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Sometimes pain does not go away with medications or other treatments. Pain that lasts many weeks or months is called long-term or chronic pain. After a spinal cord injury, this kind of pain is often caused by damage to your nerves or spinal cord. When your spinal cord does not heal very well, this pain can last for months or even years. This handout will teach some helpful tips for coping with chronic pain.

Pain is an experience that happens in your brain. With practice, you can learn to shift focus away from that experience. By trying different strategies, you can learn to control pain instead of letting it control you. This allows you to get on with your day-to-day life.

Pain is an unpleasant and emotional experience. It can affect your mood and your drive to do things. It can lead to feelings of stress and intense negative emotions that make your pain feel worse. You might feel sad, anxious, fearful or frustrated, and angry a lot. These feelings, if not managed well, can lead to a vicious cycle of pain and emotions.

Your brain and nerves communicate with chemical messengers called neurotransmitters. Many pain medications work by copying or stopping the actions of these messengers. Some strategies can reduce pain by affecting how much your body produces them. The more you practice pain coping strategies, the better your body gets at dealing with pain. Here are some of your body’s chemicals and their actions:

Pain can make you stressed and upset. This stress can affect your mood, make your body more tense, and cause your pain to get worse. Activities that reduce stress can reduce pain and help you cope with your pain. Relaxation techniques can help calm you and improve your sleep, mood, focus, and immune system.

Breathing exercises improve oxygen intake, reduce stress, and reduce muscle tension. They help with your pain and sleep. The following exercise describes a belly breathing technique (abdominal breathing).

1. Sit in a comfortable chair or lie on your back.
2. Place one hand on your belly and the other hand in the middle of your chest.
3. Take long, slow breaths. You should try to bring the air deep into your belly. Breathe in with your nose and out with your mouth.
4. When you inhale, the hand on your belly should move further out than the hand on your chest. When you exhale, the hand on your belly should go deeper than the hand on your chest.
5. Normal breathing is about 16-20 breaths per minute. Your goal in this exercise is to have six to ten breaths per minute. Do not hold your breath between breaths. You might need to practice to get it this low.
6. Clear your mind or use imagery while focusing on your slow breathing.
7. Aim to do this for 20 minutes or more.

Imagining peaceful and positive images in your mind can help move your mind away from pain. There are many examples of imagery techniques. Some involve picturing beautiful scenery or past experiences. Others involve relaxing specific body parts one at a time. Learning to use imagery gives your mind a new place to go when you are in pain. The pain might still be there but less attention is given to it. Inhale Blue, Exhale Red is an example of using imagery with relaxation and breathing.

1. In a seated or lying position, close your eyes.
2. Each time you inhale, picture in your mind that you are inhaling peace and quiet.
3. Each time you exhale, picture that you are exhaling stress and pain.
4. Imagine that the positive, peaceful emotions are blue-coloured air entering your nose with every breath
5. Imagine that the negative emotions and pain are red-coloured air leaving your mouth with every breath.
6. Aim to do this for 20 minutes or more while belly breathing (see above).

• clearing your mind
• using imagery
• using a mantra (repeating a word or short phrase out loud or in your mind)

Healthy living involves balancing work, exercise, day-to-day tasks, recreation, and sleep. Doing too much or too little of any of these can make your pain worse. Listen to your body and find the balance that works for you.

Exercise is one of the most effective ways to manage long-term pain. Exercise also improves blood flow, breathing, and sleep. It can be done at a gym, in exercise classes, or in your own home. There are guidelines on how much exercise you need after a spinal cord injury. If you have not exercised in a long time, slowly work towards reaching these goals. You should try to do both aerobic and strength exercises two times per week.

• Aerobic activity: Do at least 20 minutes of moderate to vigorous intensity. You can do this by wheeling, arm cycling, cycling, or body-weight supported treadmill.
• Strength training: Exercise each major muscle group by doing three sets of 8-10 repetitions. Major muscle groups include your arms, shoulders, chest, back, upper legs, and lower legs. Exercise the muscles that you can. You can do this with free weights, elastic resistance bands, weight machines, or functional electrical stimulation.

• Plan your activities by spreading them throughout the day and week.
• Prioritize what is most important. Sometimes you might need to cancel an activity to complete something else.
• Pace your tasks. Don’t rush things. Schedule 3-5min breaks every hour.
• Eliminate some activities which are not important.
• Delegate by letting someone else complete tasks for you.
• Organize your home to have little clutter. Keep important things that you use often in easy to reach locations.
• Equip yourself with the right tools for the right job.

• Go to bed at a regular hour to get your body used to a sleep pattern.
• Wear comfortable clothing and keep a good temperature in the bedroom.
• Make your bedroom a place for sleep only; not for work or stressful activities.
• Get comfortable by using extra pillows to position your body in your bed.
• Try relaxation or breathing techniques to reduce stress before or while in bed.
• Read, journal, or listen to soft music before bed to help relax your mind.

Your thoughts, thinking style, and actions affect your pain experience. Organizing how your thoughts and actions respond to pain helps you understand it better. Finding creative ways to express your pain can help you better cope and come up with healthy solutions.

Self-talk is your own personal conversation that happens in your head. It’s the language of your thoughts and can happen with words, images, and sounds. Pain can cause negative self-talk which affects your mood and motivation. Negative self-talk can also cause your pain to get worse or affect your actions. Learning what triggers negative self-talk and stopping it early can improve how you cope with pain. When you understand your own self-talk, you have the power to change the way it affects your actions and emotions.

• Event: Think about your pain. Write down only the facts about your pain (no assumptions).
• Emotions: Write down the emotions your pain causes you to feel (e.g., irritated, stressed, angry, sad, anxious, afraid, etc.).
• Automatic Thoughts: Write down all the thoughts (self‐talk) you have when you experience pain. Be as honest as possible. It might take a few minutes.
• Reality Check: Ask yourself questions about your thoughts.
  • Are there other ways of looking at this situation?
  • What am I afraid will occur?
  • What facts do I have that this outcome will happen?
  • Are there facts that disagree with this conclusion?
  • What coping resources are available?
  • Have I only had failures in the past, or were there times I did okay?
  • There are times when I don’t do as well as I would like, but other times when I do. What are the differences between those times?
• Alternative Thoughts: Write down alternative thoughts you could have about the situation. How could you view the event more rationally?

Some techniques help you organize your thoughts about your pain. Finding different ways to express yourself about your pain can help you better understand it. By expressing your pain in creative ways, it takes the experience out of your head and puts in into the world. It gives you something to point to. This can help you and others understand your pain better. One way to try this is by journaling. Another way you can try to express your pain is with art like poetry, painting, and song. Sharing your work with others can also be a way to help them understand what you’re going through. A simple exercise is a Collage Exercise. For this exercise, you will need: old magazines, a large paper or cardboard surface, scissors, and a glue stick.

1. Cut out a collection of pictures from old magazines. The pictures should not contain any words.
2. Select pictures which illustrate the following:
   • Who you are
   • Your pain
   • How you cope with your pain
3. Glue the pictures on the paper surface.
4. Take time to reflect about the finished product. Share it friends or family members.

Sometimes you might feel like you need to talk to a professional about your pain and your problems. Psychologists and social workers are trained to help you with your thoughts and actions. They can help you analyze your thoughts and behavior. They can help you find new triggers for your pain that you were not aware of. They can also make suggestions on how to change your thoughts and behaviours to better cope with pain.

Disclaimer: Information is provided for educational purposes only. Consult a qualified health professional regarding specific medical concerns or treatment. University Health Network does not assume and disclaims any liability to any party for any loss or damage caused by errors or omissions in this publication.