most is to aim for at least 30% reduction in pain (this is the gold standard of how much we should be trying to reduce your pain, as many studies show that this much pain reduction helps you start to function better, and more pain reduction that that is frequently not possible when chronic pain has been present for years), and/or an improvement in function. Even if you don't feel your pain is much better, but you are able to walk further, sleep better, feel less depressed, have more frequent or more rewarding interaction with your family or friends, or return to sports, hobbies, or other activities what you couldn't do previous to your treatment, you have acheived valuable improvements and should feel like you have accomplished something important.
What If Your Pain Isn't Getting Better
Most patients will have improvement in their pain and function when they stick to an evidence-based treatment program such as the ones I have recommended to you at your consult (which includes the self-managment tools on this site). There are two common reasons why some patients don't report improvements in pain and/or function Please review and take action on these, so that you can begin to make more progress. If it still doesn't work you may require more individualized or intenstive and personalized treatment - ask your pain doctor if this is the case. The next section identifies common reasons why patients have severe persistent pain and emotional symptoms like feeling overwhelmed by their pain.
Problem (and Solution!) #1
Reliance on "passive" treaments rather than "active" treatments. Passive treatments are where something is being done to you. For example, taking pills or getting a massage. Active treatments are where you are actively involved in managing your own pain. For example, exercising, participating in pain psychology/self management classes and persisting with the techniques that are taught. Sometime as passive treatment (this includes certain pills or injections or other interventions for pain) are necessary to relieve your pain a bit so that you can begin exercising or meditating to improve your pain, but relying entirely on passive treatments usually provides only a small amount of short term benefit. So if you want to have less pain and be able to walk further and enjoy things you used to be able to do, make sure you are engaging yourself fully in "active" self-management of your pain. If you are having difficulty getting started, you will learn how to do this through the CCAC's "Living a Healthy Life With Chronic Pain" course (see below). Other ways include seeing a physiotherapist, orjoining the YMCA or Boys' and Girls' Club. If you are on ODSB/Disability/over 65, there may be funding available, ask your doctor or disability support program contact person, or ask the Manager at the YMCA about whether they can reduce your price given your income. When you join a gym such as the YMCA, ask whether the YMCA you are going to has a wellness coach or someone else who can help you identify what programs they offer may be suitable and helpful for you given your pain (eg do they have yoga classes geared at people who have pain or who are older, do they have an arthritis aquafit class or an aquafit class geared for beginners).
Problem (and Solution!) #2
Some patients don't make progress because there are other stresses involved. For example, if you've been abused, are severely depressed, or have difficulty with anxiety or coping with pain, you may not progress as quickly as other patients. On the other hand, even if you have any (or all) of these barriers to improving, you can overcome them with help. Ask your family doctor (or pain doctor, if your family doctor is not able to help you with this for any reason) to refer you to a counsellor, social worker, psychiatrist, extended duration pain psychology group sessions, or if all else fails, a daily, month-long comprehensive pain program (eg, including psychiatry, psychology, occupational therapy, dietitian, physiotherapy, exercise and meditation classes). Not all of these are covered by OHIP, but you can and should look into the ones that are, or that you can afford if self-managment isn't enough.
Medications and injections may help you get started in controlling your pain but...