A: First, we invite you to watch a one-hour video in the clinic about important aspects of chronic pain. The topics covered are:
- Chronic Pain myths
- Realistic goal setting
- Staying active
- Staying on track and being accountable
- Role of caregivers
- Insight into how chronic pain influences values, priorities and goals in everyday life situations
- Learning to set priorities despite chronic pain
- Avoidance and activity cycling
- Pacing activity
- How chronic pain influences the pattern of communication with our primary support system
- Coping with stress and anxiety
- Depression and pain
- Challenging negative thoughts
After this session, the patient can decide whether to go on with their current treatment or to join the program. This is an important decision, because the program requires that the patient:
- Accepts the fact that their pain is permanent
- Has specific goals they want to achieve
The program team then makes sure that it is medically safe for the goal to be pursued, makes sure that the goal is realistic and appropriate, helps break it down into manageable stages if needed, helps make an action plan, supports with medications and counseling as needed, applauds and records successes, and holds the patient accountable for what they’ve promised themselves. This continues for as long as the patient wishes, provided each goal that is set is actively worked on.
John is a 58-year-old man from a small town 60 km from Edmonton, with low back and leg pain. He has been in pain for 10 years. He has had countless tests, drugs and 4 operations. He takes strong painkillers. Before he had pain, he happily worked long hours as a truck driver, enjoyed curling and was often to be found line dancing with his wife and friends in a local bar on a Saturday night. Now, he finds it almost unbearable to walk. He rarely goes out and gets the feeling that people around him are sick of hearing about his condition. Without saying it directly, his doctors seem to be saying that there is no reason why he can’t work. He keeps hearing that ‘his scans look good’. He has often tried to force himself to do more, but it made the pain worse. He’s gained 40 lbs in the past three years.
He attends the LDP sessions with his wife and is encouraged to learn that he is not alone. The concepts he learns are new to him, but make a lot of sense. He enrolls in the full program.
About 6 weeks after the Gold session, his intake interview appointment takes place. The three LDP professionals do a very detailed interview and he gets a top to toe physical examination from the physician. He refers to the list of goals that he brought with him. The team suggested that some of them were very ambitious (e.g. ‘walk three miles a day’), and some were not really concrete enough for the team to be able to understand (e.g. ‘get my life back’) After discussion, he decides that after a month he’d like to be able to walk a block once a day, meet an old friend for coffee at least once during the month, and lose 5 lbs in weight. The team shows him how to plan the walking, by pacing himself and setting strict targets for each day. He is a bit surprised to hear the physician tell him to continue taking his medications for now
On the first day, his goal is merely to get his boots on, step outside the door, smell the fresh air and go back inside. This seems too easy, but he remembers that one of the key points of the plan is to stick to it, even if you feel good enough to do more.
As each day goes by, he does a little more, and writes it down on paper. He manages the one block walk by day 17. With some nervousness, he phones Harvey, his former colleague from work, whom he hasn’t spoken to in two years. Harvey readily agrees to meet him for coffee the next day. It’s painful to sit in those plastic chairs, but it’s good to catch up, and Harvey invites him to go sit at the rink and watch the curling next week.
A month later, he returns for his LDP appointment. The plan worked well and everyone is genuinely encouraging. For the first time in years, John feels a little proud of himself. He makes his next set of goals. The pain is still there, but at least he can see a glimmer of light at the end of a very long tunnel.