Managing your pain

Chronic pain roadmap was developed by Fraser Health in collaboration with Doctors of BC, Shared Care and East Fraser Pain Collaborative, and includes information for daily self-management of your pain.

Consider the following three programs, based off of your preferred learning and participation style.

Independent education

Do you like to go at your own pace and have a choice to look deeper into topics that you are really interested in? Or want to get a good feel for what pain self-management is about before joining a group learning program? The LivePlanBe+ course produced by Pain BC might be right for you.

LivePlanBe+ on the Pain BC Website is for you if:

• are interested in a guided pain education program
• you would like an interactive learning experience

Learn more.

Flexible interaction

Do you enjoy interaction with others as you learn together with a structured curriculum and scheduled meeting times? Like to have some flexibility in what time you attend the program, how in-depth it is and appreciate a peer instructor who has lived pain experience? The Self-Management BC Pain Program could be right up your alley.

Self-Management BC Pain Program, a government-sponsored program is for you if:

• you would like a choice between three current pain self-management programs
• you attend the programs either virtually, by telephone or by mail for adults residing in B.C.

Learn more.

Small group sessions

Are you having difficulties coping well in your day-to-day life? Feeling you would benefit from support and guidance by Fraser Health multidisciplinary pain staff in a small group setting? You might be a great fit for the Fraser Health Community Self-management Program.

Fraser Health Community Self-management Program is for you if:

• you are able to attend and participate in a program once a week for eight weeks
• you attend the program virtually or in-person at set locations within Fraser Health
• your physician or nurse practitioner supports you attending and will refer you to the program

Learn more.

If you live in Maple Ridge, you may be eligible for the Ridge Meadows Self-management program and chronic pain clinic.

If you do not live in the Fraser Health region, ask your care provider in your region what may be available.

Apps and tools to help you manage your chronic pain.

Mental health and wellness tools

• Mindshift-CBT – A self-help anxiety relief app with guided meditations, activity logs, videos, audio clips and more.
• Pain B.C. Wellness and Support Groups – Pain Support and Wellness Groups offer an opportunity for people living with persistent pain to meet regularly online and build a community of support while learning about pain, pain management and coping strategies.
• Wellness Together Canada – A mental health and substance use website funded by the Government of Canada to support people across Canada and Canadians living abroad in both official languages.
• BounceBack: Reclaim Your Health program – Designed to help adults with mild to moderate depression, low mood or stress. Delivered online or over the phone with a coach, you will get access to tools that will support you on your path to mental wellness.
• ACTivate Your Life – Free online self-help course from Wales Public Health site. It is meant to be a beginning step for those who are looking to develop skills and actions to improve mental health and well-being.
• CBT Skills – The Cognitive Behavioural Therapy (CBT) Skills Groups are an eight week psycho-educational class for adults, aged 17.5 and older. The groups are designed to teach you practical tools to recognize, understand and manage patterns of feeling, thinking and behaving aimed at improving your mental health.
• Coaching for Health - A free telephone coaching program designed to teach people living with pain self-management skills, regain function and improve their well-being. Up to 12 weeks of one-to-one weekly phone support. Referral entry from any health care provider or patients can access through the Support Line via a referral.

Relaxation and meditation tools and apps

• Healthline BC – Learn deep breathing.
• The Mindfulness App – A guided mindfulness meditation app.
• Insight Timer – The app features guided meditations, music and talks for stress, sleep and anxiety.
• Calm – A guided meditation app for sleep, stress and anxiety
• Learn Mindfulness – Free online mindfulness courses and plans for beginners.

Sleep wellness tools and apps

• CBT-Insomnia app – The app will guide you through a structured program that teaches strategies proven to improve sleep and ease the symptoms of insomnia.
• Sleep Labs – Sleep labs investigate, diagnose and treat sleep disorders. Sleep studies are conducted to monitor your brain waves, movements, heart and other levels while you sleep:
  • Fraser Health Sleep Labs
  • UBC Sleep Disorder Program
• Kelty's Key - Sleep Diary – Use a sleep diary to document your sleep patterns so you and your health care provider can determine the problem.
• Center For Clinical Intervention – Easy to read handouts about sleep, insomnia and steps you can try.
• Vancouver Anxiety – A video on CBTi, a form of cognitive behavioural therapy which was specifically developed for treating insomnia. It is recommended as the first-line treatment of insomnia.

Pain Education Tools and Apps

• Retrain Pain – Learn a science based approach to overcome chronic pain through self-directed online modules
• Tame The Beast – Learn to retrain your brain.
• Pain Management Network – Develop skills and strategies to manage your pain.
• Kelty’s Key – Online modules on coping with chronic pain.
• The Pain Truth App – Consists of a series of videos and activity logs to help empower people to regain their sense of control and their quality of life:
  • Search App store to download
• Pathways Pain Relief App – Helps you change the way your brain perceives pain through various scientific and proven methods.
• Science of Pain - The mysterious science of pain.
• Understanding Pain – Pain: a quick review.
• Pain in Your Nervous System Video – Explains neuroplasticity.

Financial tools

• Pain B.C. Support Line – Provides free information, support, and a listening ear to people wanting to talk about their own pain or that of a family member or friend. The support line is manned by social workers who are able to help connect you with pain resources and services within your community and on-line.
• ICBC Insurance – Link update for disability discount on car insurance.

Movement and Activity Tools

• YMCA offers a series of videos for gentle seated exercises (Gold Series) with a focus on those who have limited mobility or have been inactive.
  
  • YMCA seated exercises, 20 minutes
  • YMCA seated upper body exercises, 15 minutes
  • YMCA chair yoga, 20 minutes
• Pain BC: Gentle Movement – Teaches us how to feel safe to move again. Live streaming sessions are available through Pain B.C. Each session is led by physiotherapists and other therapeutic movement professionals. Topics include breath awareness and regulation, body tension regulation, and movement and relaxation techniques in both seated and standing positions. Each class is approximately 50 - 65 minutes in duration.

Nutrition Tools

• Healthy Families BC: Nutrition basics – Tips for healthy eating, sodium sense and meal planning
• Nutrition and pain management – Alberta Health Chronic Pain Management Lecture Series
• Canada’s Food Guide – Follow the recommended guidelines for a healthy balanced diet that includes all the vitamins, minerals and other nutrients for vitality and health

Pacing and Prioritization Tools and Apps

• My Pain Diary – An app used to track your pain on a day to day basis
• Pain B.C.: Pacing – Tips on how to pace and increase activities
• Pain Health - Advice and tips on how you can approach musculoskeletal pain and form a co-management plan through goals and pacing
• London Pain Clinic – Video and article on pacing and chronic pain

Communicating with your loved ones about your pain and support for caregivers.

Chronic pain, like any chronic illness, can easily take a toll on relationships. We can’t control how others act or react, but we can learn ways to communicate more effectively.

Effective communication sounds like it should be instinctive. But all too often, when we try to communicate with others something goes astray. We say one thing, the other person hears something else, and misunderstandings, frustration and conflicts ensue. This can cause problems. Communicating more clearly and effectively requires learning some important skills. Whether you’re trying to improve communication with your spouse, kids, boss or coworkers, learning these skills can deepen your connections to others, build greater trust and respect, improve teamwork, problem-solving, and your overall social and emotional health.

As well as being able to clearly convey a message, you need to also listen in a way that gains the full meaning of what’s being said and makes the other person feel heard and understood.

To learn more about effective communications, review the Toronto Academic Medicine Institute Pain U module of Communication.

Tips for communicating your pain effectively

• Be as clear and direct about your needs, concerns and experiences as possible. Don’t expect others to read your mind.
• Remember that others will see your behaviour (such as withdrawing from interactions or holding painful parts of your body), and without clear communication they will be left to try to interpret what your behaviour means. Some will interpret incorrectly. You can improve this situation by explaining reasons for your withdrawal and agreeing in advance how you will indicate that your pain has increased, etc.
• Living with chronic pain can impact mood, emotions, the ability to cope and how we react to others. If you are struggling with feelings of sadness, frustration, irritability, anger or other negative emotions speak with your doctor or nurse practitioner on how this is impacting you and your relationships. If you are wanting to better understand how much impact pain is having on your mental health and life here is a self-survey that may be helpful.
• Balance is important. Talking too much about your pain will likely overwhelm others. It is also important to be clear with others about what is going on for you.
• Try to take an interest in others and the world around you. This can be difficult with chronic pain.
• Remember that chronic pain is difficult for loved ones as well. It can also be important for them to talk about their feelings, experiences and concerns.

Resources

• Pain B.C. - Live Plan Be: Support and relationships
• Pain B.C. - Live Plan Be: Parenting and chronic pain

Caregiver support

Caregivers play a vital role by providing hands-on care, assistance and emotional support to family members or friends who need them.
Caregivers are also often so busy providing care for others that they do not pay close attention to their own needs. It is important for caregivers to remember to actively care for their own physical, mental and emotional well-being.

Tips to manage caregiver stress

• Have realistic expectations. Learn all you can about your loved one’s condition and be realistic about what you can and cannot do.
• Ask for and accept help. Share the care. Most people are willing to help when you take the step to let them know what you need.
• Bring humour into your life. Laughter helps put things in a more positive perspective. Seeing the lighter side of things may help you cope.
• Connect with others to help ensure that you do not become isolated physically or emotionally. This could mean finding someone you trust who you can talk to, joining a suitable support group, being involved regularly in a hobby or participating in a recreational activity.
• Learn to control what causes you stress. Establish limits. Identify what you can and cannot change. Practice slow, deep and mindful breathing. By regulating your breath, it is possible to slow down all physiological activity, including heartbeat. Blood pressure lowers, pulse rate slows and tense muscles release.
• Recognize your physical signs of stress. Eat well, get adequate amounts of rest and visit your doctor.
• Accept and share your feelings. It is normal for caregivers to experience a wide range of emotions. Find someone you are comfortable with talking to about how you feel and what is troubling you.
• Take time for yourself so you can find the renewed energy to return to your tasks with the care, dedication and inner strength that brought you to this role of caregiving in the first place. Identify and engage in activities and interests that have a calming effect on you such as walking, listening to music and reading. Research respite options in your community.

Resource for caregivers

• Caring for the caregiver
  Resources help to assess one's personal balance in caring for a loved one.

For help living with chronic pain, follow the five P's: pace, prioritize, plan, posture and positivity. 

1. Pace
   • Break down tasks into smaller manageable steps with breaks in between.
   • Allow yourself to work at your present ability (which may fluctuate daily).
   • Listen to your body for early signs and symptoms of pain (fatigue, discomfort or tingling etc.).
   • Don’t wait until signs and symptoms appear as it may be too late; use time as a measurement.
   • This principle applies to activities and exercises.
2. Prioritize
   • Decide on the most important activities that you would like to accomplish in your day (e.g. attending a medical appointment).
   • If you have more than one important task, start with the most important to make sure it gets done.
   • Reschedule tasks that you don’t have to do and ask for help when needed.
3. Plan
   • Creating a schedule for the week will help you to see your week at a glance and help you to spread out your activities.
   • Your schedule may help you to identify when to ask for help or plan an extra quiet day.
   • Planning for a specific task will help decrease the number of steps and time required to complete the task.
4. Posture
   • Modify a task to make it friendlier for the body.
   • Avoid over-stretching, reaching or twisting.
   • As much as possible, keep work close, in front of you and at an easy-to-reach height.
   • Use your legs for bending and not your back.
   • Incorporate tools to help protect your posture (a reacher, step stool or long handled equipment).
5. Positivity
   • Look for ways to modify a task to make it more enjoyable (i.e. listen to music or have someone help you).
   • Focus on the positive aspects of the activity.
   • Use positive self-talk to keep you motivated.
   • Compare yourself to your progress last week, rather than comparing to yourself before your injury.
   • Record your successes and celebrate them.

Depression is a common experience among people living with chronic pain. About half the people waiting for pain care experience moderate to severe levels of depression.

Fortunately there are some very good resources available to support you. 

Getting help

Often a good place to start is speaking with your primary care provider or any other health care professional you feel comfortable with. They can provide you with direction on next steps and help you find the support you need.

Call the Fraser Health Crisis Line: 604-951-8855 or toll-free 1-877-820-7444. Trained volunteers provide toll-free telephone support and crisis intervention counselling, 24 hours a day, seven days a week.

Call the Culturally sensitive crisis line for Aboriginal peoples: 1-800-KUU-US17 (588-8717). Provides culturally sensitive support and counselling to Aboriginal peoples 24 hours a day, seven days a week.

Psychologists and clinical counsellors can help you learn how to live life with chronic pain. Learn more about accessing chronic pain care.

BounceBack: Reclaim Your Health program. This program is designed to help adults with mild to moderate depression, low mood or stress. Delivered online or over the phone with a coach, you will get access to tools that will support you on your path to mental wellness.

Wellness Together Canada. This is a mental health and substance use website funded by the Government of Canada to support people across Canada and Canadians living abroad in both official languages. They provide the following resource at no cost:

CBT skills. The Cognitive behavioural therapy (CBT) skills groups are an eight week psycho-educational class for adults. The groups are designed to teach you practical tools to recognize, understand and manage patterns of feeling, thinking and behaving aimed at improving your mental health. Designed by psychiatrists and taught by physicians. Free for B.C. patients (deposit of $60 is returned if you attend six out of eight online classes; waver for people with low incomes possible).

Pain B.C. - LivePlanBe: Depression.

Pain B.C. - LivePlanBe: Emotional well-being.

Kelty’s Key - Online chronic pain course introducing various pain management topics, including mental health related concerns.

Emotional changes are a natural part of the experience of persistent pain. Your emotions are created by the way you think about things happening in your life, rather than by the things themselves. You can learn to have control of your thoughts, and by doing that, change your emotions. So even if your pain continues, you can improve your mood, and in turn, improve how you manage your pain.

Developing healthy thinking

Cognitive-behaviour therapy (CBT) is a type of therapy that can help you replace unhelpful thoughts that discourage you with helpful thoughts that improve your mood. CBT can help change the way people view their pain and reduce the negative response from the brain that can make pain worse.

CBT involves steps such as learning to monitor your thoughts and to identify the particular thoughts that trigger the negative moods. Then, you decide how true those thoughts are and have the option of replacing them with helpful or balanced thoughts that lead towards mood change and improvement. With practice and effort, it will become more natural and you will see improvements in your mood.

Visit HealthLink BC to read about how to stop negative thoughts.

Acceptance commitment therapy

Acceptance commitment therapy (ACT) is a type of therapy which uses an action-oriented approach involving acceptance, commitment and mindfulness strategies to work towards behaviour-change that can positively improve a person’s quality of life. The main goal of ACT for chronic pain is to help people improve their quality of life through clarifying their values.

• This free on-line self-help course from Wales Public Health is meant to be a beginning step for those who are looking to develop skills and actions to improve mental health and well-being.

Resource specific for those living with pain

Pain BC Support Line

Income assistance and other benefits are available.

Living with a chronic pain condition can impact your financial situation. Find programs that offer income assistance and other benefits.

Prescription drugs and medical supplies

PharmaCare helps B.C. residents with the cost of eligible prescription drugs and certain medical supplies. Coverage is based on your family’s net income. For details, visit PharmaCare.

Employment and income assistance

• B.C. Employment and Assistance Program
  Eligibility is based on your income and assets. Find a self-assessment tool and application online.
• Persons with Disabilities Assistance
  Provides disability assistance and supplements. Assistance to persons with disabilities is subject to both income and asset eligibility criteria and the payment of assistance is based on an individual's ongoing financial eligibility. Find a self-assessment tool and application online.
• Service Canada: Employment Insurance (EI) Sickness Benefits
  Temporary financial assistance for those unable to work because of sickness, injury or quarantine.
• Service Canada: Disability Benefit
  For people who have contributed to the Canada Pension Plan and who are not able to work regularly at any job because of a disability. It is not designed to pay for medications and assistive devices.
• Disability Tax Credits
  Tax credits and deductions are available for persons with disabilities, their supporting family members and their caregivers.

Housing

• Home Owner Grant
  Home owners with a disability or home owners living with a relative or spouse with a disability are eligible for the additional home owner grant.
• Property Tax Deferment Program
  A low-interest loan program that assists qualifying homeowners in paying the annual property taxes on their homes.
• Home Adaptations for Independence (HAFI) program
  Provides financial assistance to help eligible low-income seniors and people with disabilities with home modifications for accessible, safe and independent living in B.C.

Transportation

• Bus Pass Program
  Offers a reduced cost, annual bus pass for low income seniors and individuals receiving disability assistance from the Province of B.C. Passes are valid in communities serviced by B.C. Transit or TransLink. HandyDart is not included in this program.
• TransLink HandyCard
  For those with a permanent physical or cognitive disability that makes it difficult to use the public transit system without assistance. Discount allows you to travel for concession fares and if you’re accompanied by someone to assist you, they can ride for free.
• Parking permit for people with disabilities
  A permit to park in designated parking stalls to access buildings and services in the community.
• Federal Excise Gasoline Tax Refund Program
  For those with a permanent mobility impairment who cannot safely use public transportation as certified by a qualified medical practitioner. You can apply for a refund of part of the federal excise tax on the gasoline you buy.
• Motor vehicle insurance
  ICBC offers a 25 per cent discount on basic Autoplan insurance to persons with a disability – even if you don’t drive the vehicle you’re insuring.

Assistance with advocating for benefits

• Disability Alliance BC
  Offers free one-to-one assistance with provincial and federal disability benefits.
• Newton Advocacy Group
  Provides advocacy for people on income assistance. Call 604-596-2311.

Resource

Pain B.C. Support Line: Provides assistance in finding community resources, completing forms or finding potential financial support for disability and equipment needs.

Nutrition and our diet are important factors in general health and wellness. Studies are beginning to show a connection between what we eat with certain health conditions, including pain. Healthy eating includes having a balance of foods from each food group in your meals. Each food group contains different nutrients that your body needs to function properly.

Chronic inflammation can lead to chronic pain, fatigue and brain fog. Many factors can increase inflammation, such as poor diet, food allergies, food sensitivities, food intolerances, environmental toxins and stress. The foods we choose to eat may help in reducing inflammation in our bodies.

Anti-inflammatory foods

• Unsaturated fats: Also known as “healthy fats”, these are fats found mainly in plant foods such as olive oil, avocado, nuts and seeds.
• Fruits and vegetables: These foods are a great source of fibre, in addition to vitamins and minerals. Many pain medications can cause constipation, and a diet high in fibre can help you maintain a regular bowel pattern and reduce inflammation in the gut.

Foods that can contribute to inflammation

• Refined carbohydrates: Avoiding refined carbohydrates such as the processed sugars and/or white flour found in foods like candy bars and pastries can help reduce inflammation.
• Saturated fats: Also known as “unhealthy fats”, these are fats are found mainly in animal sources such as fatty meats, butter and cheese.
• Food chemicals: Foods like cured or preserved meats contain food chemicals (e.g. nitrates and preservatives). Avoiding these foods can help to reduce inflammation.

Follow the recommended guidelines in the Canada’s Food Guide for a healthy, balanced diet that includes all the vitamins, minerals and other nutrients for vitality and health.

Talk to a dietitian directly at HealthLink BC Dietitian Services (call 8-1-1).

Resources

• Canada’s Food Guide
• Dietitian Services HealthLink BC
• Healthy Plate
• Plant Proteins
• Protein
• Healthy Eating on a Budget
• Guide to Heart-Healthy Label Reading

Having chronic pain while being able to complete your work can be a challenge. Here are some simple tips to help manage your pain in the workplace. You can also read the following resource from Pain B.C. for more information about returning to work.

How to make your workstation more comfortable

• Tell your employer about your pain. If they know your situation, they can better understand your need for medical appointments, to pace your work or to change your work environment.
• Modify your workstation, such as an ergonomic chair and keyboard placement. View WorkSafeBC’s How to Make Your Computer Workstation Fit You, a self-help guide on how to identify and solve problems with computer workstations.
• Sitting or standing for long periods of time will increase your pain; it is important to change positions frequently or take five minute stretch breaks regularly.
• Watch this ergonomic video about using laptops for work and at home.
• Reduce lifting and bending with heavy objects. Avoid twisting as you lift. Watch this video on lifting in the workplace.

Resources

• WorkBC Employment Centres
  Support services to finding a job
• Government of B.C.: Job and career training

Different types of pain medication and side effects

Alongside non-medication strategies, several types of medications may be used to treat pain.

Medications for treating pain are chosen based on the following factors: type of pain, severity and how long the pain has lasted. Mild pain is usually managed with over-the-counter medication such as ibuprofen (Advil®, Motrin®) or acetaminophen (Tylenol®).

Depending on the type of pain you are having, your doctor or nurse practitioner might recommend other medications such as antidepressants (e.g. amitriptyline, nortriptyline, duloxetine, venlafaxine) or antiepileptics (e.g. gabapentin, pregabalin) that are specifically helpful for chronic pain.

Opioids such as morphine or hydromorphone are often reserved for severe acute pain such as pain after surgery or cancer pain. For chronic pain the use of opioids often do not appear to have long term benefit.

Discuss with your doctor, nurse practitioner or pharmacist about options that may be suitable for you. Here are some additional resouces:

• Medications to treat pain
• Possible side effects of medications

Don’t wait for the pain to get bad

By controlling your pain early on, you can prevent the cycle of stress and increased pain.

Make the most of your pain medications:

• If you have regular medication, take them on time (by the clock). If your medication is to be taken as needed, don’t wait until your pain is getting out of control.
• Your pain management plan with your doctor or nurse practitioner may include strategies for dealing with flare ups of your pain. These strategies may include pacing your activities, taking breaks and self-care techniques that work you. Depending on your pain condition there may be medication to take as needed as part of your flare up plan. See 'Pacing' under 'Daily living with chronic pain' above.
• If you have more than one doctor or nurses practitioner, pick one to be in charge of all your pain medications. If more than one doctor or nurse practitioner prescribes pain medication, make sure they are aware of this and talk to each other.

Finding the right pain treatment for you

If you have any chronic medical conditions such as high blood pressure, heart failure, kidney disease, liver disease or stomach problems, make sure your health care provider is aware so they can recommend the best medication for you.

For most chronic pain conditions, medications work best in combination with other strategies such as psychological therapy (e.g. acceptance commitment therapy (ACT) and/or cognitive behavioural therapy), movement, activity and self-care techniques.

Can I get addicted to pain medication?

Many people often confuse the term “addiction.” People who are addicted abuse or misuse the drug for reasons other than pain relief. Addiction can occur with certain pain medication, like opioids; be sure to discuss the risks and benefits of these medications with your doctor or nurse practitioner.

You may find that if you are taking opioids (for example, morphine and hydromorphone) for awhile, you may need more of the medication to achieve the same effect in reducing your pain. This is called tolerance – which is not the same as addiction.

Over an extended period of time, your body can develop physical dependence. Your body becomes used to the medication so that if you abruptly stop taking it, you may get withdrawal symptoms such as nausea, diarrhea, vomiting, temporary increase in pain, irritability or anxiety. This is also not the same as addiction.

Pain medications and constipation

Some pain medications, including opioids, can slow down movement of your digestive system and cause constipation.

Tips to combat constipation

• Increase your fluid intake.
• Increase your dietary fiber intake by eating more fruits (prunes) and vegetables. HealthLink BC constipation information: Constipation
• Talk to your health care provider about whether it is appropriate for you to use a stimulant laxative (for example, sennosides or bisacodyl) or other medications such as PEG 3350 (Restoralax®, Lax-A-Day®), lactulose or magnesium-containing medications.
• Docusate is not effective for opioid-induced constipation.
• Use Metamucil or other over-the-counter fiber supplements with caution. They may not help and may lead to blockage in your intestines if you are on opioids.

Pain medication safety

• Do not make any changes or stop taking any pain medication without first checking with your doctor or nurse practitioner. If a pain medication is not working to improve your pain, your doctor or nurse practitioner may change your dose or try another medication.
• Keep a current list of all your medications and bring it to your health care providers at every visit.
• Store pain medications in a safe place, out of reach and out of sight of children, teens and pets.
• Keep pain medicine in its original container so you do not take it by mistake.
• Do not share medications with others and do not borrow medications from a friend or relative.
• Dispose of unused or expired medications safely.
• Ask about a naloxone kit if you are taking opioid medications. Healthlink: Naloxone.
• Let your health care team know if you take any mind-altering substances including sleeping pills, alcohol, cannabis and illegal drugs.
• If you feel sleepy and/or dizzy, do not drive or work with machinery.

Resources

• Pain B.C. - LivePlanBe: Medications
• Brainman stops his opioids (video)
• Pain and role of medications

Free self-management workshops

There are programs available in the community as well as virtually. Workshops vary in length but generally most cover the following topics:

• Techniques to deal with problems such as stress, tension, anger, frustration, depression, fatigue and isolation
• Appropriate exercise for maintaining and improving strength, flexibility and endurance
• Appropriate use of pain medications
• Communicating effectively with family, friends and health professionals
• Nutrition
• Pacing activity and rest
• How to evaluate new treatments

What to expect

• Share how your chronic pain affects you in your daily life
• Learn a number of self-management strategies
• Find mutual support from peers
• Make realistic goals and achieve them
• Build confidence in your ability to manage your health and maintain an active and fulfilling life

Self-management workshop

Workshops are now available virtually, Here is the link for more information and dates for upcoming workshops. Find a workshop near you. 

Self-Management BC

Health programs for adults of all ages living with one or multiple ongoing health conditions (including chronic pain), offered throughout British Columbia online, by telephone or by mail.

• Online Self-Management Program (web-based)
• Health Coach Program (one-to-one telephone-based)
• Tool Kit for Active Living with Chronic Conditions (one-time mailed package)
• Tool Kit for Active Living with Chronic Conditions + Telephone Calls Program (Tool Kit materials and small group conference calls)

Online Self-Management Tools

• Kelty’s Key
  Online chronic pain course introducing various pain management topics
• Pain B.C. LivePlanBe
  Online self-management portal
  Learn about the science behind chronic pain and develop a plan for self management
  Keep track of your symptoms and their impacts
  Connect with a like-minded community of others who live with pain
• Toronto Academic Pain Medicine Institute (TAPMI)
  Online chronic pain self-management learning modules on various topics

Fraser Health Self-Management Program

Fraser Health offers a comprehensive eight-week self-management program. Now accepting referrals for all patients living with persistent pain. This program is now offered online.

Community Pain Program information

Peer support groups

Connecting to peers with similar experiences can be a tremendous support in your journey. Peer support groups:

• Assist with finding and navigating health care and community resources
• Share personal stories of managing chronic pain: fears, barriers, struggles and coping strategies
• Listen and provide a supportive presence
• Decrease isolation and foster social support

Peer Support Group Resources

Pain B.C. Wellness and Support Groups offer an opportunity for people living with persistent pain to meet regularly online (now online secondary to COVID-19) and build a community of support while learning about pain, pain management and coping strategies.

Other Resources

• Pain B.C. - LivePlanBe: Real stories
  People living with chronic pain share their personal stories of coming to know their pain and find what works for them

Develop healthy sleep habits and find resources for better sleep.

It is common for people with pain to have sleep problems. It’s important to address any sleep issues you may experience with your doctor.

Healthy sleep habits

• Get up at the same time every morning. This helps regulate your body’s clock.
• Exercise but not close to bedtime. Exercise can help regulate your body and make you physically tired by the time you’re ready to sleep.
• Avoid naps in the afternoon. Napping can take away from your nighttime sleep. If you need to nap, keep it less than 30 minutes and before 2:00 p.m.
• Avoid caffeine, alcohol and tobacco in the evening. These can delay or disrupt your sleep.
• Evaluate your room. Make sure your environment is comfortable, quiet and dark. Install blackout curtains and use a quiet fan to block outside noise. Use a few extra pillows and place one between your knees when lying on your side with leg bent.
• Wind down. Your body needs to time to switch into sleep mode so consider doing a calming activity such as reading, listening to soothing music or meditating. Avoid using electronic devices such has laptops or mobile phones because the light from the screen activates the brain.

Resources

• Pain B.C. - LivePlanBe: Sleep Webinars, articles and podcasts about pain and sleep
• CCI Sleep – Easy to read handouts about sleep, insomnia and steps you can try.
• Vancouver Anxiety – CBT for Sleep: A video on CBTi, a form of cognitive behavioural therapy which was specifically developed for treating insomnia. It is recommended as the first-line treatment of insomnia.
• Kelty’s Key - Nine modules on sleep and insomnia with worksheets and audio clips.

Guided meditation and relaxation for better sleep

Try these resources to help with sleep:

• UCLA Health: Guided meditations
• MIT Medical: Guided relaxation

Apps

• Insight Timer - Meditation app that includes a timer, guided meditations, courses and calming music.
• Headspace - Guide to everyday mindfulness. Hundreds of guided meditations to help with various areas such as sleep, productivity and exercise. First 10 sessions are free.

Sleep diary

Use a sleep diary to document your sleep patterns so you and your health care provider can determine the problem.

Sleep clinics

Sleep labs investigate, diagnose and treat sleep disorders. Sleep studies are conducted to monitor your brain waves, movements, heart and other levels while you sleep.

• Fraser Health Sleep Labs
• UBC Sleep Disorder Program

If you are still having difficulties with sleep despite using the healthy sleep habits resources, please speak with your doctor or nurse practitioner for alternative options. Sleep is important to your overall health and pain.

A common thought is exercise will increase pain or cause more problems. In fact, regular structured and graded activity can decrease pain and increase function.

Inactivity can lead to weight gain, joint strain, muscle tightness, fatigue and wider health issues.

10 benefits to increasing your activity

1. Increases muscle strength.
2. Improves flexibility/movement.
3. Increases endurance and stamina.
4. Releases natural pain killers (called endorphins) in your body which controls pain.
5. Helps to improve sleep.
6. Helps to prevent constipation.
7. Helps with weight control.
8. Helps combat depression and anxiety.
9. Reduces fatigue and increases energy.
10. Reduces muscular tension and stress.

Tips to think about

• Always talk to your doctor before starting an exercise program.
• Start slowly and pace yourself. Exercise is best done for short periods of time frequently.
• Increase the duration or intensity of any activity by no more than 10 per cent at a time.
• Find activities you enjoy.
• Be persistent and patient. It takes practice to balance the activity while monitoring your pain. Don’t be discouraged if you have a setback.
• Talk with your physiotherapist or occupational therapist to design a program tailored to your needs.

Getting started

Gentle movement sessions teach how us to feel safe to move again. Recorded sessions are available through Pain B.C. Each session is led by physiotherapists and other therapeutic movement professionals, and are designed to help people with persistent pain learn to feel safe moving again. Topics include breath awareness and regulation, body tension regulation, and movement and relaxation techniques in both seated and standing positions. Each class is approximately 50 - 65 minutes in duration.

YMCA offers a series of videos for gentle seated exercises (Gold Series) with a focus on those who have limited mobility or have been inactive.

• YMCA seated exercises, 20 minutes
• YMCA seated upper body exercises, 15 minutes
• YMCA chair yoga, 20 minutes

Swimming

Swimming is a gentle, low impact exercise that is easy on sore muscles, joints and bones. Join a water aerobics class at your community centre. Some classes are designed specifically for people with back pain or arthritis.

Yoga

Gentle restorative yoga can help decrease pain, increase function, and improve your overall mood and well-being. It is more than just stretching. It involves relaxation, body awareness, breathing, gentle movements and meditation. Join a class at your local community centre or try a yoga DVD at home.

Resource

• Pain B.C. - LivePlanBe: Paced activities

People with persistent pain may experience increased physical tension, stress, worry and fear. Pain itself can also be a source of stress. Other commonly experienced stressors include lack of sleep, financial concerns, relationships and family responsibilities.

Stress and anxiety can impact the way we think, feel and behave. This in turn may negatively impact the experience of pain as well.

One way to help reduce the impact of stress is through utilizing mind-body techniques. Mind-body techniques have been shown to help relieve pain, tense muscles, anger, stress, anxiety and improve sleep.  

There are many different mind-body techniques to choose from. It’s important to try different methods and find one that suits you.

Deep breathing

A simple technique that is highly effective. As you breathe deeply, your brain learns to calm down and relax. This can be a helpful skill for those suffering with persistent pain. Find simple breathing exercises.

Guided imagery

Guided imagery helps you use your imagination to direct your thoughts toward a relaxing or peaceful scene (e.g. lying on a tropical beach). You can do guided imagery with audio recordings, an instructor or a script. Learn more about guided imagery techniques.

Mindfulness meditation

Mindfulness is a regular, disciplined practice of paying attention to the present, without trying to fix or change anything. The goal is not relaxation, but relaxation is often the result.

Research has shown that mindfulness can have numerous benefits for those with chronic pain, such as decreasing pain intensity, stress, anxiety and allowing people to feel more in control of the pain experience. Mindfulness can create change in both brain structure and function.

Learning meditation is like learning to play an instrument. It takes coaching and practice. You can learn through books, apps, websites or in-person classes.

Apps and online videos:

• Search for mindfulness videos by Jon-Kabat Zinn, Vidyamala Burch, Elisha Goldstein and Mark Williams
• Headspace
• The mindfulness app

Classes:

• Local park/recreation and senior centers
• Learn Mindfulness
• Palouse Mindfulness - Free eight week mindfulness course

Progressive muscle relaxation

Progressive muscle relaxation involves a series of exercise in which you tense your muscles as you breathe in and relax them as you breathe out. You work on specific muscle groups in a certain order. Find a step-by-step guide on how to do progressive muscle relaxation.

Resources for stress and anxiety

• Pain B.C. - LivePlanBe: Anxiety
• Pain B.C. - LivePlanBe: Mind-body therapies
• Anxiety Canada– Mindshift App
• The YMCA offers a free adult seven week program for those who are experiencing stress and mild to moderate anxiety.
  To learn more, contact ymind@gv.ymca.ca or 604-673-6182.